A travers ce projet de recherche nous avons exploré différents aspects d’une dérégulation du système dopaminergique sur les troubles du repos, en prenant pour exemple deux maladies neurologiques : la maladie de Willis-Ekbom (MWE) et la maladie de Parkinson (MP). La MWE est une maladie neurologique sensorimotrice caractérisée par des douleurs dans les membres inférieurs, s’accompagnant d’un besoin irrépressible de bouger et ce, suivant un profil circadien. Ainsi, le premier volet de ces travaux s’est appliqué à reproduire chez le macaque, les principales altérations du métabolisme du fer et de celui de la dopamine reportées dans la MWE. Tout d’abord, nous avons établit les bases physiologiques des variations circadiennes des concentrations du fer et de ses biomarqueurs au niveau central et périphérique. Puis, nous avons développé un protocole simple, uniquement basé sur des prélèvements sanguins répétés, permettant d’induire efficacement une déplétion en fer sérique et de ses protéines associées. Finalement, ce protocole nous a permis d’explorer les liens entre l’altération de l’homéostasie du fer au niveau du système nerveux central, les perturbations neurochimiques dans différentes structures cérébrales ainsi que les modifications locomotrices qui en résultent. Le second volet de cette thèse a testé l’impact des agonistes des récepteurs dopaminergiques de type D1 (SKF38393) et D2 (quinpirole), sur les troubles du sommeil dans un modèle macaque de la MP, à l’aide d’enregistrements polysomnographiques. Pour cela, nous avons évalué les effets de ces agents pharmacologiques sur l’émergence de la somnolence diurne et sur l’altération du sommeil paradoxal, induits par une intoxication au MPTP. Nos résultats mettent en évidence que le quinpirole est inefficace pour restaurer les niveaux de base de ces deux paramètres. En revanche, le SKF38393 permet une diminution notable de la somnolence diurne ainsi qu’une restauration du sommeil paradoxal. Finalement, les perturbations monoaminergiques liées à la déplétion en fer ouvrent de multiples perspectives de recherche sur la physiopathologie de la MWE. De même, l’amélioration des troubles veille-sommeil par l’agoniste des récepteurs D1, offre de nouvelles pistes thérapeutiques quant à la prise en charge des troubles du repos dans la MP. L’ensemble de nos résultats apporte un niveau de compréhension supplémentaire quant au rôle de la dopamine dans les altérations du repos. / During this thesis project we explored several aspects of the impact of a dopaminergic system dysregulation on the rest alterations, through two neurological diseases: the Willis-Ekbom’s disease (WED) and Parkinson’s diseases (PD). The WED is a neurological sensorimotor disorder mainly characterized by pain in lower limbs. It preferentially appears in the evening and transiently and partially is alleviated by motor activity. Thus, the first part of this work aimed at reproducing the main dysfunctions of the iron and dopaminergic metabolisms observed in WED, in the macaque monkey. We first established the circadian variations of iron-indicator concentrations in serum and cerebrospinal fluid. Then we developed a rapid protocol based on repeated blood withdrawals, allowing to efficiently induce serum iron depletion. Finally, this protocol enabled us to investigate the relationship between iron metabolism dysfunctions, neurochemical alterations and the subsequent locomotor behavioural changes. In the second part, of this research project we examined the impact of selective D1 (SKF38393) and D2 (quinpirole) receptor agonists on the sleep impairments in a macaque model of PD using the polysomnographic recording technique. Thus we investigated the effects of these two pharmacological compounds on the daytime sleepiness and on the paradoxical sleep induced by MPTP intoxication. Our results demonstrated the inefficacy of quinpirole to restore these two altered sleep parameters. By contrast, SKF38393 significantly decreased daytime napping and substantially restored paradoxical sleep. Finally, the monoaminergic dysregulations, induced by iron depletion, may offer multiple perspectives to unravel the WED pathophysiology. In the same line, the beneficial effects exhibited by the D1 receptor agonist bring new therapeutic avenues to treat sleep-wake disorders in PD. Together, the global results bring new insights in the underlying mechanisms of sleep impairment involving dopamine.

