Les antagonistes du récepteur N-méthyl-D-aspartate (NMDA) comme la kétamine, le dextrométhorphane et la mémantine sont utilisés pour la prise en charge de la douleur neuropathique. La kétamine est très efficace contre les douleurs neuropathiques réfractaires aux traitements conventionnels. Cependant, son utilisation est limitée du fait de nombreux effets indésirables. Un relais antalgique est alors proposé. Ce travail de thèse s’insère dans un programme de recherche dédié aux antagonistes du récepteur NMDA dans la prise en charge de la douleur neuropathique. Le premier objectif était d’évaluer dans une étude clinique randomisée, en simple insu, en groupes parallèles, contrôlée versus placebo, les effets antalgiques du dextrométhorphane et de la mémantine, administrés en relais de la kétamine chez 60 patients souffrant de douleurs neuropathiques d’origine périphérique. L’impact de ces traitements sur le statut cognitivo-émotionnel des patients et leur qualité de vie a également été examiné, ainsi que la modulation des effets de ces médicaments par le polymorphisme génétique impliqué dans le métabolisme (CYP2D6, CYP3A4,5), la biodisponibilité et l’élimination (NR1I2) de ces deux molécules. En parallèle une étude mécanistique centrée sur le dextrométhorphane a été réalisée chez vingt volontaires sains (étude randomisée, en double aveugle, en groupes croisés). L’objectif était d’étudier dans un modèle d’hyperalgie induite par le froid « Freeze injury » les caractéristiques pharmacologiques et mécanistiques déterminant les effets anti-nociceptifs, centraux et cognitifs du dextrométhorphane ainsi que le polymorphisme génétique impliqué dans leur modulation. Chez les patients, les effets antalgiques immédiats de la kétamine ont été confirmés et s’accompagnaient de l’amélioration des scores d’anxiété et de dépression, des aspects cognitifs et affectifs et du sommeil. Toutefois, par rapport au placebo, la mémantine et le dextrométhorphane n’ont pas permis de renforcer significativement l’antalgie induite par la kétamine. Chez les volontaires sains, le dextrométhorphane a révélé des effets anti-hyperalgiques suite à une sensibilisation périphérique et centrale. Cependant, aucun effet analgésique sur la douleur thermique aiguë n’a été observé. Ces deux approches clinique et mécanistique concernant l’effet curatif des antagonistes du récepteur NMDA ont permis d’une part de montrer : 1 - chez le patient, l’effet curatif prolongé de la kétamine et l’intérêt du dextrométhorphane et de la mémantine dans la prise en charge du retentissement négatif de la douleur neuropathique sur le statut cognitivo-émotionnel et la qualité de vie des patients; 2 - chez le volontaire sain, l’efficacité anti-hyperalgique du dextrométhorphane sur les phénomènes de sensibilisation périphérique et centrale ainsi que ses répercussions sédatives et cognitives. En complément de ces deux études et dans le but de confirmer en clinique les effets curatifs du dextrométhorphane sur le triptyque douleur-cognition-émotion, une étude clinique randomisée, en double aveugle, en groupes parallèles, contrôlée versus placebo est en cours de réalisation chez 40 patientes souffrant de douleur neuropathique chimio-induite subséquente au traitement du cancer du sein. En conclusion de ce travail de thèse, l’étude des effets du dextrométhorphane dans deux populations différentes souligne l’intérêt de la recherche translationnelle. Chez le sujet volontaire sain, le dextrométhorphane exerce un effet anti-hyperalgique marqué et provoque des effets centraux délétères. Chez le patient présentant une douleur neuropathique d’origine périphérique et étant répondeur à la kétamine, seule une tendance est observée en faveur de l’effet anti-nociceptif du dextrométhorphane donné en relais de la kétamine. En revanche l’administration de dextrométhorphane s’accompagne d’un certain bénéfice au niveau cognitif et sur la qualité de vie des patients. / N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine, dextromethorphan and memantine have gained an increasing interest in the management of neuropathic pain. In Pain Clinics, ketamine is widely used in the relief of neuropathic pain. However, its use in clinical practice is limited due to its numerous side effects. It is therefore necessary to propose to patients a drug relay with other NMDA receptor antagonists. This work is part of an academic program research dedicated to NMDA receptor antagonists in the management of neuropathic pain. Its first objective was to evaluate the antalgic effects of dextromethorphan and memantine. This randomized, single-blind, parallel-group, placebo-controlled study in 60 ketamine responder patients aimed also to assess the cognitive-emotional status of patients and their quality life. In parallel, a mechanistic study focusing on dextromethorphan was performed in 20 healthy volunteers in a randomized, double-blind, cross-over, placebo-controlled study. The objective was to investigate in a freeze-injury model the pharmacokinetic and mechanistic characteristics of the anti-nociceptive, central and cognitive effects of dextromethorphan as well as the genetic polymorphism involved in its response variability.In patients, the immediate analgesic effects of ketamine were confirmed with improved anxiety and depression scores, cognitive and affective aspects of pain, and different sleep parameters. However, memantine and dextromethorphan, compared to placebo, did not significantly increase the ketamine-induced analgesia. The analysis of the genetic polymorphism did not reveal any variability in the analgesic efficacy of these treatments. In healthy volunteers, dextromethorphan revealed anti-hyperalgesic effects following peripheral and central sensitization but no analgesic effect on acute heat pain. Moreover, the variability of the anti-nociceptive activity of dextromethorphan described in the literature seems to be more related to the genetic polymorphism of the CYP2D6 gene than to that of the CYP3A4,5 and ABCB1 genes. Finally, dextrorphan, the main active metabolite of dextromethorphan, appears to be responsible for the deleterious sedative and cognitive effects of the drug. These two clinical and mechanistic approaches concerning the curative effect of the NMDA receptor antagonists showed : 1 - in patients, the prolonged curative effect of ketamine