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Brooks S, Zuiker R, Bleys C, Ziagkos D, Moyer JA, van Nueten L, Bonaventure P, Drevets WC, van Gerven J, Salvadore G, Jacobs GE. Pharmacological characterization of the selective orexin-1 receptor antagonist JNJ-61393215 in healthy volunteers. J Psychopharmacol 2023:2698811231167989. [PMID: 37165642 DOI: 10.1177/02698811231167989] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Up to 40% of patients suffering from anxiety disorders do not benefit from currently available pharmacological treatments. Overactivity of the orexin-1 receptor (OX1R) has been implicated in anxiety- and panic-related states. AIM & METHODS We investigated the pharmacokinetics and characterized the pharmacodynamic (PD) profile of the OX1R antagonist JNJ-61393215 using a battery of central nervous system assessments investigating relevant functional domains such as alertness, attention, (visuo)motor coordination, balance, subjective effects and resting-state electroencephalography in a single ascending dose placebo-controlled study in doses from 1 to 90 mg inclusive, assessing PD up to 10 h after dosing, safety and pharmacokinetic in 48 healthy male subjects. RESULTS Average time to maximal plasma concentration (Tmax) ranged between 1.0 and 2.25 h; average half-life ranged from 13.6 to 24.6 h and average maximum plasma concentration ranged from 1.4 to 136.8 ng/mL in the 1 and 90 mg groups, respectively. JNJ-61393215 did not demonstrate any statistically significant or clinically meaningful effects on any PD endpoint at any dose investigated at Tmax nor over the total period up to 10 h post-dose and was well tolerated. The reported somnolence rate was 16.7% (which was attributable to the cohorts receiving 6 mg and higher doses) compared to 12.5% in placebo. CONCLUSION This observation is in line with our knowledge about the OX1R in preclinical studies, where only inconsistent and non-dose-dependent changes in electroencephalography or other behavioural measures were observed under non-challenged conditions, potentially exemplifying the need for a challenged subject.
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Affiliation(s)
- S Brooks
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Rgja Zuiker
- Centre for Human Drug Research, Leiden, The Netherlands
| | - C Bleys
- Janssen Research & Development, LLC, Beerse, Belgium
| | - D Ziagkos
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J A Moyer
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - L van Nueten
- Janssen Research & Development, LLC, Beerse, Belgium
| | - P Bonaventure
- Janssen Research & Development, LLC, San Diego, CA, USA
| | - W C Drevets
- Janssen Research & Development, LLC, San Diego, CA, USA
| | - Jma van Gerven
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - G Salvadore
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - G E Jacobs
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Tishler TA, Ellingson BM, Salvadore G, Baker P, Turkoz I, Subotnik KL, de la Fuente-Sandoval C, Nuechterlein KH, Alphs L. Effect of treatment with paliperidone palmitate versus oral antipsychotics on frontal lobe intracortical myelin volume in participants with recent-onset schizophrenia: Magnetic resonance imaging results from the DREaM study. Schizophr Res 2023; 255:195-202. [PMID: 37004331 DOI: 10.1016/j.schres.2023.03.023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 02/10/2023] [Accepted: 03/11/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE We investigated changes in brain intracortical myelin (ICM) volume in the frontal lobe after 9 months of treatment with paliperidone palmitate (PP) compared with 9 months of treatment with oral antipsychotics (OAP) in participants with recent-onset schizophrenia or schizophreniform disorder from the Disease Recovery Evaluation and Modification (DREaM) study, a randomized, open-label, delayed-start trial. METHODS DREaM included 3 phases: Part I, a 2-month oral run-in; Part II, a 9-month disease progression phase (PP or OAP); and Part III, 9 months of additional treatment (participants receiving PP continued PP [PP/PP] and participants receiving OAP were rerandomized to receive either PP [OAP/PP] or OAP [OAP/OAP]). In Part II, magnetic resonance imaging (MRI) and functional and symptomatic assessment was performed at baseline, day 92, and day 260. ICM volume as a fraction of the entire brain volume was quantified by subtraction of a proton density image from an inversion recovery image. Within-treatment-group changes from baseline were assessed by paired t-tests. Analysis of covariance was used to analyze ICM volume changes between treatment groups, adjusting for country. RESULTS The MRI analysis sample size included 71 DREaM participants (PP, 23; OAP, 48) and 64 healthy controls. At baseline, mean adjusted ICM fraction values did not differ between groups (PP, 0.057; OAP, 0.058, p = 0.79). By day 92, the adjusted ICM fraction in the OAP group had decreased significantly (change from baseline, -0.002; p = 0.001), whereas the adjusted ICM fraction remained unchanged from baseline in the PP group (0.000; p = 0.80). At day 260, the change from baseline in adjusted ICM fraction was -0.004 (p = 0.004) in the OAP group and -0.001 (p = 0.728) in the PP group. The difference between treatment groups did not reach statistical significance (p = 0.147). CONCLUSIONS In participants with recent-onset schizophrenia or schizophreniform disorder, frontal ICM volume was preserved at baseline levels in those treated with PP over 9 months. However, a decrease of frontal ICM volume was observed among participants treated with OAPs. TRIAL REGISTRATION clinicaltrials.gov identifier NCT02431702.
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Affiliation(s)
- T A Tishler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
| | - B M Ellingson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; UCLA Center for Computer Vision and Imaging Biomarkers, Departments of Radiological Sciences and Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
| | - G Salvadore
- Janssen Research and Development, LLC, Titusville, NJ, USA.
| | - P Baker
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
| | - I Turkoz
- Janssen Research and Development, LLC, Titusville, NJ, USA.
| | - K L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
| | - C de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico; Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
| | - K H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA.
| | - L Alphs
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
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Turkoz I, Nelson JC, Wilkinson ST, Borentain S, Macaluso M, Trivedi MH, Williamson D, Sheehan JJ, Salvadore G, Singh J, Daly E. Predictors of response and remission in patients with treatment-resistant depression: A post hoc pooled analysis of two acute trials of esketamine nasal spray. Psychiatry Res 2023; 323:115165. [PMID: 37019044 DOI: 10.1016/j.psychres.2023.115165] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 04/07/2023]
Abstract
This exploratory post hoc analysis of two pooled 4-week, phase 3, double-blind, placebo- and active-controlled studies that compared esketamine nasal spray plus a newly initiated oral antidepressant (ESK+AD; n = 310) with a newly initiated oral AD plus placebo nasal spray (AD+PBO; n = 208) in patients with treatment-resistant depression (TRD) examined baseline patient demographic and psychiatric characteristics as potential predictors of response (≥50% reduction from baseline in Montgomery-Åsberg Depression Rating Scale [MADRS] total score) and remission (MADRS total score ≤12) at day 28. Overall, younger age, any employment, fewer failed ADs in the current depressive episode, and reduction in Clinical Global Impression-Severity (CGI-S) score at day 8 were significant positive predictors of response and remission at day 28. Treatment assignment was an important predictor of both response and remission. Patients treated with ESK+AD had 68% and 55% increased odds of achieving response and remission, respectively, versus those treated with AD+PBO. In the ESK+AD group, attainment of response and remission was more likely in patients who were employed, without significant anxiety at baseline, and who experienced a reduction in CGI-S score at day 8. Identification of predictors of response and remission may facilitate identification of those patients with TRD most likely to benefit from ESK+AD. Trial Registration: ClinicalTrials.gov: NCT02417064 (clinicaltrials.gov/ct2/show/NCT02417064) and NCT02418585 (clinicaltrials.gov/ct2/show/NCT02418585).
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Affiliation(s)
- Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, NJ, United States of America.
| | - J Craig Nelson
- Department of Psychiatry, UCSF, San Francisco, CA, United States of America.
| | - Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America.
| | - Stephane Borentain
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America.
| | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States of America.
| | - David Williamson
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America.
| | - John J Sheehan
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America.
| | - Giacomo Salvadore
- Janssen Research & Development, LLC, Titusville, NJ, United States of America.
| | - Jaskaran Singh
- Janssen Research & Development, LLC, Titusville, NJ, United States of America
| | - Ella Daly
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America.
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Vigolo V, Franzoi M, Cendron F, Salvadore G, Penasa M, Cassandro M, De Marchi M. Characterization of the genetic polymorphism linked to the β-casein A1/A2 alleles using different molecular and biochemical methods. J Dairy Sci 2022; 105:8946-8955. [PMID: 36085110 DOI: 10.3168/jds.2022-22136] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022]
Abstract
The 2 major subvariants of β-casein (A1 and A2), coded by CSN2 gene, have received great interest in the last decade both from the scientific community and the dairy sector due to their influence on milk quality. The consumption of the A1 variant, compared with the A2 variant, has a potential negative effect on human health after its digestion but, at the same time, its presence improves the milk technological properties. The aim of the present study was to compare the best method in terms of time required, costs, and technical engagement for the identification of β-casein A1 and A2 variants (homozygous and heterozygous animals) in milk to offer a reliable service for large-scale screening studies. Two allele-specific PCR procedures, namely RFLP-PCR and amplification refractory mutation system (ARMS-PCR), and one biochemical technique (HPLC) were evaluated and validated through sequencing. Manual and automated DNA extraction protocols from milk somatic cells were also compared. Automated DNA extraction provided better yield and purity. Chromatographic analysis was the most informative and the cheapest method but unsuitable for large-scale studies due to lengthy procedures (45 min per sample). Both allele-specific PCR techniques proved to be fast and reliable for differentiating between A1 and A2 variants but more expensive than HPLC analysis. Specifically, RFLP-PCR was the most expensive and labor-demanding among the evaluated techniques, whereas ARMS-PCR was the fastest while also requiring less technical expertise. Overall, automated extraction of DNA from milk matrix combined with ARMS-PCR is the most suitable technique to provide genetic characterization of the CSN2 gene on a large scale.
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Affiliation(s)
- V Vigolo
- Department of Agronomy, Food, Natural resources, Animals and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - M Franzoi
- Department of Agronomy, Food, Natural resources, Animals and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - F Cendron
- Department of Agronomy, Food, Natural resources, Animals and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro (PD), Italy.
| | - G Salvadore
- Department of Agronomy, Food, Natural resources, Animals and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - M Penasa
- Department of Agronomy, Food, Natural resources, Animals and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro (PD), Italy
| | - M Cassandro
- Department of Agronomy, Food, Natural resources, Animals and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro (PD), Italy; Federazione delle Associazioni Nazionali di Razza e Specie, Via XXIV Maggio 44, 00187 Roma, Italy
| | - M De Marchi
- Department of Agronomy, Food, Natural resources, Animals and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro (PD), Italy
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Turkoz I, Lopena O, Salvadore G, Sanacora G, Shelton R, Fu DJ. Treatment response to esketamine nasal spray in patients with major depressive disorder and acute suicidal ideation or behavior without evidence of early response: a pooled post hoc analysis of ASPIRE. CNS Spectr 2022; 28:1-7. [PMID: 35904046 DOI: 10.1017/s1092852922000931] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the likelihood of attaining response/remission of depressive symptoms with esketamine nasal spray (ESK) plus standard of care (SoC) vs placebo nasal spray (PBO) plus SoC at 4 weeks in patients with major depressive disorder and active suicidal ideation with intent (MDSI) without early response. METHODS A post hoc analysis of pooled data from ASPIRE I and ASPIRE II evaluated ESK plus SoC vs PBO plus SoC in adults with MDSI without response (≥50% improvement from baseline in Montgomery-Åsberg Depression Rating Scale [MADRS] score) at 24 hours after the first dose or at week 1 after the first two doses (ie, 24-hour and week 1 nonresponders). Response and remission (MADRS score ≤ 12) rates were assessed on day 25. RESULTS The analysis included 362 patients (n = 182, ESK plus SoC; n = 180, PBO plus SoC). Among 24-hour nonresponders, more patients receiving ESK plus SoC vs PBO plus SoC achieved response (63.9% vs 48.0%, P = .010) and remission (35.1% vs 24.4%, P = .074) at day 25. Odds of response/remission were higher with ESK plus SoC vs PBO plus SoC (response: 1.89, 95% CI, 1.17-3.05; remission: 1.48, 95% CI, 0.93-2.35). Similar findings were observed among week 1 nonresponders for response (48.4% vs 34.5%, P = .075), remission (25.0% vs 13.1%, P = .060), and odds of response/remission (response: 2.03, 95% CI, 1.22-3.40; remission: 1.63, 95% CI, 1.01-2.62). CONCLUSIONS Patients with MDSI not responding within the first week of treatment with ESK plus SoC may still benefit from a full 4-week treatment course.