A monitorização terapêutica permite a individualização do regime de dosagem, assegurando a eficácia clínica e minimizando os efeitos adversos dos fármacos, prescritos na clínica. Os antidepressivos têm sido monitorados, pois, apresentam intervalos terapêuticos bem estabelecidos, ou seja, a maioria dos pacientes, que apresentam concentrações plasmáticas dentro deste intervalo fixo, tem as desordens psiquiátricas mantidas sob controle e efeitos adversos aceitáveis. Os antidepressivos tricíclicos (ADTs): imipramina, amitriptilina, nortriptilina e desipramina, embora eficazes e ainda muito utilizados, apresentam efeitos adversos, não desejáveis. Os antidepressivos, inibidores seletivos da recaptação de serotonina (ISRSs): citalopram e sertralina, apresentam eficácia clínica comparável aos clássicos ADTs, mas destituídos dos efeitos adversos associados aos mesmos. Os métodos convencionais, empregados no tratamento de amostras biológicas, para análises de antidepressivos por técnicas cromatográficas, têm sido a extração líquido-líquido e extração em fase sólida. A extração sortiva em barra de agitação (SBSE), técnica recente de preparo de amostras para a préconcentração de compostos orgânicos presentes em amostras biológicas, baseiase na extração estática, através do polímero polidimetilsiloxano (PDMS), no qual ocorre a dissolução (sorção, partição) do analito. Neste trabalho, as técnicas SBSE e cromatografia líquida de alta eficiência foram avaliadas para a análise simultânea dos antidepressivos em amostras de plasma para fins de monitorização terapêutica. As condições cromatográficas de análise, assim como as variáveis SBSE de extração (tempo, temperatura, força iônica, pH da matriz) e tempo de dessorção, foram otimizadas, visando adequada sensibilidade analítica. A validação analítica foi realizada segundo normas da ANVISA, em diferentes concentrações plasmáticas, as quais contemplam o intervalo terapêutico. O método SBSE/HPLC padronizado apresentou linearidade na faixa de concentração plasmática de 20 a 1000 ng mL-1, precisão interensaio com coeficientes de variação menor que 14% e recuperação relativa de 83 a 110%. Segundo a validação analítica, a metodologia SBSE/HPLC apresentou linearidade, alta sensibilidade, seletividade e precisão analítica adequadas para a análise dos antidepressivos: imipramina, amitriptilina, nortriptilina, desipramina, citalopram e sertralina, em amostra de plasma, para fins de monitorização terapêutica. / Therapeutic drug monitoring allows individualization of drug dosage assuring its clinical efficacy and at the same time minimizing adverse effects of the drugs prescribed in clinics. The antidepressants have been monitored since they present a very well established therapeutic interval. In this sense, most of the patients whose plasmatic concentrations are ranged at that interval present psychiatric disorders under control and drug adverse effects at bearable levels. Despite tricyclic antidepressants (TCAs) such as imipramine, amitriptyline, nortriptyline and desipramine are highly efficient and widely used, they also present undesirable adverse effects. The antidepressants: citalopram and sertraline, which are selective serotonin reuptake inhibitors (SSRIs), present clinical efficacy comparable to the classic TACs, but with no adverse effects associated to the last ones. Liquid-liquid extraction (LLE) and solid phase extraction (SPE) have been usually employed in biological sample pre-treatment for chromatographic analysis. A new technique named sorptive stir bar extraction (SBSE) for sample pre-concentration of organic compounds from biological samples was recently proposed. This technique is based on static extraction through the polymer polidimetilsiloxane (PDMS), in which analyte sorption occurs. In this work, SBSE and HPLC techniques have been evaluated for out antidepressants simultaneous analysis in plasma samples for therapeutic drug monitoring. The chromatographic conditions of analysis, as well as SBSE parameters (time, temperature, ionic strength, matrix pH, desorption time) have been optimized in order to obtain best analytical sensitivity. Analytical validation was carried out according to the norms established by ANVISA, in different plasmatic concentrations, which represent the therapeutic interval. The SBSE/HPLC method developed showed linearity in a concentration plasmatic ranging from 20 to 1000 ng mL-1, inter assay precision with coefficient of the variation lower than 14%, and relative recovery from 83 a 110%. Based on analytical validation, the SBSE/HPLC methodology showed good linearity, high sensitivity, selectivity and suitable repeatability to the analyzed antidepressants: imipramine, amitriptyline, nortriptyline, desipramine, citalopram and sertraline in plasma samples for therapeutic drug monitoring.

