Rapid-onset antidepressant action of ketamine: potential revolution in understanding and future pharmacologic treatment of depression

WHAT IS KNOWN AND OBJECTIVE

The current pharmacotherapeutic treatment of major depressive disorder (MDD) generally takes weeks to be effective. As the molecular action of these drugs is immediate, the mechanistic basis for this lag is unclear. A drug that has a more rapid onset of action would be a major therapeutic advance and also be a useful comparator to provide valuable mechanistic insight into the disorder and its treatment.

COMMENT

Recent evidence suggests that ketamine produces rapid-onset antidepressant action. Important questions are as follows: is it specific or coincidental to other effects; is there a dose-response relationship; and is the mechanism related to that of current antidepressants. NMDA receptor antagonism is unlikely the explanation for ketamine's antidepressant action.

WHAT IS NEW AND CONCLUSION

It is not an exaggeration to state that the new findings, if validated, might produce a revolution in understanding and treating depressive disorders.

Histidine-rich glycoprotein prevents the formation of insoluble immune complexes by rheumatoid factor

In previous studies we have shown that histidine-rich glycoprotein (HRG), a relatively abundant plasma protein, can bind to immunoglobulin G (IgG) and inhibit the insolubilization of IgG-containing immune complexes (IC). It was of interest, therefore, to determine whether HRG can inhibit the formation of insoluble IC (IIC) resulting from the interaction of rheumatoid factor (RF) with human IgG-containing IC. Light scattering techniques were used to examine the effect of HRG on the formation of IIC between RF and IC containing human IgG according to three different models. In all three models physiological concentrations of HRG could block the formation of IIC induced by RF. Optical biosensor studies of the RF-IgG interaction also revealed that HRG can mask the epitopes on IgG recognized by RF. Additional studies examined whether HRG can solubilize already formed IIC and demonstrated that HRG can, in fact, partially solubilized IIC. These data indicate that HRG can regulate the formation of IIC induced by RF at three levels: namely by inhibiting the initial recognition of IgG containing IC by RF, by inhibiting the subsequent insolubilization of IgG containing IC by RF and by solubilizing already formed IIC. Collectively, these findings suggest that HRG may be an important inhibitor of the formation of pathogenic IC in diseases such as systemic lupus erythematosus and rheumatoid arthritis.

Differential binding of histidine-rich glycoprotein (HRG) to human IgG subclasses and IgG molecules containing kappa and lambda light chains

In previous studies we showed that the plasma protein histidine-rich glycoprotein (HRG) binds strongly to pooled human IgG. In the present work myeloma proteins consisting of different human IgG subclasses were examined for their ability to interact with human HRG. Using an IAsys optical biosensor we found initially that IgG subclasses differ substantially in their affinity of interaction with HRG. However, the most striking finding was the observation that the kinetics of the HRG interaction was dramatically affected by whether the IgG subclasses contained the kappa or lambda light (L)-chains. Thus, the on-rate for the binding of HRG to the kappa L-chain containing IgG1 and IgG2 (IgG1kappa and IgG2kappa) was approximately 4- and approximately 10-fold faster than that for the binding of HRG to lambda L-chain containing IgG1 and IgG2 (IgG1lambda and IgG2lambda), respectively, with the dissociation constants (K(d)) in the range 3-5 nM and 112-189 nM for the kappa and lambda isoforms, respectively. In contrast, the on-rate for the binding of HRG to IgG3kappa and IgG4kappa was found to be 9- and 20-fold slower than that for the binding of HRG to IgG3lambda and IgG4lambda, respectively, with the K(d) in the range 147-268 nM and 96-109 nM for the kappa and lambda isoforms, respectively. The binding of HRG to immunoglobulins containing the kappa L-chain (particularly IgG1kappa) was generally potentiated in the presence of a physiological concentration (20 microM) of Zn(2+) (K(d) decreased to 0.60 +/- 0.01 for IgG1kappa), but Zn(2+) had no effect or slightly inhibited the binding of HRG to immobilized IgG subclasses possessing the lambda L-chain. Interestingly, HRG also bound differentially to Bence Jones (BJ) proteins containing kappa and lambda L-chains, with HRG having a 14-fold lower K(d) for BJkappa than for BJlambda when 20 microM Zn(2+) was present. HRG also bound to IgM (IgMkappa), but the affinity of this interaction (K(d) approximately 1.99 +/- 0.05 microM) was markedly lower than the interaction with IgG, and the affinity was actually decreased 4-fold in the presence of Zn(2+). The results demonstrate that both the heavy (H)- and L-chain type have a profound effect on the binding of HRG to different IgG subclasses and provide the first evidence of a functional difference between the kappa and lambda L-chains of immunoglobulins.