and the interest of dextromethorphan and memantine in the management of the neuropathic pain-related cognitive-emotional and quality of life impairment; 2 - in healthy volunteers, the anti-hyperalgesic efficacy of dextromethorphan on peripheral and central sensitization and its sedative and cognitive side effects. In addition to these two studies, a randomized, double-blind, parallel-group, placebo-controlled clinical study is ongoing in 40 patients with chemotherapy-induced peripheral neuropathic pain subsequently to the treatment of breast cancer. In conclusion the assessment of the effects of dextromethorphan in two different populations led to discordant results. In the healthy volunteer, dextromethorphan exerts a marked anti-hyperalgesic effect and causes deleterious central effects. In the patient with peripheral neuropathic pain, only a trend is observed in favor of the anti-nociceptive effect of dextromethorphan given in ketamine responder patients. More studies with larger population are needed to determine the importance of the CYP2D6, CYP3A4,5 and ABCB1 genetic polymorphisms on the anti-nociceptive activity of dextromethorphan. The translational approach of this thesis does not allow a firm conclusion on the clinical use of dextromethorphan in the curative treatment of chronic peripheral neuropathic pain. The use of dextromethorphan as a preventive agent via other administration routes (i.e. local) or in combination with other drugs, all require further exploration in order to improve the benefit/risk ratio of this molecule.

>Magister Scientiae - MSc / This study focused on the synthesis of a series of novel tricycloundecane derivatives and evaluation of these compounds for neuroprotection using the fluorescent ratiometric calcium assay that indicates the ability of the test compounds to inhibit NMDA receptors and VGCC. The cycloaddition reaction between p-benzoquinone and monomerised dicyclopentadiene yielded tricycloundeca- 4,9-diene-3,6-dione which was used as the base structure and further derivatised. These derivatives were conjugated with benzylamine to form a series of imines and amines. A total of 10 compounds were synthesised for evaluation of inhibition of calcium influx through NMDA receptor channels and voltage-gated calcium channels. The structures were confirmed using NMR, IR and MS. On the proton NMR, the characteristic AB-quartet system was observed in the region of 1-2 ppm for all the compounds and the aromatic moiety was observed between 6.5-7.5 ppm for the novel polycyclic amines. These, with other functional groups, were used to confirm the individual structures

<p>The interest for the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis and its role in the central nervous system (CNS) has grown during the past decade. GH has been associated with psychological functions as sleep, mood, general well-being and learning and memory. The present thesis is a contribution to clarify the functions and mechanisms involved in the actions of GH and IGF-1 in the CNS. A variant of the GH receptor (GHR) gene transcript lacking exon 3 (GHR3-) was cloned from ovine choroid plexus epithelial cells and tissue. The GHR3- transcript has previously only been identified in human tissue. Further, an anatomical study of the localization of GHR mRNA in the rat brain stem and spinal cord was carried out by the use of in situ hybridization. High densities of GHRs were found in areas associated with the regulation of food intake, sleep and nociception, functions known to be influenced by the GH/IGF-1 axis. The interaction with the opioid system was studied by an acute treatment with morphine. The levels of the transcripts for GHR and GHBP in the rat hippocampus and spinal cord were decreased 4 h after the injection of the opiate and restored to normal levels after 24 h. Young and aged rats injected with GH or IGF-1 showed differential gene regulation of subunits of the NMDA subtype of glutamate receptor in the hippocampus. This indicates an age-related difference in the sensitivity to GH/IGF-1 mediated effects on memory functions. Moreover, hypophysectomized rats treated with GH showed improved performance in the Morris water maze, a spatial memory task. The effect was accompanied with an increase in transcripts for NMDA receptor subunits and its associated membrane anchoring PSD-95 protein. Taken together, the results suggest that GH and/or IGF-1 play important roles in mechanisms associated with cognitive functions.</p>

The interest for the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis and its role in the central nervous system (CNS) has grown during the past decade. GH has been associated with psychological functions as sleep, mood, general well-being and learning and memory. The present thesis is a contribution to clarify the functions and mechanisms involved in the actions of GH and IGF-1 in the CNS. A variant of the GH receptor (GHR) gene transcript lacking exon 3 (GHR3-) was cloned from ovine choroid plexus epithelial cells and tissue. The GHR3- transcript has previously only been identified in human tissue. Further, an anatomical study of the localization of GHR mRNA in the rat brain stem and spinal cord was carried out by the use of in situ hybridization. High densities of GHRs were found in areas associated with the regulation of food intake, sleep and nociception, functions known to be influenced by the GH/IGF-1 axis. The interaction with the opioid system was studied by an acute treatment with morphine. The levels of the transcripts for GHR and GHBP in the rat hippocampus and spinal cord were decreased 4 h after the injection of the opiate and restored to normal levels after 24 h. Young and aged rats injected with GH or IGF-1 showed differential gene regulation of subunits of the NMDA subtype of glutamate receptor in the hippocampus. This indicates an age-related difference in the sensitivity to GH/IGF-1 mediated effects on memory functions. Moreover, hypophysectomized rats treated with GH showed improved performance in the Morris water maze, a spatial memory task. The effect was accompanied with an increase in transcripts for NMDA receptor subunits and its associated membrane anchoring PSD-95 protein. Taken together, the results suggest that GH and/or IGF-1 play important roles in mechanisms associated with cognitive functions.