O transtorno obsessivo-compulsivo (TOC) é um transtorno psiquiátrico freqüentemente crônico caracterizado pela presença de obsessões e/ou compulsões. Tratamentos de primeira linha, que incluem os inibidores seletivos da recaptura de serotonina (ISRS) e a terapia cognitivocomportamental com técnicas de exposição e prevenção de respostas não conseguem melhora satisfatória em até 40% dos pacientes. Para estes casos, existem evidências que apóiam o uso de antipsicóticos como a quetiapina, na potencialização dos ISRS. No entanto, os antipsicóticos são eficazes para apenas um terço dos pacientes e estão associados a eventos adversos preocupantes no longo prazo. Este estudo tem como objetivo comparar a eficácia da potencialização do ISRS fluoxetina com a clomipramina, um inibidor de recaptura da serotonina não-seletivo, ou quetiapina, versus placebo. Para inclusão neste estudo, os pacientes precisavam: relatar os sintomas de TOC como sendo seu problema principal; estar em uso da dose máxima tolerada ou recomendada de fluoxetina por pelo menos oito semanas; ter um escore total na escala Yale Brown Obsessive-Compulsive Disorder Scale (YBOCS) de pelo menos 16; e ter tido uma redução do escore inicial da YBOCS menor do que 35% após tratamento com fluoxetina. Os pacientes (N=54) foram alocados por meio de um método de minimização em três grupos: quetiapina (até 200mg/dia) com fluoxetina (até 40mg/dia) (QTP/FLX) (N=18); clomipramina (até 75mg/dia) com fluoxetina (até 40mg/dia) (CMI/FLX) (N=18); e placebo com dose máxima de fluoxetina (até 80mg/dia) (PLC/FLX) (N=18). Avaliadores cegos obtiveram os escores da YBOCS nas semanas 0 e 12. As análises foram realizadas por intenção de tratar, com imputação do tipo hot-deck para os dados faltantes. Teste de Wald por ANCOVA não paramétrico para medidas ordinais repetidas foi utilizado para avaliar efeitos de grupo, tempo e interação para os resultados da YBOCS e desfechos secundários, tendo as medidas iniciais como co-variáveis. Os resultados da impressão clínica global de melhora (ICG-M) foram utilizados para classificar os pacientes como respondedores ou não-respondedores. O teste qui-quadrado foi utilizado para avaliar a freqüência de respondedores em cada grupo. Foram feitos gráficos de percentis e análises de sensibilidade. Quarenta pacientes (74%) completaram o seguimento. Não foram observados efeitos adversos graves. Pacientes dos grupos PLC/FLX (YBOCS final: média=10, DP=4; redução em relação ao inicial: média=49%, DP=0.49) e CMI/FLX (YBOCS final: média=10, DP=4; redução em relação ao inicial: média=46%, DP=0.51) melhoraram significativamente e tiveram uma melhor resposta quando comparados aos do grupo QTP/FLX (YBOCS final: média=13, DP=3; redução em relação ao inicial: média=18%, DP=0.20; p=0.001). Não foram encontradas diferenças significativas para as medidas secundárias. Os gráficos de percentis confirmaram que os pacientes do grupo QTP/FLX pioraram com maior freqüência e melhoraram menos do que os pacientes dos outros dois grupos. Análises de sensibilidade demonstraram que outros métodos de análise não modificaram significativamente os resultados. Este é o primeiro estudo duplo-cego controlado de potencialização de ISRS com clomipramina em TOC e também o primeiro a comparar a eficácia de potencialização com quetiapina à de outro potencializador. Limitações deste estudo incluem o uso de doses baixas dos potencializadores, taxas de abandono diferentes para os três grupos e período curto de seguimento. Apesar dessas limitações, nossos resultados apóiam o uso da clomipramina como potencializador (principalmente para aqueles que não toleram doses altas de fluoxetina) e o aumento do período de seguimento com fluoxetina em dose máxima antes de uma potencialização medicamentosa ser tentada / Obsessive-compulsive disorder (OCD) manifests often as a chronic illness and is characterized by the presence of obsessions and compulsions. Firstline treatment options, which include selective serotonin