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Affiliation(s)
- Ibrahim Turkoz
- Department of Statistics & Decision Sciences, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Oliver Lopena
- Department of Neuroscience, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Giacomo Salvadore
- Department of Neuroscience Experimental Medicine, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Richard Shelton
- Department of Psychiatry, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dong-Jing Fu
- Deparment of Neuroscience, Janssen Research & Development, LLC, Titusville, USA
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Daly EJ, Turkoz I, Salvadore G, Fedgchin M, Ionescu DF, Starr HL, Borentain S, Trivedi MH, Thase ME, Singh JB. The effect of esketamine in patients with treatment-resistant depression with and without comorbid anxiety symptoms or disorder. Depress Anxiety 2021; 38:1120-1130. [PMID: 34293233 PMCID: PMC9291524 DOI: 10.1002/da.23193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 12/23/2020] [Revised: 04/23/2021] [Accepted: 06/11/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Comorbid anxiety is generally associated with poorer response to antidepressant treatment. This post hoc analysis explored the efficacy of esketamine plus an antidepressant in patients with treatment-resistant depression (TRD) with or without comorbid anxiety. METHODS TRANSFORM-2, a double-blind, flexible-dose, 4-week study (NCT02418585), randomized adults with TRD to placebo or esketamine nasal spray, each with a newly-initiated oral antidepressant. Comorbid anxiety was defined as clinically noteworthy anxiety symptoms (7-item Generalized Anxiety Disorder scale [GAD-7] score ≥10) at screening and baseline or comorbid anxiety disorder diagnosis at screening. Treatment effect based on change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score, and response and remission were examined by presence/absence of comorbid anxiety using analysis of covariance and logistic regression models. RESULTS Approximately 72% (162/223) of patients had baseline comorbid anxiety. Esketamine-treated patients with and without anxiety demonstrated significant reductions in MADRS (mean [SD] change from baseline at day 28: -21.0 [12.51] and -22.7 [11.98], respectively). Higher rates of response and remission, and a significantly greater decrease in MADRS score at day 28 were observed compared to antidepressant/placebo, regardless of comorbid anxiety (with anxiety: difference in LS means [95% CI] -4.2 [-8.1, -0.3]; without anxiety: -7.5 [-13.7, -1.3]). There was no significant interaction of treatment and comorbid anxiety (p = .371). Notably, in the antidepressant/placebo group improvement was similar in those with and without comorbid anxiety. CONCLUSION Post hoc data support efficacy of esketamine plus an oral antidepressant in patients with TRD, regardless of comorbid anxiety.
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Affiliation(s)
- Ella J. Daly
- Department of Neuroscience Medical AffairsJanssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | - Ibrahim Turkoz
- Department of Statistics & Decision SciencesJanssen Research & Development, LLCTitusvilleNew JerseyUSA
| | - Giacomo Salvadore
- Department of NeuroscienceJanssen Research & Development, LLCTitusvilleNew JerseyUSA
| | - Maggie Fedgchin
- Department of NeuroscienceJanssen Research & Development, LLCTitusvilleNew JerseyUSA
| | - Dawn F. Ionescu
- Department of NeuroscienceJanssen Research & Development, LLCSan DiegoCaliforniaUSA
| | - H. Lynn Starr
- Department of Neuroscience Medical AffairsJanssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | - Stephane Borentain
- Department of Neuroscience Medical AffairsJanssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | - Madhukar H. Trivedi
- Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of MedicineUniversity of Pennsylvania and the Corporal Michael J. Crescenz VAMCPhiladelphiaPennsylvaniaUSA
| | - Jaskaran B. Singh
- Department of NeuroscienceJanssen Research & Development, LLCSan DiegoCaliforniaUSA
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Meder A, Liepelt-Scarfone I, Sulzer P, Berg D, Laske C, Preische O, Desideri D, Zipser CM, Salvadore G, Tatikola K, Timmers M, Ziemann U. Motor cortical excitability and paired-associative stimulation-induced plasticity in amnestic mild cognitive impairment and Alzheimer’s disease. Clin Neurophysiol 2021; 132:2264-2273. [DOI: 10.1016/j.clinph.2021.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 12/14/2022]
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Turkoz I, Daly E, Singh J, Lin X, Tymofyeyev Y, Williamson D, Salvadore G, Nash AI, Macaluso M, Wilkinson ST, Nelson JC. Treatment Response With Esketamine Nasal Spray Plus an Oral Antidepressant in Patients With Treatment-Resistant Depression Without Evidence of Early Response: A Pooled Post Hoc Analysis of the TRANSFORM Studies. J Clin Psychiatry 2021; 82. [PMID: 34288609 DOI: 10.4088/jcp.20m13800] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/20/2020] [Accepted: 05/17/2021] [Indexed: 10/20/2022]
Abstract
Objective: To evaluate response to esketamine nasal spray plus an oral antidepressant (ESK + AD) at day 28 in patients with major depressive disorder (DSM-5) and treatment-resistant depression (TRD) who did not meet response criteria within the first week of treatment. Methods: The current study is a pooled post hoc analysis of two phase 3, double-blind, active-controlled studies, conducted between August 2015 and February 2018, comparing ESK + AD with an oral antidepressant plus placebo (AD + PBO). Early treatment response was defined as a ≥ 50% decrease in Montgomery-Åsberg Depression Rating Scale total score at day 2 or days 2 and 8. Response rates at day 28 were determined among those not meeting early response criteria. Results: 518 patients in the analysis had day 28 observations (ESK + AD, n = 310; AD + PBO, n = 208). A greater percentage of patients treated with ESK + AD versus AD + PBO met response criteria beginning at day 2 (17.3% [55/318] vs 9.4% [19/203]) and at all subsequent timepoints, including day 28 (58.7% [182/310] vs 45.2% [94/208]). In day 2 nonresponders, 54.9% vs 44.3% (ESK + AD vs AD + PBO, respectively) achieved response at day 28 (P < .01). Similarly, among day 2 and 8 nonresponders, 52.1% vs 42.4% achieved response by day 28 (P = .01). In nonresponders at day 2 and at days 2 and 8, the odds ratio for a response at day 28 was 1.61 (95% CI, 1.09-2.40) with ESK + AD versus 1.56 (95% CI, 1.04-2.35) with AD + PBO. Conclusions: Patients with TRD without a demonstrated response within the first week of treatment may still derive benefit from a full 4-week induction course of esketamine nasal spray. Trial Registration: ClinicalTrials.gov identifiers NCT02417064 and NCT02418585.
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Affiliation(s)
- Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, New Jersey.,Corresponding author: Ibrahim Turkoz, PhD, Department of Statistics & Decision Sciences, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560
| | - Ella Daly
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Jaskaran Singh
- Janssen Research & Development, LLC, San Diego, California.,Now with Neurocrine Biosciences Inc, San Diego, California
| | - Xiwu Lin
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | | | | | - Giacomo Salvadore
- Janssen Research & Development, LLC, Titusville, New Jersey.,Now with Acadia Pharmaceuticals Inc, Princeton, New Jersey
| | | | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Samuel T Wilkinson
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
| | - J Craig Nelson
- Department of Psychiatry, University of California San Francisco, San Francisco, California
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Becker S, Granert O, Timmers M, Pilotto A, Van Nueten L, Roeben B, Salvadore G, Galpern WR, Streffer J, Scheffler K, Maetzler W, Berg D, Liepelt-Scarfone I. Association of Hippocampal Subfields, CSF Biomarkers, and Cognition in Patients With Parkinson Disease Without Dementia. Neurology 2020; 96:e904-e915. [PMID: 33219138 DOI: 10.1212/wnl.0000000000011224] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine whether hippocampal volume loss is primarily associated with cognitive status or pathologic β-amyloid 1-42 (Aβ42) levels, this study compared hippocampal subfield volumes between patients with Parkinson disease (PD) with mild cognitive impairment (PD-MCI) and without cognitive impairment (PD-CN) and between patients with low and high Aβ42 levels, in addition exploring the relationship among hippocampal subfield volumes, CSF biomarkers (Aβ42, phosphorylated and total tau), neuropsychological tests, and activities of daily living. METHODS Forty-five patients with PD without dementia underwent CSF analyses and MRI as well as comprehensive motor and neuropsychological examinations. Hippocampal segmentation was conducted using FreeSurfer image analysis suite 6.0. Regression models were used to compare hippocampal subfield volumes between groups, and partial correlations defined the association between variables while controlling for intracranial volume (ICV). RESULTS Linear regressions revealed cognitive group as a statistically significant predictor of both the hippocampal-amygdaloid transition area (HATA; β = -0.23, 95% CI -0.44 to -0.02) and the cornu ammonis 1 region (CA1; β = -0.28, 95% confidence interval [CI] -0.56 to -0.02), independent of disease duration and ICV, with patients with PD-MCI showing significantly smaller volumes than PD-CN. In contrast, no subfields were predicted by Aβ42 levels. Smaller hippocampal volumes were associated with worse performance on memory, language, spatial working memory, and executive functioning tests. The subiculum was negatively correlated with total tau levels (r = -0.37, 95% CI -0.60 to -0.09). CONCLUSION Cognitive status, but not CSF Aβ42, predicted hippocampal volumes, specifically the CA1 and HATA. Hippocampal subfields were associated with various cognitive domains, as well as with tau pathology.
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Affiliation(s)
- Sara Becker
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany.
| | - Oliver Granert
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Maarten Timmers
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Andrea Pilotto
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Luc Van Nueten
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Benjamin Roeben
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Giacomo Salvadore
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Wendy R Galpern
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Johannes Streffer
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Klaus Scheffler
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Walter Maetzler
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Daniela Berg
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
| | - Inga Liepelt-Scarfone
- From the Department of Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Hertie Institute for Clinical Brain Research; German Center for Neurodegenerative Diseases (S.B., B.R., I.L.-S.), Tübingen; Department of Neurology (O.G., W.M., D.B.), Christian-Albrechts-University, Kiel, Germany; Janssen Research and Development, a Division of Janssen Pharmaceutica N.V. (M.T., L.V.N., J.S.), Beerse; Reference Center for Biological Markers of Dementia (M.T.), Institute Born-Bunge, University of Antwerp, Belgium; Department of Clinical and Experimental Sciences (A.P.), University of Brescia; Parkinson's Disease Rehabilitation Centre (A.P.), FERB ONLUS Sant'Isidoro Hospital, Trescore Balneario, Italy; Janssen Research and Development LLC (G.S., W.R.G.), Titusville, NJ; Translational Medicine Neuroscience (J.S.), UCB Biopharma SPRK, Braine-l'Alleud, Belgium; Magnetic Resonance Center (K.S.), Max Planck Institute for Biological Cybernetics; and Department of Biomedical Magnetic Resonance (K.S.), University Hospital Tübingen, Germany
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10
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Salvadore G, Bonaventure P, Shekhar A, Johnson PL, Lord B, Shireman BT, Lebold TP, Nepomuceno D, Dugovic C, Brooks S, Zuiker R, Bleys C, Tatikola K, Remmerie B, Jacobs GE, Schruers K, Moyer J, Nash A, Van Nueten LGM, Drevets WC. Translational evaluation of novel selective orexin-1 receptor antagonist JNJ-61393215 in an experimental model for panic in rodents and humans. Transl Psychiatry 2020; 10:308. [PMID: 32895369 PMCID: PMC7477545 DOI: 10.1038/s41398-020-00937-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/30/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 11/24/2022] Open
Abstract
Orexin neurons originating in the perifornical and lateral hypothalamic area project to anxiety- and panic-associated neural circuitry, and are highly reactive to anxiogenic stimuli. Preclinical evidence suggests that the orexin system, and particularly the orexin-1 receptor (OX1R), may be involved in the pathophysiology of panic and anxiety. Selective OX1R antagonists thus may constitute a potential new treatment strategy for panic- and anxiety-related disorders. Here, we characterized a novel selective OX1R antagonist, JNJ-61393215, and determined its affinity and potency for human and rat OX1R in vitro. We also evaluated the safety, pharmacokinetic, and pharmacodynamic properties of JNJ-61393215 in first-in-human single- and multiple-ascending dose studies conducted. Finally, the potential anxiolytic effects of JNJ-61393215 were evaluated both in rats and in healthy men using 35% CO2 inhalation challenge to induce panic symptoms. In the rat CO2 model of panic anxiety, JNJ-61393215 demonstrated dose-dependent attenuation of CO2-induced panic-like behavior without altering baseline locomotor or autonomic activity, and had minimal effect on spontaneous sleep. In phase-1 human studies, JNJ-61393215 at 90 mg demonstrated significant reduction (P < 0.02) in CO2-induced fear and anxiety symptoms that were comparable to those obtained using alprazolam. The most frequently reported adverse events were somnolence and headache, and all events were mild in severity. These results support the safety, tolerability, and anxiolytic effects of JNJ-61393215, and validate CO2 exposure as a translational cross-species experimental model to evaluate the therapeutic potential of novel anxiolytic drugs.