Les récepteurs glutamatergiques de type N-Méthyl-D-Aspartate (RNMDA) jouent un rôle majeur dans de nombreux processus physiologiques, et leur implication dans la physiopathologie de certains troubles neuropsychiatriques tels que la schizophrénie est suggérée par un robuste faisceau de données cliniques et précliniques. Cependant, les mécanismes cellulaires et moléculaires conduisant à une telle dérégulation des RNMDA restent inexpliqués. La diffusion membranaire, mécanisme de contrôle spatial et temporel de la distribution des RNMDA à la surface des neurones, constitue un puissant régulateur de la transmission synaptique. Mon projet de thèse repose ainsi sur l’hypothèse originale qu’une altération de la diffusion de surface des RNMDA jouerait un rôle central dans l’émergence de troubles psychotiques. Afin d‘explorer cette piste, j’ai étudié l’impact de molécules aux propriétés psychomimétiques (i.e induisant un état psychotique) sur la diffusion de surface des RNMDA. Les résultats obtenus au cours de ma thèse démontrent que des molécules psychomimétiques, aux modes d’action distincts (antagonistes du RNMDA et autoanticorps anti-RNMDA), perturbent la diffusion membranaire ainsi que la localisation synaptique des RNMDA, conduisant à terme à des défauts de transmission glutamatergique. Mon travail de thèse propose donc qu’un défaut de diffusion membranaire des RNMDA conduirait à des altérations fonctionnelles pouvant contribuer à l’émergence de troubles psychotiques. L’ensemble de mon travail apporte ainsi un regard nouveau sur la mécanistique des troubles psychotiques et ouvre la voie à de nouvelles pistes thérapeutiques. / Glutamatergic N-Methyl-D-Aspartate receptors (NMDAR) play a key role in many physiological processes, and their implication in the pathophysiology of several neuropsychiatric disorders is now well established. Multiple lines of evidence converge towards a dysregulation of the NMDAR in psychotic disorders such as schizophrenia (SCZ). However, the molecular and cellular deficits underlying NMDAR dysfunction remain misunderstood. By tightly controlling NMDAR synaptic localization, surface trafficking represents a powerful regulator of synaptic transmission. Could an alteration of NMDAR surface trafficking underlie NMDAR dysfunction and contribute to the emergence of psychotic disorders? To tackle this question, my PhD project aimed at investigating the impact of different psychotomimetic molecules on NMDAR surface trafficking. In the first part of my project, I explored the impact of NMDAR autoantibodies (NMDAR-Ab) from SCZ and healthy subjects. My results revealed that NMDAR-Ab from SCZ patients rapidly disturb NMDAR synaptic trafficking and distribution, through a loss of NMDAR-EphrinB2 receptor interaction, eventually preventing the induction of synaptic plasticity. In the second part of my PhD project, I showed that psychotomimetic NMDAR antagonists also alter NMDAR synaptic mobility and localization. Downregulation of PSD proteins expression prevented NMDAR antagonists-induced deficits, suggesting that such alterations ensue from modifications of NMDAR intracellular interactions. Taken together, these results demonstrate that psychotomimetic molecules profoundly impact NMDAR surface trafficking, supporting a pathogenic role of this unsuspected process in the emergence of psychotic symptoms.