reuptake inhibitors (SSRI) and cognitive-behavior therapy with exposure and response prevention techniques, fail to achieve a satisfactory response in up to 40% of patients. Current evidence supports the augmentation of SSRI with antipsychotics, such as quetiapine. However, anti-psychotics are effective for only one-third of the patients and have been associated with severe long term side effects. This study aimed to compare clomipramine and quetiapine augmentation of the SSRI fluoxetine. Previously to the beginning of this trial all patients had to: report OCD as they primary diagnosis, be taking the highest tolerated or recommended dose of fluoxetine for at least eight weeks, have a current Yale Brown Obsessive-Compulsive Scale (YBOCS) total of at least 16, and have had a reduction of less than 35% of the initial total YBOCS score with fluoxetine treatment. Fifty-four patients were allocated trough a minimization procedure in one of three arms: quetiapine (up to 200 mg/day) plus fluoxetine (up to 40 mg/day) (QTP/FLX) (N=18), clomipramine (up to 75 mg/day) plus fluoxetine (up to 40 mg/day) (CMI/FLX) (N=18) and 18 placebo plus sustained maximum dose fluoxetine (up to 80 mg/day) (PLC/FLX) (N=18). Blinded raters collected YBOCS scores at weeks 0 and 12. Analyses were made with intention-to-treat and hot-deck imputation of missing data. Wald statistics from non-parametric ANCOVA for ordinal categorical repeated measures were used to evaluate group, time and interaction effects for YBOCS scores and secondary outcome measures considering initial measures as covariates. Clinical Global Impression scores of improvement (CGI-I) were used to classify individuals in responders or non-responders. Chi-square was used to evaluate frequency of responders in each group. Percentile-plots were built and sensitivity analyses were performed. Completion rate was 74% (N=40). No severe adverse events occurred during the trial. Patients from the PLC/FLX (final YBOCS score: mean=10, SD=4; reduction from initial YBOCS score: mean=49%, SD=0.49) and CMI/FLX (final YBOCS score: mean=10, SD=4; reduction from initial YBOCS score: mean=46%, SD=0.51) groups improved significantly and also had a significantly better response than the ones from the QTP/FLX group (final YBOCS score: mean=13, SD=3; reduction from initial YBOCS score: mean=18%, SD=0.20; p=0.001). No significant differences were evident for secondary outcome measures. Percentile plots confirmed that patients in the QTP/FLX group got worse more often or improved less than in the other two groups. Sensitivity analyses showed that other analytical methods did not significantly change results. This is the first double-blind placebo-controlled trial of clomipramine augmentation and the first to compare quetiapine augmentation with another active augmenter. Limitations of our trial include the use of low dose of augmenters, differential drop-out rates for each treatment arm and short period of follow-up. Despite these limitations, our results support the use of clomipramine as an augmentation strategy (mainly for those who do not tolerate higher doses of fluoxetine) and the prorogation of the period of maximum dose of fluoxetine before an augmentation is tried

Des anomalies biochimiques de la voie sérotonine-N-acétylsérotonine-mélatonine ont été observées dans les Troubles du Spectre Autistique (TSA) et la prématurité. Cependant, les mécanismes moléculaires de régulation de cette voie et les causes des anomalies biochimiques observées dans ces maladies sont encore mal connus. Afin de mieux comprendre les bases génétiques de la voie sérotonine-N-acétylsérotonine-mélatonine, nous avons utilisé une approche de génétique quantitative au travers de deux populations d’étude indépendantes, dans lesquelles des paramètres de cette voie ont été mesurés. Ces deux cohortes, composées d’une part de plus de 250 familles avec autisme et plus de 300 témoins et d’autre part, de 183 nouveau-nés dont 93 nés très