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Affiliation(s)
- Giacomo Salvadore
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
| | | | - Anantha Shekhar
- grid.257413.60000 0001 2287 3919Departments of Psychiatry, and Pharmacology, Indiana University, School of Medicine, Indianapolis, IN USA
| | - Philip L. Johnson
- grid.257413.60000 0001 2287 3919Department of Anatomy, Physiology and Cell Biology, Indiana University, School of Medicine, Indianapolis, IN USA
| | - Brian Lord
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, San Diego, CA USA
| | - Brock T. Shireman
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, San Diego, CA USA
| | - Terry P. Lebold
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, San Diego, CA USA
| | - Diane Nepomuceno
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, San Diego, CA USA
| | - Christine Dugovic
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, San Diego, CA USA
| | - Sander Brooks
- grid.418011.d0000 0004 0646 7664Centre for Human Drug Research, Leiden, The Netherlands ,grid.10419.3d0000000089452978Leiden University Medical Center, Leiden, The Netherlands
| | - Rob Zuiker
- grid.418011.d0000 0004 0646 7664Centre for Human Drug Research, Leiden, The Netherlands
| | - Cathy Bleys
- grid.419619.20000 0004 0623 0341Janssen Research & Development, LLC, Beerse, Belgium
| | - Kanaka Tatikola
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | - Bart Remmerie
- grid.419619.20000 0004 0623 0341Janssen Research & Development, LLC, Beerse, Belgium
| | - Gabriel E. Jacobs
- grid.418011.d0000 0004 0646 7664Centre for Human Drug Research, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen Schruers
- grid.5012.60000 0001 0481 6099Research School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - John Moyer
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
| | - Abigail Nash
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | - Luc G. M. Van Nueten
- grid.419619.20000 0004 0623 0341Janssen Research & Development, LLC, Beerse, Belgium
| | - Wayne C. Drevets
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, San Diego, CA USA
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11
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Tkaczynska Z, Becker S, Maetzler W, Timmers M, Van Nueten L, Sulzer P, Salvadore G, Schäffer E, Brockmann K, Streffer J, Berg D, Liepelt-Scarfone I. Executive Function Is Related to the Urinary Urgency in Non-demented Patients With Parkinson's Disease. Front Aging Neurosci 2020; 12:55. [PMID: 32210789 PMCID: PMC7069351 DOI: 10.3389/fnagi.2020.00055] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/18/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Evidence suggests urinary urgency is associated with cognitive impairment in a subtype of Parkinson’s disease (PD) patients. This study investigates if cognitive impairment independently predicts the presence of urinary dysfunction. Methods: We report data of 189 idiopathic PD patients, excluding those with concomitant diseases or medication interacting with bladder function. A standardized questionnaire was used to define the presence of urinary urgency. All patients underwent a comprehensive motor, cognitive non-motor and health-related quality of life (HRQoL) assessment. Multivariable linear regression analysis was performed to identify independent variables characterizing urinary urgency in PD (PD-UU), which were assigned as discriminant features to estimate their individual contribution to the phenotype of the PD-UU group. Results: Of 189 PD patients, 115 (60.8%) reported PD-UU. The linear regression analysis showed that among cognitive domains, executive function (EF; p = 0.04) had a significant negative association with PD-UU. In a second model, scores of the Montreal Cognitive Assessment (MoCA) significantly differentiated between study groups (p = 0.007) and also non-motor symptom (NMS) burden (p < 0.001). The third model consisted of reports of HRQoL, of which stigma was the only subscale of the Parkinson’s Disease Questionnaire (PDQ-39) differentiating between patients with and without PD-UU (p = 0.02). The linear discriminant analysis provided evidence that the combination of EF, NMS burden, nocturia, and stigma discriminated between groups with 72.4% accuracy. Conclusion: In our large, non-demented PD cohort, urinary urgency was associated with executive dysfunction (EF), supporting a possible causative link between both symptoms. A combination of neuropsychological and non-motor aspects identified patients with PD-UU with high discriminative accuracy.
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Affiliation(s)
- Zuzanna Tkaczynska
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Sara Becker
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Maarten Timmers
- Janssen Research and Development, Janssen-Pharmaceutical Companies of Johnson & Johnson, 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, Janssen-Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium
| | - Patricia Sulzer
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Giacomo Salvadore
- Janssen Research and Development LLC, Janssen-Pharmaceutical Companies of Johnson & Johnson, Titusville, NJ, United States
| | - Eva Schäffer
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Johannes Streffer
- Janssen Research and Development, Janssen-Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Daniela Berg
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
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12
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Becker S, Bäumer A, Maetzler W, Nussbaum S, Tkaczynska Z, Sulzer P, Timmers M, Van Nueten L, Salvadore G, Brockmann K, Streffer J, Berg D, Liepelt-Scarfone I. Association of cognitive activities of daily living (ADL) function and nonmotor burden in nondemented Parkinson's disease patients. Neuropsychology 2020; 34:447-455. [PMID: 32191056 DOI: 10.1037/neu0000627] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE In Parkinson's disease (PD), nonmotor symptoms (NMS) considerably influence disease progression and cognitive decline. Depression, anxiety, sleep disturbances, and hallucinations (DASH), may indicate a risk for dementia (PDD). Mild impairments in activities of daily living (ADL) caused by cognitive dysfunction are also present in the prodromal stage of PDD. The association of both factors has been sparsely investigated. Aim was to evaluate these specific NMS in a large nondemented PD cohort and their co-occurrence with cognitive dysfunction and ADL impairments. METHOD Data of 226 PD patients was analyzed. Using corresponding items, two DASH scores were constructed from the NMS-Scale and Parkinson's disease Questionnaire (PDQ-39). Correlations between DASH scores and PDD risk factors were examined. PD patients with mild cognitive impairment (PD-MCI) were additionally split into patients with low and high DASH burden, the latter group additionally stratified by presence of cognitive-driven ADL impairment. RESULTS DASH-NMS scores differed significantly between PD-MCI and cognitively normal (PD-CN) patients (p = .04), while the DASH-PDQ did not (p = .73). The only significant predictor of the DASH-NMS score was cognitive-driven ADL (p = .01). PD-MCI patients with a high DASH burden and more cognitive ADL impairment presented with worse global cognition than patients with a low burden (p = .045). CONCLUSION Our results show that the DASH-NMS is superior to the DASH-PDQ score, related to the severity of cognitive impairment, and strongly influenced by cognitive-driven ADL impairment. Presence of DASH symptoms and cognitive-ADL in PD-MCI patients may define a risk group for PDD conversion. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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13
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Li M, Woelfer M, Colic L, Safron A, Chang C, Heinze HJ, Speck O, Mayberg HS, Biswal BB, Salvadore G, Fejtova A, Walter M. Default mode network connectivity change corresponds to ketamine's delayed glutamatergic effects. Eur Arch Psychiatry Clin Neurosci 2020; 270:207-216. [PMID: 30353262 DOI: 10.1007/s00406-018-0942-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 06/19/2018] [Accepted: 09/10/2018] [Indexed: 12/29/2022]
Abstract
Ketamine exerts rapid antidepressant effects peaking 24 h after a single infusion, which have been suggested to be reflected by both reduced functional connectivity (FC) within default mode network (DMN) and altered glutamatergic levels in the perigenual anterior cingulate cortex (pgACC) at 24 h. Understanding the interrelation and time point specificity of ketamine-induced changes of brain circuitry and metabolism is thus key to future therapeutic developments. We investigated the correlation of late glutamatergic changes with FC changes seeded from the posterior cingulate cortex (PCC) and tested the prediction of the latter by acute fractional amplitude of low-frequency fluctuations (fALFF). In a double-blind, randomized, placebo-controlled study of 61 healthy subjects, we compared effects of subanesthetic ketamine infusion (0.5 mg/kg over 40 min) on resting-state fMRI and MR-Spectroscopy at 7 T 1 h and 24 h post-infusion. FC decrease between PCC and dorsomedial prefrontal cortex (dmPFC) was found at 24 h post-infusion (but not 1 h) and this FC decrease correlated with glutamatergic changes at 24 h in pgACC. Acute increase in fALFF was found in ventral PCC at 1 h which was not observed at 24 h and inversely correlated with the reduced dPCC FC towards the dmPFC at 24 h. The correlation of metabolic and functional markers of delayed ketamine effects and their temporal specificity suggest a potential mechanistic relationship between glutamatergic modulation and reconfiguration of brain regions belonging to the DMN.
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Affiliation(s)
- Meng Li
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Otto-von-Guericke-University, Magdeburg, Germany
| | - Marie Woelfer
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Otto-von-Guericke-University, Magdeburg, Germany
- New Jersey Institute of Technology, Newark, NJ, USA
| | - Lejla Colic
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Otto-von-Guericke-University, Magdeburg, Germany
| | - Adam Safron
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Catie Chang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke-University, Magdeburg, Germany
- Department Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Oliver Speck
- Department Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Department of Biomedical Magnetic Resonance, Otto-von-Guericke-University, Magdeburg, Germany
| | - Helen S Mayberg
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Anna Fejtova
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- RG Presynaptic Plasticity, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Magdeburg, Germany.
- Otto-von-Guericke-University, Magdeburg, Germany.
- Department Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany.
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Osianderstrasse 24, 72076, Tuebingen, Germany.
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14
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Liepelt-Scarfone I, Vanderstichele HM, Maetzler W, Francois C, Becker S, Timmers M, Van Nueten L, Salvadore G, Brockmann K, Gasser T, Streffer J, Stoops E, Berg D. P1-230: MEMORY FUNCTION IS ASSOCIATED WITH TAU PATHOLOGY IN PARKINSON'S DISEASE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.785] [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)
- Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | | | | | | | - Sara Becker
- Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | | | | | | | - Kathrin Brockmann
- Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - Thomas Gasser
- Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | | | | | - Daniela Berg
- University Hospital Schleswig-Holstein; Kiel Germany
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15
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Becker S, Bäumer A, Maetzler W, Nussbaum S, Timmers M, Van Nueten L, Salvadore G, Zaunbrecher D, Roeben B, Brockmann K, Streffer J, Berg D, Liepelt-Scarfone I. Assessment of cognitive-driven activity of daily living impairment in non-demented Parkinson's patients. J Neuropsychol 2018; 14:69-84. [PMID: 30320954 DOI: 10.1111/jnp.12173] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/10/2018] [Indexed: 01/15/2023]
Abstract
The core criterion for Parkinson's disease dementia (PDD) is the impairment in activities of daily living (ADL) function primarily caused by cognitive, not motor symptoms. There is evidence to assume that mild ADL impairments in mild cognitive impairment (PD-MCI) characterize those patients at high risk for dementia. Data of 216 Parkinson's disease (PD) patients assessed with comprehensive motor and neuropsychological assessments were analysed. Based on linear regression models, subscores of the Functional Activities Questionnaire (FAQ) primarily reflecting patients' global cognitive status (FAQC ) or PD-related motor severity (FAQM ) were developed. A quotient (FAQQ ) of both scores was calculated, with values >1 indicating more cognitive- compared to motor-driven ADL impairment. Both FAQC and FAQM scores were higher in PD-MCI than cognitively normal (PD-CN) patients, indicating more severe cognitive- and motor-driven ADL impairments in this group. One third (31.6%) of the PD-MCI group had a FAQQ score >1, which was significantly different from patients with PD-CN (p = .02). PD-MCI patients with an FAQQ score >1 were more impaired on tests assessing attention (p = .019) and language (p = .033) compared to PD-MCI patients with lower FAQQ values. The differentiation between cognitive- and motor-driven ADL is important, as the loss of functional capacity is the defining factor for a diagnosis of PDD. We were able to differentiate the cognitive-driven from the motor-driven ADL impairments for the FAQ. PD-MCI patients with more cognitive- compared to motor-driven ADL impairments may pose a risk group for conversion to PDD and can be targeted for early treatments.