Histidine-rich glycoprotein regulates the binding of monomeric IgG and immune complexes to monocytes

Histidine-rich glycoprotein (HRG) is a relatively abundant plasma protein which we have shown previously inhibits the formation of insoluble immune complexes (IC). In this study we examined the ability of HRG to regulate the binding of monomeric IgG and IC to monocytes. Initial studies demonstrated that HRG interacts with FcgammaRI on the monocytic cell line THP1 and blocks the binding of monomeric IgG to these cells. However, despite totally blocking the binding of monomeric IgG to FcgammaRI, pre-incubation of THP1 cells with HRG had no effect on the binding of IC to these cells. In contrast, depending on the HRG:IgG molar ratio, pre-incubation of monomeric IgG with HRG resulted in either enhanced or reduced IgG binding to FcgammaRI. Similarly, under certain highly defined conditions, incorporation of HRG in IgG-containing IC potentiated the binding of IC to THP1 cells. The key conditions involved incorporating approximately equimolar concentrations of HRG and IgG in the IC, the IC being formed at a near equivalence antigen:antibody ratio and usually physiological concentration (20 microM) of Zn(2+) being present. Collectively these observations indicate that HRG is an important regulator of IC uptake by monocytes. Thus HRG can interact with FcgammaRI on monocytes and block monomeric IgG binding, whereas when incorporated in IgG containing IC, HRG can enhance the uptake of IC by monocytes, probably via its heparan sulfate binding domain.

Theoretical and experimental considerations of the pseudo-first-order approximation in conventional kinetic analysis of IAsys biosensor data

The validity of the conventional interpretation of IAsys biosensor profiles in terms of pseudo-first-order kinetic behavior is subjected to closer scrutiny by its application to simulated data for low- and high-affinity interactions between ligate and immobilized ligand. As might reasonably have been expected, analysis of the simulated data for the low-affinity system (association equilibrium constant of 10(5) M-1) in such terms returned the input association and dissociation rate constants (10(3) M-1 s-1 and 10(-2) s-1, respectively)-a consequence of essential compliance with the assumed constancy of ligate concentration in the liquid phase. For the high-affinity interaction (ka = 10(5) M-1 s-1, kd = 10(-2) s-1, KAX = 10(7) M-1) the ligate concentration was depleted by up to 35%, and hence its assumed constancy was clearly an untenable approximation. Whereas no symptomatic evidence of such violation (apart from the return of incorrect estimates of ka and kd) was evident from pseudo-first-order kinetic analysis of the adsorption profiles, the corresponding analysis of desorption profiles was more informative in that the data deviated demonstrably from pseudo-first-order kinetic behavior. A second-order kinetic analysis was therefore developed and shown to be applicable to adsorption and desorption profiles, irrespective of the validity or otherwise of the pseudo-first-order kinetic approximation. Experimental results obtained for the interaction of histidine-rich glycoprotein with immobilized IgG were then used to illustrate various features of the pseudo-first-order and second-order kinetic analyses, and to determine from the second-order analysis an association equilibrium constant of 2 x 10(8) M-1, which is 20-fold greater than the value obtained by interpretation of the profiles in terms of pseudo-first-order kinetic behavior.

