Introduction: The aim of the project was to investigate the effects of antidepressants on brain networks whilst at rest. My hypothesis was that antidepressants work by reversing persistent activity in the brain’s default mode network (DMN). The DMN is implicated in self-reflection and rumination in MDD. The methodologies and results of studies of resting state networks in MDD and the effects of antidepressants are reviewed in the thesis. Increasing evidence implicates glutamate in the action of antidepressant drugs. Whether there are illness related changes in glutamate function is unresolved, largely because of the lack of techniques for assessing it. Ketamine and other NMDA antagonists have improved MDD symptoms within 24 hours though the effects are short lasting. The molecular neural networks involved in ketamine’s putative antidepressant effects are unclear. The thesis reviews the evidence. Much evidence implicates ACC as a site of action of antidepressant effects but whether this is through its regulation of the DMN or other networks is not known. This thesis compares the effect of ketamine and citalopram on ACC-related systems. Method: The thesis combines two systematic reviews of the effects of MDD and antidepressant drugs on i) resting state networks (53 studies) and ii) glutamate neurotransmission (45 studies of clinical efficacy of ketamine). There are two experimental chapters. The first describes investigation into two rapid acting antidepressant drugs acting via glutamate mechanisms. 54 unmedicated cMDD were scanned across two centres on 3T MRI scanners while being infused with placebo (0.5% saline), 0.5mg/kg ketamine or 100mg AZD6765 over 1 hour. fMRI resting state data between drug treatments was compared for the final 25 minutes of the drug infusion and for a 25 minute resting state scan a day later. The second experimental chapter examines whether these effects were shared by citalopram, a standard antidepressant. 67 unmedicated cMDD, rMDD and HC were administered citalopram 7.5mg i.v. and scanned on a 1.5T MRI scanner. In a second study 63 cMDD and HC were administered i.v. citalopram 7.5mg or placebo (0.5% saline). fMRI resting state data for the final 12 ½ minutes following drug infusion was compared. Independent Component Analysis was performed using the Group ICA for fMRI toolbox. The resting component with the highest spatial correlation to the ACC was used. Brain maps of the intensity of the selected component were constructed for each individual. Group averages were calculated and compared using SPM. Regional analysis was performed using Marseille Boite a Regions d'interet. Results: On day 1 AZD6765 significantly increased mean intensity of ACC resting component in the right insula, right IPL and left cingulate gyrus greater than ketamine or placebo. Ketamine increased mean intensity of ACC resting component greater than placebo in the right lentiform nucleus and left mFG. Significantly decreased mean intensity of ACC resting component in the left insula in the AZD6765 group compared to placebo was noted. On day 2 AZD6765 increased mean intensity of ACC resting component greater than ketamine and placebo in the left and right lentiform nuclei. AZD6765 reduced mean intensity of the ACC resting component in the left and right MFG. The first citalopram study revealed reduced mean intensity of ACC resting component in cMDD compared to rMDD and HC in PCC. rMDD had reduced mean intensity of ACC resting component in the precuneus compared to HC. In the second study, citalopram had no effect in HC but normalised precuneus activity in cMDD producing a significant drug x group interaction. Conclusions: The acute antidepressant effects of citalopram are modulated by changes in the bilateral precuneus. The precuneus is central to connectivity with other regions in MDD. It has a prominent role in the DMN and is linked to rumination. The mechanism of the antidepressant effects of AZD6765 is different from those of ketamine and citalopram. The insula, IPL, MFG, cingulate gyrus and lentiform nuclei are all regions implicated in MDD suggesting antidepressant effects. The rapid antidepressant effects of AZD6765 are possibly due to a resetting of the interface between DMN and salience networks.