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Affiliation(s)
- Sara Becker
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Alena Bäumer
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Walter Maetzler
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Susanne Nussbaum
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Maarten Timmers
- Janssen Research and Development, Janssen - Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Belgium
| | - Luc Van Nueten
- Janssen Research and Development, Janssen - Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium
| | - Giacomo Salvadore
- Janssen Research and Development LLC, Janssen - Pharmaceutical Companies of Johnson & Johnson, Raritan, New Jersey, USA
| | - Detlev Zaunbrecher
- Private Practice for Neurology, Psychiatry, and Psychotherapy, Mössingen, Germany
| | - Benjamin Roeben
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
| | - Johannes Streffer
- Janssen Research and Development, Janssen - Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Belgium
| | - Daniela Berg
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Germany
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16
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Anderson AE, Marder S, Reise SP, Savitz A, Salvadore G, Fu DJ, Li Q, Turkoz I, Han C, Bilder RM. Bifactor Modeling of the Positive and Negative Syndrome Scale: Generalized Psychosis Spans Schizoaffective, Bipolar, and Schizophrenia Diagnoses. Schizophr Bull 2018; 44:1204-1216. [PMID: 29420822 PMCID: PMC6192503 DOI: 10.1093/schbul/sbx163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Common genetic variation spans schizophrenia, schizoaffective and bipolar disorders, but historically, these syndromes have been distinguished categorically. A symptom dimension shared across these syndromes, if such a general factor exists, might provide a clearer target for understanding and treating mental illnesses that share core biological bases. METHOD We tested the hypothesis that a bifactor model of the Positive and Negative Syndrome Scale (PANSS), containing 1 general factor and 5 specific factors (positive, negative, disorganized, excited, anxiety), explains the cross-diagnostic structure of symptoms better than the traditional 5-factor model, and examined the extent to which a general factor reflects the overall severity of symptoms spanning diagnoses in 5094 total patients with a diagnosis of schizophrenia, schizoaffective, and bipolar disorder. RESULTS The bifactor model provided superior fit across diagnoses, and was closer to the "true" model, compared to the traditional 5-factor model (Vuong test; P < .001). The general factor included high loadings on 28 of the 30 PANSS items, omitting symptoms associated with the excitement and anxiety/depression domains. The general factor had highest total loadings on symptoms that are often associated with the positive and disorganization syndromes, but there were also substantial loadings on the negative syndrome thus leading to the interpretation of this factor as reflecting generalized psychosis. CONCLUSIONS A bifactor model derived from the PANSS can provide a stronger framework for measuring cross-diagnostic psychopathology than a 5-factor model, and includes a generalized psychosis dimension shared at least across schizophrenia, schizoaffective, and bipolar disorder.
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Affiliation(s)
- Ariana E Anderson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA,Department of Statistics, University of California, Los Angeles, Los Angeles, CA,To whom correspondence should be addressed; Semel Institute at UCLA, 760 Westwood Plaza, Suite 28–224, Los Angeles, CA 90095; tel: (310)-254-5680, fax: (310)-825-0733, e-mail:
| | - Stephen Marder
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Steven P Reise
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA
| | - Adam Savitz
- Janssen Research and Development, Titusville, NJ
| | | | - Dong Jing Fu
- Janssen Research and Development, Titusville, NJ
| | - Qingqin Li
- Janssen Research and Development, Titusville, NJ
| | | | - Carol Han
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Robert M Bilder
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA,Department of Psychology, University of California, Los Angeles, Los Angeles, CA
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17
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Richards EM, Zanotti-Fregonara P, Fujita M, Newman L, Farmer C, Ballard ED, Machado-Vieira R, Yuan P, Niciu MJ, Lyoo CH, Henter ID, Salvadore G, Drevets WC, Kolb H, Innis RB, Zarate Jr CA. PET radioligand binding to translocator protein (TSPO) is increased in unmedicated depressed subjects. EJNMMI Res 2018; 8:57. [PMID: 29971587 PMCID: PMC6029989 DOI: 10.1186/s13550-018-0401-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/30/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Inflammation is associated with major depressive disorder (MDD). Translocator protein 18 kDa (TSPO), a putative biomarker of neuroinflammation, is quantified using positron emission tomography (PET) and 11C-PBR28, a TSPO tracer. We sought to (1) investigate TSPO binding in MDD subjects currently experiencing a major depressive episode, (2) investigate the effects of antidepressants on TSPO binding, and (3) determine the relationship of peripheral and central inflammatory markers to cerebral TSPO binding. Twenty-eight depressed MDD subjects (unmedicated (n = 12) or medicated (n = 16)) and 20 healthy controls (HC) underwent PET imaging using 11C-PBR28. Total distribution volume (VT, proportional to Bmax/Kd) was measured and corrected with the free fraction in plasma (fp). The subgenual prefrontal cortex (sgPFC) and anterior cingulate cortex (ACC) were the primary regions of interest. Peripheral blood samples and cerebrospinal fluid were analyzed to investigate the relationship between TSPO binding and peripheral and central inflammatory markers, including interleukins and neurotrophic factors previously linked to depression. RESULTS TSPO binding was higher in MDD versus HC in the sgPFC (Cohen's d = 0.64, p = .038, 95% CI 0.04-1.24) and ACC (d = 0.60, p = .049, 95% CI 0.001-1.21), though these comparisons missed the corrected threshold for statistical significance (α = .025). Exploratory analyses demonstrated that unmedicated MDD subjects had the highest level of TSPO binding, followed by medicated MDD subjects, who did not differ from HC. TSPO binding correlated with interleukin-5 in cerebrospinal fluid but with no other central inflammatory markers. CONCLUSIONS This study found a trend towards increased TSPO binding in the brains of MDD subjects, and post hoc analysis extended these findings by demonstrating that this abnormality is significant in unmedicated (but not medicated) MDD subjects.
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Affiliation(s)
- Erica M. Richards
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
| | | | - Masahiro Fujita
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
| | - Laura Newman
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
| | - Cristan Farmer
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
| | - Elizabeth D. Ballard
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
| | - Rodrigo Machado-Vieira
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX USA
| | - Peixiong Yuan
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
| | - Mark J. Niciu
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ioline D. Henter
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
| | | | | | - Hartmuth Kolb
- Janssen Research and Development, LLC, Titusville, NJ USA
| | - Robert B. Innis
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
| | - Carlos A. Zarate Jr
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 6-5340, 10 Center Drive, Bethesda, MD 20892 USA
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18
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Timmers M, Sinha V, Darpo B, Smith B, Brown R, Xue H, Ferber G, Streffer J, Russu A, Tritsmans L, Solanki B, Bogert J, Van Nueten L, Salvadore G, Nandy P. Evaluating Potential QT Effects of JNJ-54861911, a BACE Inhibitor in Single- and Multiple-Ascending Dose Studies, and a Thorough QT Trial With Additional Retrospective Confirmation, Using Concentration-QTc Analysis. J Clin Pharmacol 2018; 58:952-964. [PMID: 29505101 DOI: 10.1002/jcph.1087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/21/2017] [Accepted: 01/05/2018] [Indexed: 11/10/2022]
Abstract
Nonclinical assays with JNJ-54861911, a β-secretase 1 inhibitor have indicated that at high concentrations, it may delay cardiac repolarization. A 4-way crossover thorough QT (TQT) study was performed in 64 healthy subjects with 50 and 150 mg JNJ-54861911 once daily for 7 days, placebo, and 400 mg moxifloxacin. Retrospective high-precision QT (HPQT) analysis was performed on serial elecrocardiograms extracted from first-in-human single-ascending dose (SAD) and multiple-ascending dose (MAD) studies to evaluate if early studies could detect and predict QT effect. In the TQT study, a high therapeutic 50 mg dose did not cause QT prolongation, and an effect >10 milliseconds could be excluded at all postdose timepoints. QT prolongation with peak effect on placebo-corrected change from baseline QTcF of 15.5 milliseconds (90%CI, 12.9-18.1 milliseconds) was observed following a supratherapeutic dose (150 mg). No clinically relevant QT changes were observed in earlier studies. However, with SAD/MAD findings by HPQT, the slope of the exposure-response (ER) relationship in the SAD study (doses up to 150 mg) was similar to the TQT study slope, and the estimated QT effect was comparable at high plasma levels. In the MAD study, doses up to 90 mg once daily for 7 days resulted in JNJ-54861911 peak plasma concentrations (Cmax ) comparable to those in the SAD study (∼750 ng/mL), but ER by HPQT failed to detect a QT effect and resulted in negative estimations. Adding a higher dose cohort (150 mg; Cmax , 1125 ng/mL) demonstrated a QT effect, with a slightly lower ER slope than the TQT study. JNJ-54861911 (up to 50 mg) did not cause QT prolongation at clinically relevant plasma concentrations in any studies. Provided sufficiently high plasma concentrations were captured, mild QT prolongation observed postdose with a supratherapeutic dose could be detected (TQT study) and estimated in SAD/MAD studies. Based on population pharmacokinetic modeling and simulation, 5 and 25 mg doses are currently considered for further phase 3 studies and are expected not to cause any relevant QT prolongation.
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Affiliation(s)
- Maarten Timmers
- Janssen Research & 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
| | - Vikash Sinha
- Janssen Research & Development LLC, Titusville, NJ, USA
| | - Borje Darpo
- Karolinska Institute, Stockholm, Sweden.,iCardiac Technologies, Rochester, NY, USA
| | | | | | - Hongqi Xue
- iCardiac Technologies, Rochester, NY, USA
| | - Georg Ferber
- Statistik Georg Ferber GmbH, Riehen, Switzerland
| | - Johannes Streffer
- Janssen Research & 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
| | - Alberto Russu
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Luc Tritsmans
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | | | | | - Luc Van Nueten
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Giacomo Salvadore
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Partha Nandy
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
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19
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Anderson AE, Mansolf M, Reise SP, Savitz A, Salvadore G, Li Q, Bilder RM. Measuring pathology using the PANSS across diagnoses: Inconsistency of the positive symptom domain across schizophrenia, schizoaffective, and bipolar disorder. Psychiatry Res 2017; 258:207-216. [PMID: 28899614 PMCID: PMC5681392 DOI: 10.1016/j.psychres.2017.08.009] [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] [Received: 08/23/2016] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/25/2022]
Abstract
Although the Positive and Negative Syndrome Scale (PANSS) was developed for use in schizophrenia (SZ), antipsychotic drug trials use the PANSS to measure symptom change also for bipolar (BP) and schizoaffective (SA) disorder, extending beyond its original indications. If the dimensions measured by the PANSS are different across diagnoses, then the same score change for the same drug condition may have different meanings depending on which group is being studied. Here, we evaluated whether the factor structure in the PANSS was consistent across schizophrenia (n = 3647), bipolar disorder (n = 858), and schizoaffective disorder (n = 592). Along with congruency coefficients, Hancock's H, and Jaccard indices, we used target rotations and statistical tests of invariance based on confirmatory factor models. We found the five symptom dimensions measured by the 30-item PANSS did not generalize well to schizoaffective and bipolar disorders. A model based on an 18-item version of the PANSS generalized better across SZ and BP groups, but significant problems remained in generalizing some of the factors to the SA sample. Schizophrenia and bipolar disorder showed greater similarity in factor structure than did schizophrenia and schizoaffective disorder. The Anxiety/Depression factor was the most consistent across disorders, while the Positive factor was the least consistent.
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Affiliation(s)
- Ariana E. Anderson
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA,University of California, Los Angeles, Department of Statistics, Los Angeles, CA, USA,Correspondence to: 760 Westwood Plaza, Suite 28–224, Los Angeles, CA 90095, USA. (A.E. Anderson)
| | - Maxwell Mansolf
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Steven P. Reise
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Adam Savitz
- Janssen Scientific Affairs, Titusville, NJ, USA
| | | | - Qingqin Li
- Janssen Scientific Affairs, Titusville, NJ, USA
| | - Robert M. Bilder
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA,University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
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20
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Sun Y, Wang D, Salvadore G, Hsu B, Curran M, Casper C, Vermeulen J, Kent JM, Singh J, Drevets WC, Wittenberg GM, Chen G. The effects of interleukin-6 neutralizing antibodies on symptoms of depressed mood and anhedonia in patients with rheumatoid arthritis and multicentric Castleman's disease. Brain Behav Immun 2017; 66:156-164. [PMID: 28676350 DOI: 10.1016/j.bbi.2017.06.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 03/23/2017] [Revised: 06/11/2017] [Accepted: 06/25/2017] [Indexed: 12/11/2022] Open
Abstract
Cytokines, including interleukin-6 (IL-6), modulate neuronal plasticity and stress coping. Depressive symptoms and major depressive disorder (MDD) have been associated with changes in cytokines and their signaling. The current study examined the effect of IL-6 monoclonal antibody administration on depressive symptoms in patients with rheumatoid arthritis (RA) or multicentric Castleman's disease (MCD). The data were obtained from two phase 2, double-blind, placebo-controlled trials designed to test the efficacy of sirukumab in RA (N=176) or of siltuximab in MCD (N=65), and were analyzed post hoc to investigate the effects of these IL-6 antibodies on depressive symptoms. The SF-36 questionnaire items on depressed-mood and anhedonia were combined as the measure for depressive symptoms. The study participants were grouped by the presence/absence of prevalent depressed mood and anhedonia (PDMA, meaning either depressed mood or anhedonia was present at least 'most of the time' and the other at least 'some of the time' for four weeks) at baseline; 26.1% of the RA sample and 15.4% of the MCD sample met criteria for PDMA at baseline. Compared with placebo, sirukumab and siltuximab produced significantly greater improvements on depressive symptoms. To account for an effect on mood due to changes in RA or MCD, the analysis was (1) adjusted for symptom severities using DAS28-CRP for RA and MCDOS for MCD alone or together with bodily pain and physical functioning, and (2) performed within RA and MCD non-responders. Improvement in depressive symptoms remained significant in the treated group for both drugs. The significance over placebo was also observed in the siltuximab study. The improvement in depressive symptoms by sirukumab correlated positively with the baseline soluble IL-6 receptor levels. The data together suggest that the IL-6 antibodies improve depressive symptoms in patients with RA and MCD. Further studies are needed to elucidate to what extents the IL-6 antibodies improve depressive symptoms through improving primary disease dependent and independent mechanisms, especially in RA patients, and the brain mechanisms underlying depressive symptom improvements.