Nos últimos anos, houve um aumento significativo no uso abusivo dos Esteróides Anabólicos Andrógenos (EAAs). Um dos efeitos comportamentais mais marcantes da administração crônica de EAAs como o Decanoato de Nandrolona (DN) é a indução do comportamento agressivo exacerbado. Atualmente o sistema glutamatérgico tem sido associado ao comportamento agressivo induzido pelos EAAs, principalmente no que se refere à modulação dos receptores N-Methyl-D-Aspartato NMDA (NMDAr). Nós investigamos os efeitos centrais e periféricos da administração do DN ao longo do tempo (4, 11 e 19 dias consecutivos de administração), e a participação de mecanismos glutamatérgicos. Para isso, camundongos CF-1 tratados com DN foram avaliados em relação ao comportamento agressivo pelo teste do intruso. Além disso, investigamos a captação de glutamato, o imunoconteúdo de GLT-1, os níveis de glutamato no líquido extracelular, e a participação dos NMDAr na manifestação do comportamento agressivo. O fenótipo agressivo foi evidenciado somente no longo tempo de exposição à DN (19 dias). Na mesma janela temporal que os animais apresentaram o fenótipo agressivo houve redução significativa de captação de glutamato em fatias cerebrais de córtex e hipocampo, como também a redução do imunoconteúdo do transportador astrocitário GLT-1 nas mesmas estruturas cerebrais. A administração de antagonistas de NMDAr como MK-801 e memantina antes do teste do intruso diminuiu o comportamento agressivo dos animais tratados cronicamente com DN a níveis iguais aos do grupo controle. Ainda, o comportamento agressivo induzido pela administração crônica de DN diminuiu a remoção do glutamato da fenda sináptica, culminando com o aumento do glutamato extracelular no SNC, o que resultou na hiperexcitabilidade dos NMDAr. Este trabalho enfatiza o papel da comunicação entre astrócitos e neurônios e a relevância da hiperstimulação de NMDAr na manifestação do comportamento agressivo. / Nandrolone decanoate (ND), an anabolic androgenic steroid (AAS), induces an aggressive phenotype by mechanisms involving glutamate-induced N-methyl-d-aspartate receptor (NMDAr) hyperexcitability. The astrocytic glutamate transporters remove excessive glutamate surrounding the synapse. However, the impact of supraphysiological doses of ND on glutamate transporters activity remains elusive. We investigated whether ND-induced aggressive behavior is correlated with GLT-1 activity, glutamate levels and abnormal NMDAr responses. Two-month-old untreated male mice (CF1, n=20) were tested for baseline aggressive behavior in the resident-intruder test. Another group of mice (n=188) was injected with ND (15mg/kg) or vehicle for 4, 11 and 19 days (short-, mid- and long-term endpoints, respectively) and was evaluated in the resident-intruder test. Each endpoint was assessed for GLT-1 expression and glutamate uptake activity in the frontoparietal cortex and hippocampal tissues. Only the long-term ND endpoint significantly decreased the latency to first attack and increased the number of attacks, which was associated with decreased GLT-1 expression and glutamate uptake activity in both brain areas. These alterations may affect extracellular glutamate levels and receptor excitability. Resident males were assessed for hippocampal glutamate levels via microdialysis both prior to, and following, the introduction of intruders. Long-term ND mice displayed significant increases in the microdialysate glutamate levels only after exposure to intruders. A single intraperitoneal dose of NMDAr antagonists, memantine or MK-801, shortly before the intruder test, decreased aggressive behavior. In summary, long-term ND-induced aggressive behavior is associated with decreased extracellular glutamate clearance and NMDAr hyperexcitability, emphasizing the role of this receptor in mediating aggression mechanisms.