prématurés, incluent ainsi des individus présentant deux situations pathologiques différentes associées à des anomalies de cette voie. Une première étude de la voie sérotonine-N-acétylsérotonine-mélatonine dans les familles avec TSA a permis d’obtenir des estimations de l’héritabilité au sens strict, allant de 0,22 pour la mélatonine à 0,72 pour la N-acétylsérotonine (NAS). Des études d’association portant dans un premier temps sur une liste de 812 gènes candidats pour la régulation de la voie sérotonine-NAS-mélatonine et dans un second temps sur tout le génome, n’ont pas permis d’identifier des variants significativement associés aux traits biochimiques. Cependant, des études d’association par gènes ont permis d’identifier trois nouveaux gènes candidats (IL21R, JMJD7 et MAPKBP1) pour la régulation de cette voie dans les familles avec TSA ainsi qu’un nouveau gène (RAET1G) dans la cohorte de nouveau-nés prématurés et témoins. Enfin une étude biochimique des phénol-sulfotransférases (PST) dans les familles avec TSA a mis en évidence une faible activité enzymatique chez 29% des patients en comparaison avec les témoins (5ème percentile). Le séquençage et le génotypage du nombre de copies des gènes de la famille SULT1A1 n’ont pas permis d’identifier des variations génétiques associées aux TSA, à l’activité PST, ou aux taux de sérotonine et de mélatonine. En conclusion, ces résultats confirment la complexité de l’architecture génétique de la voie sérotonine-NAS-mélatonine. D’autre part, ils ont permis de mettre en évidence une héritabilité élevée de cette voie et d’identifier de nouveaux gènes candidats pour comprendre la diversité inter-individuelle de cette voie chez les personnes avec TSA, les enfants prématurés et la population générale. / Biochemical abnormalities of the serotonin-N-acetylserotonin-melatonin pathway have been reported in many clinical conditions such as Autism Spectrum Disorders and preterm birth. However, molecular mechanisms underlying this pathway regulation, as well as the causes of these biochemical abnormalities remain largely unknown. The aim of this study was thus to characterize the genetic basis of the serotonin-N-acetylserotonin-melatonin pathway. To do so, we used a quantitative genetic approach in two independent populations that were previously biochemically explored for this pathway. One cohort consisted of more than 250 families with ASD and more than 300 controls and the other was composed of 183 infants including 93 very preterm newborns. Both cohorts included individuals with clinical conditions associated with disruptions of the serotonin-N-acetylserotonin-melatonin pathway. Narrow sense heritability analysis of this pathway showed relatively high estimates, ranging from 0.22 for melatonin to 0.72 for N-acetyserotonin (NAS). First, candidate-gene association studies including 812 genes related to the serotonin-NAS-melatonin pathway, then genome-wide association studies were conducted. These analyses did not identify any variant associated at the genome-wide significance level. However, a gene-based approach identified three new candidate genes (IL21R, JMJD7 and MAPKBP1) for the regulation of the pathway in families with ASD as well as one gene (RAET1G) in the cohort of preterm and term newborns. Finally, a biochemical exploration of the phenol-sulfotransferases (PST) in families with ASD revealed a decreased enzyme activity in 29% of patients compared with controls (5th percentile). SULT1A1-4 genes were then sequenced and copy number variants (CNV) were genotyped. No genetic variant could be significantly associated with PST activity, melatonin and serotonin levels, or ASD status. In conclusion, these results confirm the complexity of serotonin-NAS-melatonin pathway genetic architecture. Furthermore, this study revealed high heritability of this pathway and identified new candidate genes to understand the inter-individual variability of this pathway in ASD, preterm birth and the general population.