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Affiliation(s)
- Yu Sun
- Neuroscience Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Dai Wang
- Neuroscience Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Giacomo Salvadore
- Neuroscience Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Benjamin Hsu
- Immunology Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Mark Curran
- Immunology Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Corey Casper
- Fred Hutchison Cancer Research Center, United States
| | - Jessica Vermeulen
- Oncology Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Justine M Kent
- Neuroscience Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Jaskaran Singh
- Neuroscience Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Wayne C Drevets
- Neuroscience Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Gayle M Wittenberg
- Neuroscience Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Guang Chen
- Neuroscience Therapeutic Areas, Janssen Research & Development, LLC, Janssen Pharmaceutical Companies of Johnson & Johnson, United States.
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21
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Wise T, Radua J, Via E, Cardoner N, Abe O, Adams TM, Amico F, Cheng Y, Cole JH, de Azevedo Marques Périco C, Dickstein DP, Farrow TFD, Frodl T, Wagner G, Gotlib IH, Gruber O, Ham BJ, Job DE, Kempton MJ, Kim MJ, Koolschijn PCMP, Malhi GS, Mataix-Cols D, McIntosh AM, Nugent AC, O'Brien JT, Pezzoli S, Phillips ML, Sachdev PS, Salvadore G, Selvaraj S, Stanfield AC, Thomas AJ, van Tol MJ, van der Wee NJA, Veltman DJ, Young AH, Fu CH, Cleare AJ, Arnone D. Common and distinct patterns of grey-matter volume alteration in major depression and bipolar disorder: evidence from voxel-based meta-analysis. Mol Psychiatry 2017; 22:1455-1463. [PMID: 27217146 PMCID: PMC5622121 DOI: 10.1038/mp.2016.72] [Citation(s) in RCA: 357] [Impact Index Per Article: 51.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/01/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022]
Abstract
Finding robust brain substrates of mood disorders is an important target for research. The degree to which major depression (MDD) and bipolar disorder (BD) are associated with common and/or distinct patterns of volumetric changes is nevertheless unclear. Furthermore, the extant literature is heterogeneous with respect to the nature of these changes. We report a meta-analysis of voxel-based morphometry (VBM) studies in MDD and BD. We identified studies published up to January 2015 that compared grey matter in MDD (50 data sets including 4101 individuals) and BD (36 data sets including 2407 individuals) using whole-brain VBM. We used statistical maps from the studies included where available and reported peak coordinates otherwise. Group comparisons and conjunction analyses identified regions in which the disorders showed common and distinct patterns of volumetric alteration. Both disorders were associated with lower grey-matter volume relative to healthy individuals in a number of areas. Conjunction analysis showed smaller volumes in both disorders in clusters in the dorsomedial and ventromedial prefrontal cortex, including the anterior cingulate cortex and bilateral insula. Group comparisons indicated that findings of smaller grey-matter volumes relative to controls in the right dorsolateral prefrontal cortex and left hippocampus, along with cerebellar, temporal and parietal regions were more substantial in major depression. These results suggest that MDD and BD are characterised by both common and distinct patterns of grey-matter volume changes. This combination of differences and similarities has the potential to inform the development of diagnostic biomarkers for these conditions.
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Affiliation(s)
- T Wise
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - J Radua
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Research Unit, FIDMAG Germanes Hospitalàries – CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E Via
- Mental Health, Parc Taulí Sabadell-CIBERSAM, University Hospital, Sabadell, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - N Cardoner
- Mental Health, Parc Taulí Sabadell-CIBERSAM, University Hospital, Sabadell, Barcelona, Spain
| | - O Abe
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - T M Adams
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - F Amico
- Department of Psychiatry, Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - Y Cheng
- Department of Psychiatry, The 1st Affiliated Hospital of Kunming Medical University, Kunming, PR China
| | - J H Cole
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Medicine, Imperial College London, London, UK
| | - C de Azevedo Marques Périco
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, Brazil
- ABC Center of Studies on Mental Health, Santo André, SP, Brazil
| | - D P Dickstein
- PediMIND Program, Bradley Hospital, Department of Psychiatry, Brown University, East Providence, RI, USA
| | - T F D Farrow
- Academic Clinical Neurology, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - T Frodl
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
- Department of Psychiatry, University of Dublin, Trinity College, Dublin, Ireland
| | - G Wagner
- Psychiatric Brain and Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - I H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - O Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - B J Ham
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - D E Job
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Imaging Network–A Platform for Scientific Excellence (SINAPSE), Giffnock, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - M J Kim
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - P C M P Koolschijn
- Department of Psychology, Dutch Autism and ADHD Research Center, Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - G S Malhi
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - D Mataix-Cols
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - A C Nugent
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - J T O'Brien
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S Pezzoli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK
| | - M L Phillips
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - P S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - G Salvadore
- Janssen Research and Development, Titusville, NJ, USA
| | - S Selvaraj
- Department of Psychiatry and Behavioral Sciences, Center of Excellence on Mood Disorders, Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A C Stanfield
- The Patrick Wild Centre, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - A J Thomas
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - M J van Tol
- NeuroImaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - N J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - D J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - A H Young
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - C H Fu
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- School of Psychology, University of East London, London, UK
| | - A J Cleare
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - D Arnone
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Li M, Demenescu LR, Colic L, Metzger CD, Heinze HJ, Steiner J, Speck O, Fejtova A, Salvadore G, Walter M. Temporal Dynamics of Antidepressant Ketamine Effects on Glutamine Cycling Follow Regional Fingerprints of AMPA and NMDA Receptor Densities. Neuropsychopharmacology 2017; 42:1201-1209. [PMID: 27604568 PMCID: PMC5437874 DOI: 10.1038/npp.2016.184] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 01/07/2016] [Revised: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 11/09/2022]
Abstract
The anterior cingulate cortex (ACC) has shown decreased glutamate levels in patients with major depressive disorder. Subanesthetic doses of ketamine were repeatedly shown to improve depressive symptoms within 24 h after infusion and this antidepressant effect was attributed to increased α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate (AMPA) throughput. To elucidate ketamine's mechanism of action, we tested whether the clinical time course of the improvement is mirrored by the change of glutamine/glutamate ratio and if such effects show a regional and temporal specificity in two distinct subdivisions of ACC with different AMPA/N-methyl-D-aspartate receptor profiles. In a double-blind, placebo-controlled intravenous infusion study of ketamine, we measured glutamate and glutamine in the pregenual ACC (pgACC) and the anterior midcingulate cortex at 1 and 24 h post infusion with magnetic resonance spectroscopy at 7 T. A significant interaction of time, region, and treatment was found for the glutamine/glutamate ratios (placebo, n=14; ketamine, n=12). Post-hoc analyses revealed that the glutamine/glutamate ratio increased significantly in the ketamine group, compared with placebo, specifically in the pgACC after 24 h. The glutamine/glutamate increase in the pgACC caused by ketamine at 24 h post infusion was reproduced in an enlarged sample (placebo, n=24; ketamine, n=20). Our results support a significant temporal and regional response in glutamine/glutamate ratios to a single subanesthetic dose of ketamine, which mirrors the time course of the antidepressant response and reversal of the molecular deficits in patients and which may be associated with the histoarchitectonical receptor fingerprints of the ACC subregions.
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Affiliation(s)
- Meng Li
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Otto von Guericke University, Magdeburg, Germany
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | - Liliana Ramona Demenescu
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Otto von Guericke University, Magdeburg, Germany
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | - Lejla Colic
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Otto von Guericke University, Magdeburg, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Coraline Danielle Metzger
- German Centre for Neurodegenerative Diseases (DZNE), Site Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Magdeburg, Germany
- Centre for Behavioural Brain Sciences (CBBS), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Centre for Behavioural Brain Sciences (CBBS), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Johann Steiner
- Centre for Behavioural Brain Sciences (CBBS), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Oliver Speck
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Site Magdeburg, Germany
- Centre for Behavioural Brain Sciences (CBBS), Magdeburg, Germany
- Department of Biomedical Magnetic Resonance, Otto von Guericke University, Magdeburg, Germany
| | - Anna Fejtova
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Centre for Behavioural Brain Sciences (CBBS), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Martin Walter
- Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Otto von Guericke University, Magdeburg, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Centre for Behavioural Brain Sciences (CBBS), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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23
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Rotroff DM, Corum DG, Motsinger-Reif A, Fiehn O, Bottrel N, Drevets WC, Singh J, Salvadore G, Kaddurah-Daouk R. Metabolomic signatures of drug response phenotypes for ketamine and esketamine in subjects with refractory major depressive disorder: new mechanistic insights for rapid acting antidepressants. Transl Psychiatry 2016; 6:e894. [PMID: 27648916 PMCID: PMC5048196 DOI: 10.1038/tp.2016.145] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/01/2016] [Indexed: 12/22/2022] Open
Abstract
Ketamine, at sub-anesthetic doses, is reported to rapidly decrease depression symptoms in patients with treatment-resistant major depressive disorder (MDD). Many patients do not respond to currently available antidepressants, (for example, serotonin reuptake inhibitors), making ketamine and its enantiomer, esketamine, potentially attractive options for treatment-resistant MDD. Although mechanisms by which ketamine/esketamine may produce antidepressant effects have been hypothesized on the basis of preclinical data, the neurobiological correlates of the rapid therapeutic response observed in patients receiving treatment have not been established. Here we use a pharmacometabolomics approach to map global metabolic effects of these compounds in treatment-refractory MDD patients upon 2 h from infusion with ketamine (n=33) or its S-enantiomer, esketamine (n=20). The effects of esketamine on metabolism were retested in the same subjects following a second exposure administered 4 days later. Two complementary metabolomics platforms were used to provide broad biochemical coverage. In addition, we investigated whether changes in particular metabolites correlated with treatment outcome. Both drugs altered metabolites related to tryptophan metabolism (for example, indole-3-acetate and methionine) and/or the urea cycle (for example, citrulline, arginine and ornithine) at 2 h post infusion (q<0.25). In addition, we observed changes in glutamate and circulating phospholipids that were significantly associated with decreases in depression severity. These data provide new insights into the mechanism underlying the rapid antidepressant effects of ketamine and esketamine, and constitute some of the first detailed metabolomics mapping for these promising therapies.
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Affiliation(s)
- D M Rotroff
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
| | - D G Corum
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - A Motsinger-Reif
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
| | - O Fiehn
- UC Davis Genome Center, University of California Davis, Davis, CA, USA
- Department of Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - N Bottrel
- Department of Neuroscience, Janssen Research and Development, Titusville, NJ, USA
| | - W C Drevets
- Department of Neuroscience, Janssen Research and Development, Titusville, NJ, USA
| | - J Singh
- Department of Neuroscience, Janssen Research and Development, San Diego CA, USA
| | - G Salvadore
- Department of Neuroscience, Janssen Research and Development, Titusville, NJ, USA
| | - R Kaddurah-Daouk
- Department of Psychiatry, Duke University Medical Center, Durham NC, USA
- Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
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24
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Arnone D, Job D, Selvaraj S, Abe O, Amico F, Cheng Y, Colloby SJ, O'Brien JT, Frodl T, Gotlib IH, Ham BJ, Kim MJ, Koolschijn PCMP, Périco CAM, Salvadore G, Thomas AJ, Van Tol MJ, van der Wee NJA, Veltman DJ, Wagner G, McIntosh AM. Computational meta-analysis of statistical parametric maps in major depression. Hum Brain Mapp 2016; 37:1393-404. [PMID: 26854015 DOI: 10.1002/hbm.23108] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [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: 01/12/2015] [Revised: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Several neuroimaging meta-analyses have summarized structural brain changes in major depression using coordinate-based methods. These methods might be biased toward brain regions where significant differences were found in the original studies. In this study, a novel voxel-based technique is implemented that estimates and meta-analyses between-group differences in grey matter from individual MRI studies, which are then applied to the study of major depression. METHODS A systematic review and meta-analysis of voxel-based morphometry studies were conducted comparing participants with major depression and healthy controls by using statistical parametric maps. Summary effect sizes were computed correcting for multiple comparisons at the voxel level. Publication bias and heterogeneity were also estimated and the excess of heterogeneity was investigated with metaregression analyses. RESULTS Patients with major depression were characterized by diffuse bilateral grey matter loss in ventrolateral and ventromedial frontal systems extending into temporal gyri compared to healthy controls. Grey matter reduction was also detected in the right parahippocampal and fusiform gyri, hippocampus, and bilateral thalamus. Other areas included parietal lobes and cerebellum. There was no evidence of statistically significant publication bias or heterogeneity. CONCLUSIONS The novel computational meta-analytic approach used in this study identified extensive grey matter loss in key brain regions implicated in emotion generation and regulation. Results are not biased toward the findings of the original studies because they include all available imaging data, irrespective of statistically significant regions, resulting in enhanced detection of additional areas of grey matter loss.