Nos últimos anos, houve um aumento significativo no uso abusivo dos Esteróides Anabólicos Andrógenos (EAAs). Um dos efeitos comportamentais mais marcantes da administração crônica de EAAs como o Decanoato de Nandrolona (DN) é a indução do comportamento agressivo exacerbado. Atualmente o sistema glutamatérgico tem sido associado ao comportamento agressivo induzido pelos EAAs, principalmente no que se refere à modulação dos receptores N-Methyl-D-Aspartato NMDA (NMDAr). Nós investigamos os efeitos centrais e periféricos da administração do DN ao longo do tempo (4, 11 e 19 dias consecutivos de administração), e a participação de mecanismos glutamatérgicos. Para isso, camundongos CF-1 tratados com DN foram avaliados em relação ao comportamento agressivo pelo teste do intruso. Além disso, investigamos a captação de glutamato, o imunoconteúdo de GLT-1, os níveis de glutamato no líquido extracelular, e a participação dos NMDAr na manifestação do comportamento agressivo. O fenótipo agressivo foi evidenciado somente no longo tempo de exposição à DN (19 dias). Na mesma janela temporal que os animais apresentaram o fenótipo agressivo houve redução significativa de captação de glutamato em fatias cerebrais de córtex e hipocampo, como também a redução do imunoconteúdo do transportador astrocitário GLT-1 nas mesmas estruturas cerebrais. A administração de antagonistas de NMDAr como MK-801 e memantina antes do teste do intruso diminuiu o comportamento agressivo dos animais tratados cronicamente com DN a níveis iguais aos do grupo controle. Ainda, o comportamento agressivo induzido pela administração crônica de DN diminuiu a remoção do glutamato da fenda sináptica, culminando com o aumento do glutamato extracelular no SNC, o que resultou na hiperexcitabilidade dos NMDAr. Este trabalho enfatiza o papel da comunicação entre astrócitos e neurônios e a relevância da hiperstimulação de NMDAr na manifestação do comportamento agressivo. / Nandrolone decanoate (ND), an anabolic androgenic steroid (AAS), induces an aggressive phenotype by mechanisms involving glutamate-induced N-methyl-d-aspartate receptor (NMDAr) hyperexcitability. The astrocytic glutamate transporters remove excessive glutamate surrounding the synapse. However, the impact of supraphysiological doses of ND on glutamate transporters activity remains elusive. We investigated whether ND-induced aggressive behavior is correlated with GLT-1 activity, glutamate levels and abnormal NMDAr responses. Two-month-old untreated male mice (CF1, n=20) were tested for baseline aggressive behavior in the resident-intruder test. Another group of mice (n=188) was injected with ND (15mg/kg) or vehicle for 4, 11 and 19 days (short-, mid- and long-term endpoints, respectively) and was evaluated in the resident-intruder test. Each endpoint was assessed for GLT-1 expression and glutamate uptake activity in the frontoparietal cortex and hippocampal tissues. Only the long-term ND endpoint significantly decreased the latency to first attack and increased the number of attacks, which was associated with decreased GLT-1 expression and glutamate uptake activity in both brain areas. These alterations may affect extracellular glutamate levels and receptor excitability. Resident males were assessed for hippocampal glutamate levels via microdialysis both prior to, and following, the introduction of intruders. Long-term ND mice displayed significant increases in the microdialysate glutamate levels only after exposure to intruders. A single intraperitoneal dose of NMDAr antagonists, memantine or MK-801, shortly before the intruder test, decreased aggressive behavior. In summary, long-term ND-induced aggressive behavior is associated with decreased extracellular glutamate clearance and NMDAr hyperexcitability, emphasizing the role of this receptor in mediating aggression mechanisms.

Nos últimos anos, houve um aumento significativo no uso abusivo dos Esteróides Anabólicos Andrógenos (EAAs). Um dos efeitos comportamentais mais marcantes da administração crônica de EAAs como o Decanoato de Nandrolona (DN) é a indução do comportamento agressivo exacerbado. Atualmente o sistema glutamatérgico tem sido associado ao comportamento agressivo induzido pelos EAAs, principalmente no que se refere à modulação dos receptores N-Methyl-D-Aspartato NMDA (NMDAr). Nós investigamos os efeitos centrais e periféricos da administração do DN ao longo do tempo (4, 11 e 19 dias consecutivos de administração), e a participação de mecanismos glutamatérgicos. Para isso, camundongos CF-1 tratados com DN foram avaliados em relação ao comportamento agressivo pelo teste do intruso. Além disso, investigamos a captação de glutamato, o imunoconteúdo de GLT-1, os níveis de glutamato no líquido extracelular, e a participação dos NMDAr na manifestação do comportamento agressivo. O fenótipo agressivo foi evidenciado somente no longo tempo de exposição à DN (19 dias). Na mesma janela temporal que os animais apresentaram o fenótipo agressivo houve redução significativa de captação de glutamato em fatias cerebrais de córtex e hipocampo, como também a redução do imunoconteúdo do transportador astrocitário GLT-1 nas mesmas estruturas cerebrais. A administração de antagonistas de NMDAr como MK-801 e memantina antes do teste do intruso diminuiu o comportamento agressivo dos animais tratados cronicamente com DN a níveis iguais aos do grupo controle. Ainda, o comportamento agressivo induzido pela administração crônica de DN diminuiu a remoção do glutamato da fenda sináptica, culminando com o aumento do glutamato extracelular no SNC, o que resultou na hiperexcitabilidade dos NMDAr. Este trabalho enfatiza o papel da comunicação entre astrócitos e neurônios e a relevância da hiperstimulação de NMDAr na manifestação do comportamento agressivo. / Nandrolone decanoate (ND), an anabolic androgenic steroid (AAS), induces an aggressive phenotype by mechanisms involving glutamate-induced N-methyl-d-aspartate receptor (NMDAr) hyperexcitability. The astrocytic glutamate transporters remove excessive glutamate surrounding the synapse. However, the impact of supraphysiological doses of ND on glutamate transporters activity remains elusive. We investigated whether ND-induced aggressive behavior is correlated with GLT-1 activity, glutamate levels and abnormal NMDAr responses. Two-month-old untreated male mice (CF1, n=20) were tested for baseline aggressive behavior in the resident-intruder test. Another group of mice (n=188) was injected with ND (15mg/kg) or vehicle for 4, 11 and 19 days (short-, mid- and long-term endpoints, respectively) and was evaluated in the resident-intruder test. Each endpoint was assessed for GLT-1 expression and glutamate uptake activity in the frontoparietal cortex and hippocampal tissues. Only the long-term ND endpoint significantly decreased the latency to first attack and increased the number of attacks, which was associated with decreased GLT-1 expression and glutamate uptake activity in both brain areas. These alterations may affect extracellular glutamate levels and receptor excitability. Resident males were assessed for hippocampal glutamate levels via microdialysis both prior to, and following, the introduction of intruders. Long-term ND mice displayed significant increases in the microdialysate glutamate levels only after exposure to intruders. A single intraperitoneal dose of NMDAr antagonists, memantine or MK-801, shortly before the intruder test, decreased aggressive behavior. In summary, long-term ND-induced aggressive behavior is associated with decreased extracellular glutamate clearance and NMDAr hyperexcitability, emphasizing the role of this receptor in mediating aggression mechanisms.