L’activateur tissulaire du plasminogène (tPA) est une sérine protéase initialement découverte dans le sang pour sa capacité à convertir le plasminogène en plasmine, une enzyme capable de dégrader les chaînes de fibrine des caillots sanguins. Pour cette fonction pro-fibrinolytique, le tPA est le seul traitement pharmacologique aujourd’hui utilisé dans la phase aiguë de l’accident vasculaire cérébral (AVC) de type ischémique, même s’il présente plusieurs limites. Outre son rôle dans la fibrinolyse, le tPA est aussi capable de moduler différents phénomènes physiologiques et pathologiques au sein du système nerveux central et de l’unité neurovasculaire, tels que la mémoire, l’excitotoxicité ou encore le couplage neurovasculaire comme décrit plus récemment. Plusieurs fonctions du tPA impliquent son interaction avec les récepteurs N-Methyl-D-Aspartate (NMDA), qui permet de potentialiser leur signalisation. Sur le plan structurel, deux formes du tPA ont été identifiées : une forme simple chaîne (sc-tPA) et une forme double chaîne (tc-tPA). Ces deux formes, dont les proportions peuvent varier dans la solution administrée aux patients pour la thrombolyse post-AVC ischémique, partagent certaines fonctions communes mais peuvent aussi avoir des actions différentes. Le premier objectif de nos travaux visait à mieux comprendre l’implication du tPA dans le couplage neurovasculaire, un phénomène essentiel au fonctionnement cérébral permettant aux régions en activité de bénéficier d’un apport accru en sang afin de subvenir à la demande énergétique des neurones. Dans une seconde partie, nous nous sommes intéressés aux effets des formes sc-tPA et tc-tPA utilisées lors de la thrombolyse dans un modèle murin d’AVC ischémique thromboembolique.Premièrement, nos résultats mettent en évidence la capacité du tPA vasculaire à augmenter l’hyperhémie fonctionnelle dans le cadre du couplage neurovasculaire. En effet, nous montrons chez la souris que le tPA vasculaire peut interagir avec les récepteurs NMDA présents à la surface des cellules endothéliales des artères et artérioles, et augmenter leur dilatation lors d’une activité neuronale. D’autre part, dans le cadre de l’ischémie cérébrale, nos résultats indiquent que lorsqu’ils sont utilisés pour la thrombolyse précoce, le sc-tPA et le tc-tPA ont des effets différents et parfois opposés. Le sc-tPA permet de réduire les volumes de lésion et d’améliorer la récupération fonctionnelle, alors que le tc-tPA est moins efficace pour réduire la lésion et ne diminue pas les déficits fonctionnels. De fait, nos données montrent que le tc-tPA aggrave l’altération de l’intégrité de la barrière hématoencéphalique par rapport au sc-tPA. Dans l’ensemble, ces données permettent d’améliorer les connaissances sur les mécanismes d’actions du tPA dans des phénomènes physiologiques et pathologiques importants. Nos travaux soulignent également la nécessité de prendre en compte les différences entre les formes de tPA dans l’amélioration du traitement actuel des AVC et dans l’élaboration de futures stratégies thérapeutiques impliquant cette molécule. / The tissue-type plasminogen activator (tPA) is a serine protease initially discovered in the blood for its ability to convert plasminogen into plasmin, an enzyme capable of degrading fibrin chains of blood clots. tPA is the only pharmacological treatment currently used for the acute phase of ischemic stroke, although it has several limitations. Besides its role in fibrinolysis, tPA also modulates various physiological and pathological phenomena within the central nervous system and neurovascular unit, such as memory, excitotoxicity and neurovascular coupling, which has been described recently. Several functions of tPA involve its interaction with N-Methyl-D-Aspartate (NMDA) receptors, which leads to an increase in NMDA signaling. Structurally, two forms of tPA have been identified: a single chain form (sc-tPA) and a double chain form (tc-tPA). These two forms, whose proportions vary in the solution administered for thrombolysis during ischemic stroke, share some common functions but may also differ in their therapeutic action. The first objective of our work was to better understand the implication of tPA in neurovascular coupling, which is an essential phenomenon for cerebral functioning that allows active brain regions to benefit from increased blood supply in order to meet local energy demands. In the second part of our work, we investigated the effects of sc-tPA and tc-tPA in a murine model of ischemic thromboembolic stroke.Our results establish a role for vascular tPA in increasing functional hyperemia in neurovascular coupling. We show that vascular tPA interacts with NMDA receptors present at the surface of endothelial cells of arteries and arterioles to increase their dilation during neuronal activity. In the context of cerebral ischemia, our results indicate that when administered during early thrombolysis, sc-tPA and tc-tPA have different and sometimes opposite effects. tc-tPA is less effective than sc-tPA in reducing lesion volume and protecting against functional impairment. In fact, our data show that tc-tPA worsens the integrity of the blood-brain barrier compared to sc-tPA. Overall, these data improve our knowledge of the mechanisms of action of tPA in important physiological and pathological phenomena. Our work underlines the need to take into account differences between sc-tPA and tc-tPA when trying to improve the current treatment for stroke and in the development of future therapeutic strategies involving this molecule.