<p>Neuroendocrine tumors (NET´s) are often characterized by overproduction of peptide hormones. In spite of pronounced clinical symptoms, the tumor lesions can be small and difficult to detect. The general aim of this thesis was to investigate, in vitro and in vivo, some of the potential monoamine pathways present in NET´s, using radiolabeled tracers for positron emission tomography (PET), with the intention to explore the value of PET-imaging in the management of NET´s.</p><p>We used the 11C-labeled serotonin precursor 5-hydroxy tryptophan (HTP) as the tracer for imaging of NET´s. More than 95% of the subjects displayed a high tracer uptake on PET and tumor detection rate with PET was higher in >50% of the patients compared both to computed tomography (CT) and somatostatin receptor scintigraphy (SRS). The primary tumor was imaged by PET in 84% (16/19), compared to 47% and 42% for SRS and CT, respectively. Tumor visibility was better with PET due to a higher tumor-to-background ratio and a better spatial resolution. There was a strong correlation (r = .907) between changes in urinary-5-hydroxy indole acetic acid and changes in transport rate of 11C-5-HTP during treatment, indicating the use of PET in treatment monitoring of NET´s. </p><p>Pretreatment with carbidopa decreased the urinary radioactivity concentration four-fold and significantly (p<0.001) increased the tumor tracer uptake. This greatly improved image interpretation and tumor lesion detection.</p><p>A screening for expression of monoamine pathways in NET´s revealed a high in vitro binding of the monoamineoxidase-A ligand harmine to tumor sections. PET examinations with 11C-harmine could visualize tumors in all patients, including non-functioning endocrine pancreatic tumors (EPT´s).</p><p>Finally, the in vitro turnover and in vivo distribution of the amino acids glutamate, glutamine and aspartate was investigated. Limited uptake in vivo indicates the lack of utility for these substances as PET-tracers for imaging and characterization of NET´s. </p>

<p>This thesis explored the epidemiology of Posttraumatic Stress Disorder (PTSD) and different aspects of the disorder. Firstly, we investigated the lifetime prevalence of traumatic experiences and PTSD in the general adult population in Sweden and evaluated the impact of different trauma types, trauma frequency, and perceived distress. The results show that traumatic experiences are common and PTSD is not rare; roughly one out of ten traumatic events results in PTSD, with a 5.6% lifetime prevalence. The female/male ratio is 2:1. The risk for PTSD increases considerably with a high trauma-associated emotional impact. The distressing impact of a given trauma appears to be higher in women than in men, indicating an increased vulnerability in women. Secondly, we hypothesized that traffic road accidents (TRA’s) are one of the most prevalent types of traumatic events in Swedish society; therefore, we examined the impact of event and response characteristics associated with TRA’s on PTSD development. The data demonstrate that of those who had experienced a TRA (n=1074, 58.9%), 6.1% reported lifetime PTSD. TRA’s associated with fatal accidents and injury to oneself and related to high distress more than double the risk for PTSD. Thirdly, we compared the relative merits of the DSM-IV’s three-factor solution for PTSD symptoms to alternative models. We found that the symptomatology is equally well accounted for using all factor analytic models as yet presented in the literature; the DSM-IV, we found, provides as good a fit to data as other models. Fourthly, we examined the neurofunctional correlates of PTSD symptoms and whether a treatment-induced (serotonin reuptake inhibitor - SSRI) reduction of PTSD symptoms is associated with altered rCBF during symptom provocation. Our results indicate that PTSD symptoms correlates with areas involved in memory, emotion, attention, and motor control and that SSRI treatment normalizes provocation-induced rCBF in these areas.</p>