The N-methyl-D-aspartate receptor (NMDAR) hypofunctional hypothesis is believed to explain one of the contributing factors to schizophrenia. This hypothesis suggests the dysregulation of NMDAR, a protein responsible for receiving signals from the synapses between neurons, is the cause of some of the symptoms seen in schizophrenia. The post synaptic density protein 95 (PSD95) uses its PDZ-domains to help facilitate the received signal from NMDAR to α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) which in turn transmits the signal through the neuron. One way to increase the function of NMDAR could be to increase its affinity towards PDZ-domains of PSD95 using a small molecule. Fragment based drug design (FBDD) is one way to screen for molecules that modulates the NMDAR-PDZ interaction. This work describes the development of differential scanning fluorimetry (DSF) and surface plasmon resonance (SPR) assays using a fusion protein to screen for molecules that potentiate the interaction between NMDAR and AMPAR as well as methods assisting in the prioritization of hits based on both affinity, selectivity, and mechanism. The developed assays were used to screen a library containing 768 compounds. Screen positives and other compounds of interest were triaged and evaluated based on affinity, selectivity, and ability to modulated peptide binding resulting in eight confirmed hits that interacts with the two PDZ-domains of PSD95 investigated. As part of this work, the dissociation constant (KD) was determined for a panel of peptides representing versions of the truncated NMDAR GluN2b-subunit C-terminal towards PDZ1 and 2 of PSD95.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal. / Hepatic encephalopathy (HE) is a neuropsychiatric disorder occurring in both acute and chronic liver diseases. Depending on the duration and degree of hepatic dysfunction, HE may be present as one of two major types; portal-systemic encephalopathy (PSE) (chronic liver failure) and fulminant hepatic failure (FHF) (acute liver failure). Hyperammonemia is a key feature of both PSE and FHF and it is strongly suggested that ammonia toxicity is implicated directly or indirectly in the pathogenesis of both forms of HE. The present thesis comprises 5 articles demonstrating various aspects of the pathophysiology and new approaches to the treatment of HE. In chapter 2.1; article 1, using in vivo microdialysis, brain extracellular glutamate levels were found to be increased in correlation with arterial ammonia levels and the degree of neurological impairment in rats with FHF due to liver devascularization. N-methyl-D-aspartate (NMDA) receptor binding was found to be unchanged in rats with liver devascularization compared to control rats. Treatments for both forms of HE continue to focus on ammonia-lowering strategies. When administered to portacaval shunted (PCS) rats, L-ornithine-Laspartate (OA), two substrates of the urea cycle, was observed to result in a lowering of plasma ammonia and increased plasma urea levels as well as protection against ammonia-induced coma (chapter 2.2; article 2). In acute liver failure, peripheral ammonia is removed via muscle glutamine synthetase (GS). This was confirmed in the study (chapter 2.3; article 3) in rats with liver devascularization where OA also lowered plasma ammonia and protected rats against coma and brain edema. GS activity in muscle was increased following OA treatment. Mild hypothermia was shown to be protective against coma and brain edema in rats with liver devascularization (chapter 2.5; article 5). In mildly hypothermie rats, plasma ammonia levels were unaffected whereas cerebrospinal fluid (CSF) ammonia levels were lowered suggesting that hypothermia prevents increased ammonia uptake into brain. This protective effect was associated with a decrease in extracellular brain glutamate levels, supporting the proposal that glutamate may be implicated in the pathogenesis of brain edema in FHF. Although the precise pathophysiologic mechanisms responsible for HE in FHF are not completely understood, an increased glutamatergic neurotransmission could contribute to this phenomenon. Another potential neurotoxin, manganese, is believed to be implicated in the pathogenesis of PSE. Manganese levels were found to be increased in both autopsied brain tissue from patients and in brain tissue from experimental animal models of PSE (chapter 2.4; article 4). It is suggested that manganese deposition is responsible for the signal hyperintensities on T1-weighted magnetic resonance (MR) images and the extrapyramidal symptoms found in PSE. / L'encéphalopathie hépatique (EH) est un désordre neuropsychiatrique que l'on retrouve soit dans la période aiguë ou la phase chronique d'une maladie du