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Affiliation(s)
- Danilo Arnone
- Centre for Affective Disorders, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Dominic Job
- Neuroimaging Sciences, the University of Edinburgh, Edinburgh, United Kingdom
| | - Sudhakar Selvaraj
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Osamu Abe
- Department of Radiology, Nihon University School of Medicine, Itabashi-Ku, Tokyo, Japan
| | - Francesco Amico
- Trinity College School of Medicine, Department of Psychiatry, Neuroimaging Group, Trinity College Dublin, Ireland
| | - Yuqi Cheng
- Department of Psychiatry, the 1st Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Sean J Colloby
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John T O'Brien
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas Frodl
- Trinity College School of Medicine, Department of Psychiatry, Neuroimaging Group, Trinity College Dublin, Ireland.,Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, California
| | - Byung-Joo Ham
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - M Justin Kim
- Department of Psychological & Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - P Cédric M P Koolschijn
- Dutch Autism & ADHD Research Center Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Cintia A-M Périco
- Disciplinas De Psiquiatria E Psicologia Médica Da Faculdade De Medicina Do ABC Coordenadora Da Enfermaria De Psiquiatria Do Hospital Estadual Mário Covas, San Paolo, Brazil
| | - Giacomo Salvadore
- Neuroscience Experimental Medicine, Janssen Research & Development, Raritan, New Jersey
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marie-José Van Tol
- Neuroimaging Centre, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nic J A van der Wee
- Leiden Institute for Brain and Cognition/Psychiatric Neuroimaging, Leiden University and Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Andrew M McIntosh
- Division of Psychiatry, the University of Edinburgh, Edinburgh, United Kingdom
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25
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Hsu B, Wang D, Sun Y, Salvadore G, Singh J, Curran M, Caers I, Drevets W, Wittenberg G, Chen G. SAT0182 Improvement in Measures of Depressed Mood and Anhedonia, and Fatigue, In a Randomized, Placebo-Controlled, Phase 2 Study of Sirukumab, A Human Anti-Interleukin-6 Antibody, In Patients with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Anderson A, Wilcox M, Savitz A, Chung H, Li Q, Salvadore G, Wang D, Nuamah I, Riese SP, Bilder RM. Sparse factors for the positive and negative syndrome scale: which symptoms and stage of illness? Psychiatry Res 2015; 225:283-90. [PMID: 25613662 PMCID: PMC4346367 DOI: 10.1016/j.psychres.2014.12.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 04/10/2014] [Revised: 12/06/2014] [Accepted: 12/14/2014] [Indexed: 10/24/2022]
Abstract
The Positive and Negative Syndrome Scale (PANSS) is frequently described with five latent factors, yet published factor models consistently fail to replicate across samples and related disorders. We hypothesize that (1) a subset of the PANSS, instead of the entire PANSS scale, would produce the most replicable five-factor models across samples, and that (2) the PANSS factor structure may be different depending on the treatment phase, influenced by the responsiveness of the positive symptoms to treatment. Using exploratory factor analysis, confirmatory factor analysis and cross validation on baseline and post-treatment observations from 3647 schizophrenia patients, we show that five-factor models fit best across samples when substantial subsets of the PANSS items are removed. The optimal model at baseline (five factors) omits 12 items: Motor Retardation, Grandiosity, Somatic Concern, Lack of Judgment and Insight, Difficulty in Abstract Thinking, Mannerisms and Posturing, Disturbance of Volition, Preoccupation, Disorientation, Excitement, Guilt Feelings and Depression. The PANSS factor models fit differently before and after patients have been treated. Patients with larger treatment response in positive symptoms have larger variations in factor structure across treatment stage than the less responsive patients. Negative symptom scores better predict the positive symptoms scores after treatment than before treatment. We conclude that sparse factor models replicate better on new samples, and the underlying disease structure of Schizophrenia changes upon treatment.
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Affiliation(s)
- Ariana Anderson
- Department of Psychiatry and Biobehavioral Sciences, University of California, 760 Westwood Plaza, C8-739 Semel Institute, Los Angeles, CA, USA,Correspondence to: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, C8-739 Semel Institute, Los Angeles, CA 90095, Tel.: +1 310 254 5680, fax: +1 310 206 1866
| | - Marsha Wilcox
- Janssen Research and Development, Titusville, NJ, USA
| | - Adam Savitz
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Qingqin Li
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Dai Wang
- Janssen Research and Development, Titusville, NJ, USA
| | - Isaac Nuamah
- Janssen Research and Development, Titusville, NJ, USA
| | - Steven P. Riese
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Robert M. Bilder
- Department of Psychiatry and Biobehavioral Sciences, University of California, 760 Westwood Plaza, C8-739 Semel Institute, Los Angeles, CA, USA
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Salvadore G, Singh JB. Ketamine as a fast acting antidepressant: current knowledge and open questions. CNS Neurosci Ther 2013; 19:428-36. [PMID: 23578128 DOI: 10.1111/cns.12103] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/21/2013] [Accepted: 02/18/2013] [Indexed: 12/31/2022] Open
Abstract
Several recent studies have shown that a single intravenous subanesthetic dose of ketamine, a NMDA receptor antagonist, exerts rapid antidepressant effects in patients with treatment refractory mood disorders and reduces suicidal ideation. Those insights have fueled tremendous excitement in the efforts to elucidate the mechanism underlying ketamine's antidepressant properties in animal models of depression, as well as in humans through the use of brain imaging as well as peripheral blood measurements. For example, there is emerging evidence that ketamine's antidepressant properties rely on increasing AMPA signaling and rapidly inducing synaptogenesis. While pilot clinical studies are promising, a number of critical questions still remain unanswered. They relate to the safe and effective use of ketamine in patients with mood disorders regarding the optimal dose range, modality and method of administration for acute and long-term maintenance of effect, and the biomarkers associated with response/nonresponse. In this review article, we first summarize the clinical evidence about the use of ketamine in mood disorders, as well as preclinical and humans studies which investigated the mechanisms of action of ketamine, and predictors of antidepressant response in clinical populations. We then provide a critical overview of the knowledge gaps about the use of ketamine in depression and suggest some future research directions for the investigation of ketamine as a promising tool to develop novel more effective and fast acting antidepressants.
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28
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Cornwell BR, Salvadore G, Furey M, Marquardt CA, Brutsche NE, Grillon C, Zarate CA. Synaptic potentiation is critical for rapid antidepressant response to ketamine in treatment-resistant major depression. Biol Psychiatry 2012; 72:555-61. [PMID: 22521148 PMCID: PMC3408548 DOI: 10.1016/j.biopsych.2012.03.029] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [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: 01/05/2012] [Revised: 03/15/2012] [Accepted: 03/29/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Clinical evidence that ketamine, a nonselective N-methyl-D-aspartate receptor (NMDAR) antagonist, has therapeutic effects within hours in people suffering from depression suggests that modulating glutamatergic neurotransmission is a fundamental step in alleviating the debilitating symptoms of mood disorders. Acutely, ketamine increases extracellular glutamate levels, neuronal excitability, and spontaneous γ oscillations, but it is unknown whether these effects are key to the mechanism of antidepressant action of ketamine. METHODS Twenty drug-free major depressive disorder patients received a single, open-label intravenous infusion of ketamine hydrochloride (.5 mg/kg). Magnetoencephalographic recordings were made approximately 3 days before and approximately 6.5 hours after the infusion, whereas patients passively received tactile stimulation to the right and left index fingers and also while they rested (eyes-closed). Antidepressant response was assessed by percentage change in Montgomery-Åsberg Depression Rating Scale scores. RESULTS Patients with robust improvements in depressive symptoms 230 min after infusion (responders) exhibited increased cortical excitability within this antidepressant response window. Specifically, we found that stimulus-evoked somatosensory cortical responses increase after infusion, relative to pretreatment responses in responders but not in treatment nonresponders. Spontaneous somatosensory cortical γ-band activity during rest did not change within the same timeframe after ketamine in either responders or nonresponders. CONCLUSIONS These findings suggest NMDAR antagonism does not lead directly to increased cortical excitability hours later and thus might not be sufficient for therapeutic effects of ketamine to take hold. Rather, increased cortical excitability as depressive symptoms improve is consistent with the hypothesis that enhanced non-NMDAR-mediated glutamatergic neurotransmission via synaptic potentiation is central to the antidepressant effect of ketamine.
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Affiliation(s)
- Brian R. Cornwell
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Giacomo Salvadore
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Maura Furey
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Craig A. Marquardt
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Nancy E. Brutsche
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Carlos A. Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
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Khairova R, Pawar R, Salvadore G, Juruena MF, De Sousa RT, Soeiro-De-Souza MG, Salvador M, Zarate CA, Gattaz WF, Machado-Vieira R. Effects of lithium on oxidative stress parameters in healthy subjects. Mol Med Rep 2012; 5:680-2. [PMID: 22200861 PMCID: PMC3289682 DOI: 10.3892/mmr.2011.732] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [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: 09/06/2011] [Accepted: 12/06/2011] [Indexed: 02/05/2023] Open
Abstract
Increased neuronal oxidative stress (OxS) induces deleterious effects on signal transduction, structural plasticity and cellular resilience, mainly by inducing lipid peroxidation in membranes, proteins and genes. Major markers of OxS levels include the thiobarbituric acid reactive substances (TBARS) and the enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase. Lithium has been shown to prevent and/or reverse DNA damage, free-radical formation and lipid peroxidation in diverse models. This study evaluates OxS parameters in healthy volunteers prior to and following lithium treatment. Healthy volunteers were treated with lithium in therapeutic doses for 2-4 weeks. Treatment with lithium in healthy volunteers selectively altered SOD levels in all subjects. Furthermore, a significant decrease in the SOD/CAT ratio was observed following lithium treatment, which was associated with decreased OxS by lowering hydrogen peroxide levels. This reduction in the SOD/CAT ratio may lead to lower OxS, indicated primarily by a decrease in the concentration of cell hydrogen peroxide. Overall, the present findings indicate a potential role for the antioxidant effects of lithium in healthy subjects, supporting its neuroprotective profile in bipolar disorder (BD) and, possibly, in neurodegenerative processes.
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Affiliation(s)
- Rushaniya Khairova
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Psychiatry, Maimonides Medical Center, New York, NY, USA
| | - Rohit Pawar
- Department of Psychiatry, Maimonides Medical Center, New York, NY, USA
| | - Giacomo Salvadore
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mario F. Juruena
- Department of Neuroscience and Behavior, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Rafael T. De Sousa
- Laboratory of Neuroscience, LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, SP, Brazil
| | - Márcio G. Soeiro-De-Souza
- Laboratory of Neuroscience, LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, SP, Brazil
| | - Mirian Salvador
- Institute of Biotechnology, University of Caxias do Sul, Caxias do Sul, RS
| | - Carlos A. Zarate
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Wagner F. Gattaz
- Laboratory of Neuroscience, LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, SP, Brazil
| | - Rodrigo Machado-Vieira
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Neuroscience, LIM-27, Institute and Department of Psychiatry, University of Sao Paulo, SP, Brazil
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Salvadore G, Zarate CA. Magnetic resonance spectroscopy studies of the glutamatergic system in mood disorders: a pathway to diagnosis, novel therapeutics, and personalized medicine? Biol Psychiatry 2010; 68:780-2. [PMID: 20946973 PMCID: PMC3034276 DOI: 10.1016/j.biopsych.2010.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 09/08/2010] [Indexed: 01/28/2023]
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Salvadore G, Quiroz JA, Machado-Vieira R, Henter ID, Manji HK, Zarate CA. The neurobiology of the switch process in bipolar disorder: a review. J Clin Psychiatry 2010; 71:1488-501. [PMID: 20492846 PMCID: PMC3000635 DOI: 10.4088/jcp.09r05259gre] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [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: 04/01/2009] [Accepted: 06/09/2009] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The singular phenomenon of switching from depression to its opposite state of mania or hypomania, and vice versa, distinguishes bipolar disorder from all other psychiatric disorders. Despite the fact that it is a core aspect of the clinical presentation of bipolar disorder, the neurobiology of the switch process is still poorly understood. In this review, we summarize the clinical evidence regarding somatic interventions associated with switching, with a particular focus on the biologic underpinnings presumably involved in the switch process. DATA SOURCES Literature for this review was obtained through a search of the MEDLINE database (1966-2008) using the following keywords and phrases: switch, bipolar disorder, bipolar depression, antidepressant, SSRIs, tricyclic antidepressants, norepinephrine, serotonin, treatment emergent affective switch, mania, hypomania, HPA-axis, glucocorticoids, amphetamine, dopamine, and sleep deprivation. STUDY SELECTION All English-language, peer-reviewed, published literature, including randomized controlled studies, naturalistic and open-label studies, and case reports, were eligible for inclusion. DATA SYNTHESIS Converging evidence suggests that certain pharmacologic and nonpharmacologic interventions with very different mechanisms of action, such as sleep deprivation, exogenous corticosteroids, and dopaminergic agonists, can trigger mood episode switches in patients with bipolar disorder. The switch-inducing potential of antidepressants is unclear, although tricyclic antidepressants, which confer higher risk of switching than other classes of antidepressants, are a possible exception. Several neurobiological factors appear to be associated with both spontaneous and treatment-emergent mood episode switches; these include abnormalities in catecholamine levels, up-regulation of neurotrophic and neuroplastic factors, hypothalamic-pituitary-adrenal axis hyperactivity, and circadian rhythms. CONCLUSIONS There is a clear need to improve our understanding of the neurobiology of the switch process; research in this field would benefit from the systematic and integrated assessment of variables associated with switching.