Histidine-rich glycoprotein binds to human IgG and C1q and inhibits the formation of insoluble immune complexes

Purification of the complement component C1q from human serum using an established method resulted in the copurification of two 30 kDa proteins with an N-terminal sequence identical to human histidine-rich glycoprotein (HRG). Therefore, to explore the possibility that HRG can interact with C1q, we examined the ability of 81 kDa (native) and the 30 kDa proteins (presumably proteolytic N-terminal fragments of HRG) to bind to C1q, using both ELISA and optical biosensor techniques. Both forms of HRG were found to bind to the human complement component C1q and also to purified human and rabbit IgG by ELISA. Kinetic analyses of the HRG-C1q and HRG-IgG interactions using the IAsys biosensor indicate two distinct binding sites with affinities Kd1 0.78 x 10(-8) M and Kd2 3.73 x 10(-8) M for C1q, and one binding site with affinity Kd 8.5 x 10(-8) M for IgG. Moreover, the fact that both native and 30 kDa HRG bind to C1q and to IgG suggests that the IgG and C1q binding regions on HRG are located in the 30 kDa N-terminal region of the HRG molecule. The Fab region of IgG is likely to be involved in the HRG-IgG interaction since HRG also bound to F(ab')2 fragments with an affinity similar to that seen with the complete IgG molecule. Interestingly, the binding between HRG and IgG was significantly potentiated (Kd reduced from 85.0 to 18.9 nM) by the presence of physiological concentrations of Zn2+ (20 microM). Conversely, the presence of Zn2+ weakened the binding of HRG to C1q (Kd increased from 7.80 to 29.3 nM). Modulation of these interactions by other divalent metal cations was less effective with relative potencies being Zn2+ > Ni2+ > Cu2+. An examination of the effect of native and 30 kDa HRG on the formation of insoluble immune complexes (IIC) between ovalbumin and polyclonal rabbit anti-ovalbumin IgG revealed that physiological concentrations of HRG can markedly inhibit IIC formation in vitro. The results show that human HRG binds to C1q and to IgG in a Zn2+-modulated fashion, and that HRG can regulate the formation of IIC in vitro, thus indicating a new functional role for HRG in vivo.

The formation of insoluble immune complexes between ovalbumin and anti-ovalbumin IgG occurs in at least two distinct phases dependent on reactant concentration and ionic strength

The mechanism regulating the formation of insoluble immune complexes (IIC) in serum in certain disease states is not well understood. Ovalbumin and rabbit anti-ovalbumin IgG was used to study the formation of IIC in vitro in a stirred reaction vessel; and the radii of IIC that formed was determined by light scattering techniques. Using an initial IgG concentration of 1 mg/ml at equivalence antigen:antibody ratio IIC formation was detected within 5 s, and the complexes increased in radii to approx. 100 nm after 20-30 s (phase 1). This was followed by a phase (phase 2) in which the complexes rapidly increased in radii to the point where Mie scattering was reached (approximately 200 nm). The time of onset of the second phase decreased with increasing initial IgG concentrations at a fixed antigen:antibody ratio; and was at a minimum at equivalence antigen:antibody ratio, but increased at both antigen and antibody excess ratios. Immune complexes formed using F(ab')2 fragment showed a similar pattern to those formed using IgG. A similar pattern was seen in the presence of the complement component C1q which potentiated IIC formation in phase 2, and human serum (1:10 dilution) which attenuated IIC formation in both phases. For complex formation using IgG and ovalbumin the presence of NaC1 at concentrations up to 0.6 M led to a progressive increase in the time of onset of phase 2; potencies of inhibition by other sodium halides followed the lyotropic series NaF < NaC1 < NaI. The results suggest that formation of IIC occurs in at least two distinct phases, and that the second phase leading to the generation of very large insoluble complexes is associated with a rapid polymerisation of the complexes by a mechanism that is not dependent on Fc:Fc interactions.