foie. Ainsi, selon la durée de l'atteinte hépatique, l'EH peut se présenter de 2 façons : la première étant l'encéphalopathie porto-systémique et la seconde l'encéphalopathie rencontrée au cours des hépatites fulminantes. L'encéphalopathie porto-systémique est secondaire à la dérivation portosystémique du sang veineux tel que rencontré spontanément lors de l'hypertension portale ou soit suite à une anastomose portocave chirurgicale ou radiologique (shunt intra-hépatique porto systémique transjugulaire ou TIPS). Cliniquement, l'EH portosystémique est un syndrome neurologique qui se développe lentement; le stade précoce est souvent peu apparent et se caractérise par des modifications du cycle du sommeil ainsi que des changements mineurs de personnalité. Une baisse du niveau d’attention ainsi qu'une incoordination musculaire apparaissent ensuite, progressant lentement vers la léthargie, la stupeur et le coma. Du point de vue anatomopathologique, l'EH porto-systémique est caractérisée par une astrocytose sans évidence d'altérations neuronales structurelles. L'hyperammonémie est une caractéristique importante de l'EH portosystémique et de l'encéphalopathie aiguë des hépatites fulminantes. Il est admis que l'ammoniaque est impliquée directement et/ou indirectement dans la pathogénèse dans ces deux types d'EH. À forte concentration, l'ammoniaque a le potentiel d'affecter le système nerveux central de diverses façons. Il y a d'abord un effet direct de l'ion ammonium sur la neurotransmission inhibitrice ou excitatrice ainsi qu'une inhibition de l'enzyme a-cétoglutarate déshydrogénase dans le cycle de Krebs, ce qui a comme conséquence directe d'altérer le métabolisme énergétique du cerveau. Cependant, le métabolisme énergétique du cerveau ne semble affecté que dans les stades très avancés de l'EH porto-systémique ou d'encéphalopathie aiguë des hépatites fulminantes. L'insuffisance hépatique chronique se traduit par une augmentation des concentrations de manganèse dans le sang et le cerveau. Une sélectivité des dépôts de manganèse est l'hypothèse la plus probable afin d'expliquer les signaux hyperintenses localisés dans le pallidum tel que démontré par l'imagerie par résonance magnétique chez les patients cirrhotiques. La section 2.5 démontre que les dépôts de manganèse sont augmentés dans les globus pallidus prélevés à partir d’autopsie du tissu cérébral chez des patients cirrhotiques. La concentration de manganèse est aussi élevée dans le globus pallidus dans deux modèles animaux d'insuffisance hépatique chronique. De plus, une corrélation a été établie entre le degré de dérivation porto-systémique et la quantité de dépôts de manganèse. Au contraire, le manganèse cérébral n'est pas augmenté dans un modèle animal d'hépatite fulminante, ce qui suggère que l'accumulation découle de l'insuffisance hépatique chronique, plus particulièrement suite à une dérivation porto-systémique. L'EH est caractérisée par des perturbations de plusieurs systèmes de neurotransmission cérébrale. Le système glutamatergique est celui qui a été le plus étudié et on croit qu'il est impliqué dans la pathogénèse de l'EH. Des nouveaux traitements sont requis pour traiter ou stabiliser l'EH chez les patients atteints d'EH porto-systémique ou d'encéphalopathie aiguë afin d'augmenter la période de temps nécessaire pour pouvoir effectuer une transplantation. Les traitements actuels sont soit inefficaces ou comportent des effets secondaires très néfastes. Afin de traiter l'EH porto-systémique, on préconise comme thérapie des stratégies axées sur la diminution de l'ammoniaque sérique. La L-ornithine-L-aspartate (OA) est composée de deux substrats du cycle de l'urée qui se sont avérés efficaces pour réduire l'ammoniaque et améliorer les symptômes cliniques chez des patients hyperammonémiques ayant une EH portosystémique. Nous avons démontré un effet protecteur de l'OA sur le coma précipité par une infusion d'ammoniaque chez des rats ayant une dérivation porto-cave. L'effet protecteur s'accompagne d'une réduction significative de l'ammoniaque plasmatique ainsi que d'une augmentation significative de l'urée plasmatique, ce qui suggère que la réduction de la concentration plasmatique de l'ammoniaque est en partie le résultat d'une augmentation de la synthèse d'urée par le foie. Nous croyons aussi que l'OA peut, par l'intermédiaire des transaminases, mener à la production de trois molécules de glutamate. Ce substrat (le glutamate) peut ensuite stimuler l'activité de la glutamine synthétase dans les muscles, le foie et le cerveau pour ainsi former de la glutamine. Cette possibilité est soutenue par l'augmentation du glutamate et de la glutamine dans le plasma et le liquide céphalo-rachidien (LCR). Contrairement à l'EH porto-systémique, l’insuffisance