Neurosteroids are an important group of substances that affect communication between neurons. They act as allosteric modulators of membrane receptors for neurotransmitters. One of the most important systems influenced by neurosteroids are NMDA receptors; however, a binding site(s) for their inhibition by steroids have not been found yet. This work is focused on the synthesis of fluorescently labeled photoaffinity probe, which may help explain the structure and location of binding site(s) and simplify the development of new neuroprotectives. A structural analogue of the endogenous neurosteroid, (20S)-20-Azido-5β-pregnan- 3α-yl N-(7-nitrobenz-2-oxa-1,3-diazole-4-yl)-L-glutamyl 1-ester (8), was prepared. The structure of compound 8 includes photolabile azido group, as well as covalently bounded fluorescent NBD group. In addition, a photoaffinity probe with a modified steroid skeleton - pyridinium 17aα-azido-17α-methyl-17a-homo-5β-androstan-3α-yl 3-sulfate (29) - was synthesized. The ability of compound 8 and 29 to inhibit activated NMDA receptor has been verified for recombinant NR1-1a/NR2B receptors expressed in HEK293 cells using a patch-clamp technique. Additionally, the IC50 values of compounds 8 and 29 have been calculated. (In Czech) Key words: neuroactive steroid, NMDA receptor, photoffinity...

The neuroactive steroid pregnanolone glutamate (Pg glu), a synthetic analogue of the naturally occurring pregnanolone sulfate (3alpha5betaS), has neuroprotective properties and a minimum of adverse effects. The subject of my thesis is the influence of selected structural modifications of the molecule Pg glu on biological effects. The first modification involves an increase of lipophilicity, the second involves the attachment of a positively charged group to C3. All these neuroactive steroids are use-dependent inhibitors of NMDA receptors. The first aim of this thesis was to determine the neuroprotective effectiveness of the neuroactive steroids chosen. The second aim was to explore the influence of selected neuroactive steroids on motor coordination, reflexes, anxiety and locomotor activity, as well as the effect of their high doses. The third aim was to create a battery of behavioural tests for screening the biological effects of analogues of Pg glu in laboratory rodents. The neuroprotective effects were evaluated in a model of excitotoxic damage of hippocampus in the rat on the basis of its behavioural consequences. The neuroprotective efficacy of androstane glutamate (And glu) and Pg glu was demonstrated. In the case of positively charged molecules, neuroprotective efficacy was not demonstrated....

Alzheimer's disease is a neurodegenerative disorder with the highest prevalence in the population and for which we do not have a cure so far. The aim of this thesis was to test the mediator system of the N-methyl-D-aspartate receptor and nitric oxide in an animal model of sporadic form of Alzheimer's disease (Samaritan Alzheimer's Rat Model; Taconic Pharmaceuticals, USA). Then compare these results with changes in hippocampal cholinergic system and cognitive tests. The Samaritan rat model is based on the unilateral in vivo application of β-amyloid42 and the pro-oxidative substances (ferrous sulfate heptahydrate and L-buthionine-(S,R)-sulfoximine). Neurochemical methods included testing of the NR1/NR2A/NR2B subunits of the N-methyl-D-aspartate receptor and activity of nitric oxide synthases (neuronal, endothelial, inducible) in the cortex, in both cases in the right and left hemisphere separately. Our results show that Samaritan rats exhibited significant changes in expression of NR2A/NR2B subunits of the N-methyl-D-aspartate receptor and activity of inducible nitric oxide synthase in cortex compared to control rats. The results of glutamatergic system are consistent with changes in activity of cholinergic transporter and cognitive tests (Morris water maze and active allothetic place avoidance)....

NMDA receptors belong to the family of ionotropic glutamate receptors, and are involved in synaptic plasticity, learning and memory. However, overactivation by the agonist glutamate can lead to neuronal death - excitotoxicity. Exitotoxicity is a result of excessive calcium influx into the cell through NMDA receptors, and is associated with many cental nervous system (CNS) diseases. Neurosteroids are endogenous compounds capable of NMDA receptor modulation, thus they may have pharmacological potential in the treatment of CNS disorders. The aim of this work was to investigate how pregnanolone sulfate (PA-S) and pregnanolone hemipimelate (PA-hPim) influence somatic calcium and excitotoxicity. We used fluorescence microscopy for recording changes in somatic calcium concentration. We observed that PA-S had no influence on relative somatic calcium concentration. Synthetic analog PA-hPim increased somatic calcium levels slightly. Next, we used oxygen-glucose deprivation (OGD) in vitro to study the influence of neurosteroids on excitotoxicity. Both PA-S and PA-hPim were neuroprotective in the model of acute OGD in vitro. Moreover, PA-S or PA-hPim pretreatment induced ischemic tolerance to a subsequent OGD episode. Our results suggest that neurosteroids PA-S and PA-hPim are potential candidates for the development...