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Affiliation(s)
- Giacomo Salvadore
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Jorge A. Quiroz
- Johnson & Johnson Pharmaceutical Research and Development, L.L.C., Titusville, NJ
| | - Rodrigo Machado-Vieira
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Ioline D. Henter
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Husseini K. Manji
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA,Johnson & Johnson Pharmaceutical Research and Development, L.L.C., Titusville, NJ
| | - Carlos A. Zarate
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, Maryland, USA
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Abstract
Mood disorders such as bipolar disorder and major depressive disorder are common, chronic, and recurrent conditions affecting millions of individuals worldwide. Existing antidepressants and mood stabilizers used to treat these disorders are insufficient for many. Patients continue to have low remission rates, delayed onset of action, residual subsyndromal symptoms, and relapses. New therapeutic agents able to exert faster and sustained antidepressant or mood-stabilizing effects are urgently needed to treat these disorders. In this context, the glutamatergic system has been implicated in the pathophysiology of mood disorders in unique clinical and neurobiological ways. In addition to evidence confirming the role of the glutamatergic modulators riluzole and ketamine as proof-of-concept agents in this system, trials with diverse glutamatergic modulators are under way. Overall, this system holds considerable promise for developing the next generation of novel therapeutics for the treatment of bipolar disorder and major depressive disorder.
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Affiliation(s)
- Carlos Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Department of Health & Human Services, Bethesda, MD 20892, USA.
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Diazgranados N, Ibrahim L, Brutsche NE, Newberg A, Kronstein P, Khalife S, Kammerer WA, Quezado Z, Luckenbaugh DA, Salvadore G, Machado-Vieira R, Manji HK, Zarate CA. A randomized add-on trial of an N-methyl-D-aspartate antagonist in treatment-resistant bipolar depression. ACTA ACUST UNITED AC 2010; 67:793-802. [PMID: 20679587 DOI: 10.1001/archgenpsychiatry.2010.90] [Citation(s) in RCA: 691] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Existing therapies for bipolar depression have a considerable lag of onset of action. Pharmacological strategies that produce rapid antidepressant effects-for instance, within a few hours or days-would have an enormous impact on patient care and public health. OBJECTIVE To determine whether an N-methyl-D-aspartate-receptor antagonist produces rapid antidepressant effects in subjects with bipolar depression. DESIGN A randomized, placebo-controlled, double-blind, crossover, add-on study conducted from October 2006 to June 2009. SETTING Mood Disorders Research Unit at the National Institute of Mental Health, Bethesda, Maryland. Patients Eighteen subjects with DSM-IV bipolar depression (treatment-resistant). INTERVENTIONS Subjects maintained at therapeutic levels of lithium or valproate received an intravenous infusion of either ketamine hydrochloride (0.5 mg/kg) or placebo on 2 test days 2 weeks apart. The Montgomery-Asberg Depression Rating Scale was used to rate subjects at baseline and at 40, 80, 110, and 230 minutes and on days 1, 2, 3, 7, 10, and 14 postinfusion. MAIN OUTCOME MEASURES Change in Montgomery-Asberg Depression Rating Scale primary efficacy measure scores. RESULTS Within 40 minutes, depressive symptoms significantly improved in subjects receiving ketamine compared with placebo (d = 0.52, 95% confidence interval [CI], 0.28-0.76); this improvement remained significant through day 3. The drug difference effect size was largest at day 2 (d = 0.80, 95% CI, 0.55-1.04). Seventy-one percent of subjects responded to ketamine and 6% responded to placebo at some point during the trial. One subject receiving ketamine and 1 receiving placebo developed manic symptoms. Ketamine was generally well tolerated; the most common adverse effect was dissociative symptoms, only at the 40-minute point. CONCLUSION In patients with treatment-resistant bipolar depression, robust and rapid antidepressant effects resulted from a single intravenous dose of an N-methyl-D-aspartate antagonist.
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Affiliation(s)
- Nancy Diazgranados
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Cornwell BR, Salvadore G, Colon-Rosario V, Latov DR, Holroyd T, Carver FW, Coppola R, Manji HK, Zarate CA, Grillon C. Abnormal hippocampal functioning and impaired spatial navigation in depressed individuals: evidence from whole-head magnetoencephalography. Am J Psychiatry 2010; 167:836-44. [PMID: 20439387 PMCID: PMC2905217 DOI: 10.1176/appi.ajp.2009.09050614] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [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: 11/30/2022]
Abstract
OBJECTIVE Dysfunction of the hippocampus has long been suspected to be a key component of the pathophysiology of major depressive disorder. Despite evidence of hippocampal structural abnormalities in depressed patients, abnormal hippocampal functioning has not been demonstrated. The authors aimed to link spatial navigation deficits previously documented in depressed patients to abnormal hippocampal functioning using a virtual reality navigation task. METHOD Whole-head magnetoencephalography (MEG) recordings were collected while participants (19 patients diagnosed with major depressive disorder and 19 healthy subjects matched by gender and age) navigated a virtual Morris water maze to find a hidden platform; navigation to a visible platform served as a control condition. Behavioral measures were obtained to assess navigation performance. Theta oscillatory activity (4-8 Hz) was mapped across the brain on a voxel-wise basis using a spatial-filtering MEG source analysis technique. RESULTS Depressed patients performed worse than healthy subjects in navigating to the hidden platform. Robust group differences in theta activity were observed in right medial temporal cortices during navigation, with patients exhibiting less engagement of the anterior hippocampus and parahippocampal cortices relative to comparison subjects. Left posterior hippocampal theta activity was positively correlated with individual performance within each group. CONCLUSIONS Consistent with previous findings, depressed patients showed impaired spatial navigation. Dysfunction of right anterior hippocampus and parahippocampal cortices may underlie this deficit and stem from structural abnormalities commonly found in depressed patients.
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Affiliation(s)
- Brian R. Cornwell
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Giacomo Salvadore
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Veronica Colon-Rosario
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - David R. Latov
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Tom Holroyd
- Magnetoencephalography Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Frederick W. Carver
- Magnetoencephalography Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Richard Coppola
- Magnetoencephalography Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Husseini K. Manji
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A. Zarate
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Christian Grillon
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Salvadore G, Cornwell BR, Sambataro F, Latov D, Colon-Rosario V, Carver F, Holroyd T, DiazGranados N, Machado-Vieira R, Grillon C, Drevets WC, Zarate CA. Anterior cingulate desynchronization and functional connectivity with the amygdala during a working memory task predict rapid antidepressant response to ketamine. Neuropsychopharmacology 2010; 35:1415-22. [PMID: 20393460 PMCID: PMC2869391 DOI: 10.1038/npp.2010.24] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [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] [Indexed: 11/09/2022]
Abstract
Pregenual anterior cingulate cortex (pgACC) hyperactivity differentiates treatment responders from non-responders to various pharmacological antidepressant interventions, including ketamine, an N-methyl-D-aspartate receptor antagonist. Evidence of pgACC hyperactivition during non-emotional working memory tasks in patients with major depressive disorder (MDD) highlights the importance of this region for processing both emotionally salient and cognitive stimuli. However, it is unclear whether pgACC activity might serve as a potential biomarker of antidepressant response during working memory tasks as well, in line with previous research with emotionally arousing tasks. This study tested the hypothesis that during the N-back task, a widely used working memory paradigm, low pretreatment pgACC activity, as well as coherence between the pgACC and the amygdala, would be correlated with the clinical improvement after ketamine. Magnetoencephalography (MEG) recordings were obtained from 15 drug-free patients with MDD during working memory performance 1 to 3 days before receiving a single ketamine infusion. Functional activation patterns were analyzed using advanced MEG source analysis. Source coherence analyses were conducted to quantify the degree of long-range functional connectivity between the pgACC and the amygdala. Patients who showed the least engagement of the pgACC in response to increased working memory load showed the greatest symptomatic improvement within 4 h of ketamine administration (r=0.82, p=0.0002, false discovery rate (FDR) <0.05). Pretreatment functional connectivity between the pgACC and the left amygdala was negatively correlated with antidepressant symptom change (r=-0.73, p=0.0021, FDR <0.05).These data implicate the pgACC and its putative interaction with the amygdala in predicting antidepressant response to ketamine in a working memory task context.
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Affiliation(s)
- Giacomo Salvadore
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Brian R Cornwell
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Fabio Sambataro
- Gene, Cognition, and Psychosis Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - David Latov
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Veronica Colon-Rosario
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Frederick Carver
- Magnetoencephalography Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Tom Holroyd
- Magnetoencephalography Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Nancy DiazGranados
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Rodrigo Machado-Vieira
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Christian Grillon
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Wayne C Drevets
- Section of Neuroimaging in Mood and Anxiety Disorders, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Machado-Vieira R, Salvadore G, DiazGranados N, Ibrahim L, Latov D, Wheeler-Castillo C, Baumann J, Henter ID, Zarate CA. New therapeutic targets for mood disorders. ScientificWorldJournal 2010; 10:713-26. [PMID: 20419280 PMCID: PMC3035047 DOI: 10.1100/tsw.2010.65] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Existing pharmacological treatments for bipolar disorder (BPD) and major depressive disorder (MDD) are often insufficient for many patients. Here we describe a number of targets/compounds that clinical and preclinical studies suggest could result in putative novel treatments for mood disorders. These include: (1) glycogen synthase kinase-3 (GSK-3) and protein kinase C (PKC), (2) the purinergic system, (3) histone deacetylases (HDACs), (4) the melatonergic system, (5) the tachykinin neuropeptides system, (6) the glutamatergic system, and (7) oxidative stress and bioenergetics. The paper reviews data on new compounds that have shown antimanic or antidepressant effects in subjects with mood disorders, or similar effects in preclinical animal models. Overall, an improved understanding of the neurobiological underpinnings of mood disorders is critical in order to develop targeted treatments that are more effective, act more rapidly, and are better tolerated than currently available therapies.
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Affiliation(s)
- Rodrigo Machado-Vieira
- Experimental Therapeutics, Mood and Anxiety Disorders Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
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Machado-Vieira R, Baumann J, Wheeler-Castillo C, Latov D, Henter ID, Salvadore G, Zarate CA. The Timing of Antidepressant Effects: A Comparison of Diverse Pharmacological and Somatic Treatments. Pharmaceuticals (Basel) 2010; 3:19-41. [PMID: 27713241 PMCID: PMC3991019 DOI: 10.3390/ph3010019] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [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: 11/21/2009] [Revised: 12/17/2009] [Accepted: 12/29/2009] [Indexed: 02/01/2023] Open
Abstract
Currently available antidepressants used to treat major depressive disorder (MDD) unfortunately often take weeks to months to achieve their full effects, commonly resulting in considerable morbidity and increased risk for suicidal behavior. Our lack of understanding of the precise cellular underpinnings of this illness and of the mechanism of action of existing effective pharmacological treatments is a large part of the reason that therapies with a more rapid onset of antidepressant action (ROAA) have not been developed. Other issues that need to be addressed include heterogeneous clinical concepts and statistical models to measure rapid antidepressant effects. This review describes the timing of onset of antidepressant effects for various therapies used to treat MDD. While several agents produce earlier improvement of depressive symptoms (defined as occurring within one week), the response rate associated with such agents can be quite variable. These agents include both currently available antidepressants as well as other pharmacological and non-pharmacological interventions. Considerably fewer treatments are associated with ROAA, defined as occurring within several hours or one day. Treatment strategies for MDD whose sustained antidepressant effects manifest within hours or even a few days would have an enormous impact on public health.