hépatique fulminante (HF) progresse très rapidement en quelques heures ou jours seulement, vers un état mental altéré, la stupeur et finalement le coma. Les convulsions sont rares mais des myoclonies sont souvent rencontrées avant le coma. Dans cette condition, le taux de mortalité est élevé et la mort est souvent causée par une hernie du tronc cérébral secondaire à une hypertension intracrânienne causée par un oedème cérébral massif. L'oedème cellulaire des astrocytes est fréquemment observé mais l'astrocytose Alzheimer de Type II (voir insuffisance hépatique chronique) n'est pas une caractéristique neuropathologique de l'hépatite fulminante. L'ammoniaque est aussi incriminée dans la physiopathologie de ce type d'encéphalopathie. Afin d'élucider davantage la pathophysiologie de l'encéphalopathie des HF, nous avons mesuré, par le biais d'une microdialyse cérébrale in vivo, les concentrations extracellulaires des acides aminés dans le cortex frontal de rats atteints d'HF induite par dévascularisation hépatique afin d'établir une relation avec le degré d'atteinte neurologique. Dans ce modèle, on retrouve un oedème cérébral accompagné d'une augmentation de l'eau, tel que mesurée dans le cortex frontal. Les concentrations extracellulaires de glutamate sont significativement élevées trois heures avant le début du stade précoma et continuent à augmenter jusqu'à l'état comateux. Ces données suggèrent que l'HF mène à une augmentation de la libération de glutamate et/ou une diminution de la recapture du glutamate de l'espace extracellulaire. Récemment, des études sur le tissu cérébral de rats encéphalopathiques suite à une HF ont révélé une diminution de la concentration protéique et de l'expression génique de GLT-1, un transporteur astrocytaire du glutamate. L'augmentation de la production de la glutamine via la glutamine synthétase est aussi possiblement impliquée dans la pathogénèse de ce type d'encéphalopathie. Cependant, l'augmentation constante des concentrations de glutamine extracellulaire n'est pas corrélée avec la sévérité de l'encéphalopathie. Ceci suggère que la glutamine joue un rôle plutôt mineur dans la pathogénèse de l'oedème cérébral. Les traitements de l'encéphalopathie des HF sont axés sur le contrôle de l'hypertension intracrânienne. La transplantation hépatique demeure le traitement ultime mais d'autres traitements sont nécessaires afin de prolonger la vie des patients en attente de transplantation. Des stratégies visant à diminuer les taux d'ammoniaque ont été développées depuis qu'une étude récente a démontré que la survenue d'hernie cérébrale chez les patients souffrant d'HF était corrélée à la concentration artérielle d'ammoniaque. Nous avons démontré que l'infusion d'OA chez des rats ayant subi une dévascularisation hépatique entraînait un délai significatif avant l'apparition du coma, et une diminution significative de l'ammoniaque du plasma et du LCR comparativement aux contrôles. Cette diminution d'ammoniaque était accompagnée d'une réduction du contenu cérébral en eau. Le glutamate et la glutamine plasmatiques furent aussi significativement augmentés et puisque le cycle de l'urée est non-fonctionnel dans un foie dévascularisé, la réduction d'ammoniaque ne pouvait donc être induite que par la stimulation de la glutamine synthétase des muscles squelettiques. Le glutamate présent dans le LCR diminue parallèlement à la réduction du contenu cérébral en eau. Un autre des traitements qui fut récemment développé pour contrôler l'encéphalopathie des HF est l'hypothermie modérée. En réduisant la température corporelle de rats ayant subi une dévascularisation hépatique à 34°C, nous avons démontré un effet protecteur de cette procédure sur l'apparition du coma et de l'oedème cérébral. Les niveaux des acides aminés furent aussi mesurés en utilisant la méthode de microdialyse cérébrale in vivo et nous avons démontré une diminution du glutamate extracellulaire chez les rats protégés par l’hypothermie. Les mécanismes possiblement impliqués dans l'action bénéfique de l'hypothermie modérée incluent la diminution du transfert de l'ammoniaque sanguin vers le cerveau et la diminution des concentrations extracellulaires cérébrales d'acides aminés excitateurs tels que le glutamate. Ces résultats ajoutent davantage de crédibilité à la notion que la disponibilité élevée du glutamate dans l'espace extracellulaire et donc, une neurotransmission glutamatergique élevée, est impliquée dans la pathogénèse de certaines des complications cérébrales rencontrées au cours de l'HF. Ces résultats appuient aussi l'hypothèse que l'hypothermie modérée peut s'avérer une méthode efficace de prévention de l'encéphalopathie et de l'oedème cérébral, deux complications cérébrales très sévères de l'HF.