of Ph.D. thesis Molecular mechanisms of regulation of trafficking and function of different subtypes of NMDA receptors in hippocampal neurons Mgr. Kristýna Skřenková N-methyl-D-aspartate (NMDA) receptors are ionotropic glutamate receptors that play a key role in the mammalian central nervous system. Under physiological conditions, these receptors are important for excitatory synaptic transmission and memory formation. However, under pathological conditions, their abnormal regulation or activation may lead to many neurological and psychiatric disorders, such as Alzheimer's disease, Parkinson's disease, Huntington's disease, epilepsy or schizophrenia. Previous studies have shown that the number and type of NMDA receptors on the cell surface are regulated at multiple levels, including their synthesis, folding, internalization or degradation. During the trafficking of NMDA receptors to the cell surface membrane, both the agonist binding and receptor activation are examined. Moreover, NMDA receptors undergo many posttranslational modifications such as palmitoylation, phosphorylation or N-glycosylation. In this thesis, we studied the molecular mechanisms that may affect the trafficking and functional properties of NMDA receptors in mammalian cells and rat hippocampal neurons. Specifically, we studied i)...

Several trials have reported rapid antidepressant response from the anesthetic drug ketamine although the mechanism behind this effect is not fully understood. Research has focused mainly on ketamine’s action in the brain, including its effects on chemical balance, connections between brain cells and networks, and cognition. Trials with psychedelic drugs have had similar antidepressant results as ketamine, and the quality of the subjective psychedelic experience seems to mediate antidepressant action. Ketamine causes similar alterations of consciousness, which have been viewed as side effects. This thesis examines whether ketamine works in a similar way as psychedelics, where the ketamine-induced dissociative-like experience has a relationship to antidepressant response. Leading theories of depression and ketamine’s action in the brain are presented, and eight studies examining the relationship between ketamine-induced subjective experience and antidepressant response are reviewed. Three included studies found a relationship between psychedelic- and dissociative-like symptoms and reduction in depression, while five did not. The supposed relationship between psychedelic- and dissociative-like symptoms and antidepressant action has not been adequately explored and needs further examination in clinical trials.

An increasing amount of research suggests Ketamine in subanaesthetic doses to be an effective antidepressant for Major Depressive Disorder (MDD) and Treatment-Resistant Disorder (TRD). After the finding that NMDA-receptor antagonists may hold antidepressant effect, several studies have suggested Ketamine to have great effect in relief of depressive symptoms. A time lag between biological and behavioural effects have been shown in currently available antidepressants and are not guaranteed to be efficient; only 30% of patients reach adequate response. The aim for this thesis is to systematically review available studies on the efficiency of Ketamine's antidepressant effects in patients with TRD. Scopus, Web of Science, and PubMed were the databases searched for relevant research regarding the subject. Six articles were included in the analysis. A compilation of the results presented a moderate to large effect size for Ketamine compared to placebo at 24 hours through day seven. It is of immense weight that prolonged adverse effects and possible abuse are taken into consideration for future research, as well as how to sustain the dramatic acute antidepressant effect of Ketamine.

Cognitive symptoms, considered in conjunction both with their regional brain and biomarkers as well as affective, attributional and neurode-velopmental components, demonstate ever-increasing complexity to facilitate conceptualization yet, unavoidably, bedevil diagnosis in neuropsychiatry even before considerations of the enigmatic processes in memory, such as executive function and working memory, are drawn into the myriads of equations that await remedial interpretations. Prefrontal and limbic regions of the brain are involved in a diversity of expressions of cognition, normal or dysfunctional, at synaptic, intracellular and molecular levels that mobilize a concatenation of signaling entities. Serotoninergic neurotransission at prefrontal regions directs cogntive-affective entities that mediate decision-making and goal-directed behaviour. Clinical, non-clinical and basic studies challenge attempts to consolidate the multitude of evidence in order to obtain therapeutic notions to alleviate the disordered status of the diagnosed and yet-to-be diagnosed individuals. Locus of control, a concept of some utility in health-seeking procedures, is examined in three self-report studies from the perspective of a cognitive-emotional situation through observations of ordinary, 'healthy' young and middle-aged individuals, to assess the predictors of internal and external locus of control. A notion based on high level executive functioning in the dorsolateral prefrontal cortex (DLPFC) in individuals characterised by internal locus of control is contrasted with a hypofunctional executive DLPFC, characterising individuals that express an external locus of control, is discussed.