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Affiliation(s)
- Rodrigo Machado-Vieira
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, and Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Jacqueline Baumann
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, and Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Cristina Wheeler-Castillo
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, and Department of Health and Human Services, Bethesda, MD 20892, USA
| | - David Latov
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, and Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Ioline D Henter
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, and Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Giacomo Salvadore
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, and Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Carlos A Zarate
- Experimental Therapeutics, Mood and Anxiety Disorders Program, National Institute of Mental Health, and Department of Health and Human Services, Bethesda, MD 20892, USA.
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Machado-Vieira R, Salvadore G, Ibrahim LA, Diaz-Granados N, Zarate CA. Targeting glutamatergic signaling for the development of novel therapeutics for mood disorders. Curr Pharm Des 2009; 15:1595-611. [PMID: 19442176 DOI: 10.2174/138161209788168010] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
There have been no recent advances in drug development for mood disorders in terms of identifying drug targets that are mechanistically distinct from existing ones. As a result, existing antidepressants are based on decades-old notions of which targets are relevant to the mechanisms of antidepressant action. Low rates of remission, a delay of onset of therapeutic effects, continual residual depressive symptoms, relapses, and poor quality of life are unfortunately common in patients with mood disorders. Offering alternative options is requisite in order to reduce the individual and societal burden of these diseases. The glutamatergic system is a promising area of research in mood disorders, and likely to offer new possibilities in therapeutics. There is increasing evidence that mood disorders are associated with impairments in neuroplasticity and cellular resilience, and alterations of the glutamatergic system are known to play a major role in cellular plasticity and resilience. Existing antidepressants and mood stabilizers have prominent effects on the glutamate system, and modulating glutamatergic ionotropic or metabotropic receptors results in antidepressant-like properties in animal models. Several glutamatergic modulators targeting various glutamate components are currently being studied in the treatment of mood disorders, including release inhibitors of glutamate, N-methyl-D-aspartate (NMDA) antagonists, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) throughput enhancers, and glutamate transporter enhancers. This paper reviews the currently available knowledge regarding the role of the glutamatergic system in the etiopathogenesis of mood disorders and putative glutamate modulators.
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Affiliation(s)
- Rodrigo Machado-Vieira
- Experimental Therapeutics, Mood and Anxiety Disorders Research Program, National Institute of Mental Health/NIH, 10 Center Drive, Bethesda, MD 20892, USA
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Machado-Vieira R, Salvadore G, Diazgranados N, Zarate CA. Ketamine and the next generation of antidepressants with a rapid onset of action. Pharmacol Ther 2009; 123:143-50. [PMID: 19397926 DOI: 10.1016/j.pharmthera.2009.02.010] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 02/23/2009] [Indexed: 12/28/2022]
Abstract
Existing treatments for major depressive disorder (MDD) usually take weeks to months to achieve their antidepressant effects, and a significant number of patients do not have adequate improvement even after months of treatment. In addition, increased risk of suicide attempts is a major public health concern during the first month of standard antidepressant therapy. Thus, improved therapeutics that can exert their antidepressant effects within hours or a few days of their administration are urgently needed, as is a better understanding of the presumed mechanisms associated with these rapid antidepressant effects. In this context, the N-methyl-D-aspartate (NMDA) antagonist ketamine has consistently shown antidepressant effects within a few hours of its administration. This makes it a valuable research tool to identify biomarkers of response in order to develop the next generation of fast-acting antidepressants. In this review, we describe clinical, electrophysiological, biochemical, and imaging correlates as relevant targets in the study of the antidepressant response associated with ketamine, and their implications for the development of novel, fast-acting antidepressants. We also review evidence that alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) to NMDA throughput may represent a convergent mechanism for the rapid antidepressant actions of ketamine. Overall, understanding the molecular basis of this work will likely lead to the ultimate development of improved therapeutics for MDD.
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Affiliation(s)
- Rodrigo Machado-Vieira
- Experimental Therapeutics Mood and Anxiety Disorders Program, National Institute of Mental Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Yuan P, Salvadore G, Li X, Zhang L, Du J, Chen G, Manji HK. Valproate activates the Notch3/c-FLIP signaling cascade: a strategy to attenuate white matter hyperintensities in bipolar disorder in late life? Bipolar Disord 2009; 11:256-69. [PMID: 19419383 PMCID: PMC2788821 DOI: 10.1111/j.1399-5618.2009.00675.x] [Citation(s) in RCA: 14] [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: 01/15/2023]
Abstract
OBJECTIVES Increased prevalence of deep white matter hyperintensities (DWMHs) has been consistently observed in patients with geriatric depression and bipolar disorder. DMWHs are associated with chronicity, disability, and poor quality of life. They are thought to be ischemic in their etiology and may be related to the underlying pathophysiology of mood disorders in the elderly. Notably, these lesions strikingly resemble radiological findings related to the cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephelopathy (CADASIL) syndrome. CADASIL arises from mutations in Notch3, resulting in impaired signaling via cellular Fas-associated death domain-like interleukin-1-beta-converting enzyme-inhibitory protein (c-FLIP) through an extracellular signal-regulated kinase (ERK)-dependent pathway. These signaling abnormalities have been postulated to underlie the progressive degeneration of vascular smooth muscle cells (VSMC). This study investigates the possibility that the anticonvulsant valproate (VPA), which robustly activates the ERK mitogen-activated protein kinase (MAPK) cascade, may exert cytoprotective effects on VSMC through the Notch3/c-FLIP pathway. METHODS Human VSMC were treated with therapeutic concentrations of VPA subchronically. c-FLIP was knocked down via small interfering ribonucleic acid transfection. Cell survival, apoptosis, and protein levels were measured. RESULTS VPA increased c-FLIP levels dose- and time-dependently and promoted VSMC survival in response to Fas ligand-induced apoptosis in VSMC. The anti-apoptotic effect of VPA was abolished by c-FLIP knockdown. VPA also produced similar in vivo effects in rat brain. CONCLUSIONS These results raise the intriguing possibility that VPA may be a novel therapeutic agent for the treatment of CADASIL and related disorders. They also suggest that VPA might decrease the liability of patients with late-life mood disorders to develop DWMHs.
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Affiliation(s)
- Peixiong Yuan
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Giacomo Salvadore
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Xiaoxia Li
- Department of Psychiatry, Uniformed Service University of Health Sciences, Bethesda, MD, USA
| | - Lei Zhang
- Department of Psychiatry, Uniformed Service University of Health Sciences, Bethesda, MD, USA
| | - Jing Du
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Guang Chen
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Husseini K Manji
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Salvadore G, Cornwell BR, Colon-Rosario V, Coppola R, Grillon C, Zarate CA, Manji HK. Increased anterior cingulate cortical activity in response to fearful faces: a neurophysiological biomarker that predicts rapid antidepressant response to ketamine. Biol Psychiatry 2009; 65:289-95. [PMID: 18822408 PMCID: PMC2643469 DOI: 10.1016/j.biopsych.2008.08.014] [Citation(s) in RCA: 187] [Impact Index Per Article: 12.5] [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: 05/06/2008] [Revised: 08/12/2008] [Accepted: 08/13/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most patients with major depressive disorder (MDD) experience a period of lengthy trial and error when trying to find optimal antidepressant treatment; identifying biomarkers that could predict response to antidepressant treatment would be of enormous benefit. We tested the hypothesis that pretreatment anterior cingulate cortex (ACC) activity could be a putative biomarker of rapid antidepressant response to ketamine, in line with previous findings that investigated the effects of conventional antidepressants. We also investigated patterns of ACC activity to rapid presentation of fearful faces compared with the normal habituation observed in healthy subjects. METHODS We elicited ACC activity in drug-free patients with MDD (n = 11) and healthy control subjects (n = 11) by rapidly presenting fearful faces, a paradigm known to activate rostral regions of the ACC. Spatial-filtering analyses were performed on magnetoencephalographic (MEG) recordings, which offer the temporal precision necessary to estimate ACC activity elicited by the rapid presentation of stimuli. Magnetoencephalographic recordings were obtained only once for both patients and control subjects. Patients were subsequently administered a single ketamine infusion followed by assessment of depressive symptoms 4 hours later. RESULTS Although healthy subjects had decreased neuromagnetic activity in the rostral ACC across repeated exposures, patients with MDD showed robust increases in pretreatment ACC activity. Notably, this increase was positively correlated with subsequent rapid antidepressant response to ketamine. Exploratory analyses showed that pretreatment amygdala activity was negatively correlated with change in depressive symptoms. CONCLUSIONS Pretreatment rostral ACC activation may be a useful biomarker that identifies a subgroup of patients who will respond favorably to ketamine's antidepressant effects.
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Affiliation(s)
- Giacomo Salvadore
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Brian R. Cornwell
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Veronica Colon-Rosario
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Richard Coppola
- Clinical Brain Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Christian Grillon
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Carlos A. Zarate
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Husseini K. Manji
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Abstract
Recent evidence has shown that early pharmacological and psychosocial treatment dramatically ameliorates poor prognosis and outcome for individuals with psychotic disorders, reducing conversion rates to full-blown illness and decreasing symptom severity. In a companion paper, we discussed methodological issues pertaining to early intervention in bipolar disorder (BPD), reviewed clinical studies that focus on high-risk subjects as well as first-episode patients, and reviewed findings from brain imaging studies in the offspring of individuals with BPD as well as in first-episode patients. In this paper, we discuss how drugs that modulate cellular and neural plasticity cascades are likely to benefit patients in the very early stages of BPD, because they target some of the core pathophysiological mechanisms of this devastating illness. Cellular and molecular mechanisms of action of agents with neurotrophic and neuroplastic properties are discussed, with a particular emphasis on lithium and valproate. We also discuss their potential use as early intervention strategies for improving symptoms and functioning in patients in the earliest stages of BPD, as well as high-risk individuals.
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Affiliation(s)
- Giacomo Salvadore
- Mood and Anxiety Disorders Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
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Abstract
The concept of prevention is not new to psychiatry and has long been recognized in general medicine. Recent evidence has highlighted that early pharmacological and psychosocial treatment dramatically ameliorates poor prognosis and outcome for individuals with psychotic disorders, reducing conversion rates to full-blown illness and decreasing symptom severity. Nevertheless, despite the many recent advances in our thinking about early intervention, the need for early intervention in bipolar disorder (BPD) is an area that has been relatively neglected. This review attempts to synthesize what is currently known about early intervention in BPD. We discuss methodological issues pertaining to this topic, review clinical studies that focus on high-risk subjects as well as first-episode patients and review findings from brain imaging studies in the offspring of individuals with BPD as well as in first-episode patients. A companion paper discusses the cellular and molecular mechanisms of action of agents with neurotrophic and neuroplastic properties, with a particular emphasis on lithium and valproate.
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Affiliation(s)
- Giacomo Salvadore
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
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Machado-Vieira R, Salvadore G, Luckenbaugh DA, Manji HK, Zarate CA. Rapid onset of antidepressant action: a new paradigm in the research and treatment of major depressive disorder. J Clin Psychiatry 2008; 69:946-58. [PMID: 18435563 PMCID: PMC2699451 DOI: 10.4088/jcp.v69n0610] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Current therapeutics of depression are similar in their time to antidepressant action and often take weeks to months to achieve response and remission, which commonly results in considerable morbidity and disruption in personal, professional, family, and social life, as well as risk for suicidal behavior. Thus, treatment strategies presenting a rapid improvement of depressive symptoms--within hours or even a few days--and whose effects are sustained would have an enormous impact on public health. This article reviews the published data related to different aspects of rapid improvement of depressive symptoms. DATA SOURCES Literature for this review was obtained through a search of the MEDLINE database (1966-2007) using the following keywords and phrases: rapid response, antidepressant, time to, glutamate, sleep, therapeutics, latency, and depression. The data obtained were organized according to the following topics: clinical relevance and time course of antidepressant action, interventions showing evidence of rapid response and its potential neurobiological basis, and new technologies for better understanding rapid anti-depressant actions. DATA SYNTHESIS A limited number of prospective studies evaluating rapid antidepressant actions have been conducted. Currently, only a few interventions have been shown to produce antidepressant response in hours or a few days. The neurobiological basis of these rapid antidepressant actions is only now being deciphered. CONCLUSIONS Certain experimental treatments can produce antidepressant response in a much shorter period of time than existing medications. Understanding the molecular basis of these experimental interventions is likely to lead to the development of improved therapeutics rather than simply furthering our knowledge of current standard antidepressants.
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