<p>In this study, we have addressed the serotonergic and the opioid system within the CNS. Both systems are of outmost importance in the etiology of disease states, especially mental disorders. </p><p>In our investigation of the serotonergic system, we have synthesized novel enantiomerically pure 6-aryl-3-amino- and 8-aryl-3-aminochromans as ligands for the 5-HT₇ receptor. One reason for the lack of understanding of the physiological functionality of the serotonin 5-HT₇ receptor, the most recently discovered member of the serotonin receptor family, is the absence of partial agonists and agonists. In this series, we have identified partial agonists with more than189 fold selectivity over the 5-HT_1Areceptor and one agonist with 29 fold greater selectivity over the serotonin 5-HT_1Areceptor. Thus the present series constitutes a starting point for developing highly selective ligands for the 5-HT₇ receptor. </p><p>In our investigation of the opioid system, our focus has been on the natural product salvinorin A, which is a highly selective kappa opioid receptor agonist. In the total synthesis of salvinorin A, we have accomplished the synthesis of a key intermediate, 6-(3-furyl)-4-methyl-5,6-dihydro-pyran-2-one via ring closing metathesis. Furthermore, synthetic methodologies have been developed as a part of the total synthesis. Several lipases have been screeened for their ability to generate enantiomerically pure 1-(3-Furyl)-3-buten-1-ol via bio-catalyzed hydrolysis of the corresponding acetate. The lipase from <i>Pseudomonas fluorescens</i> was identified as having stereoselectivity high enough to generate a % <i>ee </i>value above 98%. We have also developed a route for the introduction of a hydroxyl functionality in the γ position of α,β-unsaturated cyclic ketones by the regioselective oxidation of 1-silyloxy-1,3-dienes using dimethyldioxirane. We have initiated the investigation of the pharmacophore responsible for the kappa opioid activity by synthesizing simplified analogues of salvinorin A. A synthetic route providing easy access to simplified analogues of salvinorin A have been established.</p>

This thesis explored the epidemiology of Posttraumatic Stress Disorder (PTSD) and different aspects of the disorder. Firstly, we investigated the lifetime prevalence of traumatic experiences and PTSD in the general adult population in Sweden and evaluated the impact of different trauma types, trauma frequency, and perceived distress. The results show that traumatic experiences are common and PTSD is not rare; roughly one out of ten traumatic events results in PTSD, with a 5.6% lifetime prevalence. The female/male ratio is 2:1. The risk for PTSD increases considerably with a high trauma-associated emotional impact. The distressing impact of a given trauma appears to be higher in women than in men, indicating an increased vulnerability in women. Secondly, we hypothesized that traffic road accidents (TRA’s) are one of the most prevalent types of traumatic events in Swedish society; therefore, we examined the impact of event and response characteristics associated with TRA’s on PTSD development. The data demonstrate that of those who had experienced a TRA (n=1074, 58.9%), 6.1% reported lifetime PTSD. TRA’s associated with fatal accidents and injury to oneself and related to high distress more than double the risk for PTSD. Thirdly, we compared the relative merits of the DSM-IV’s three-factor solution for PTSD symptoms to alternative models. We found that the symptomatology is equally well accounted for using all factor analytic models as yet presented in the literature; the DSM-IV, we found, provides as good a fit to data as other models. Fourthly, we examined the neurofunctional correlates of PTSD symptoms and whether a treatment-induced (serotonin reuptake inhibitor - SSRI) reduction of PTSD symptoms is associated with altered rCBF during symptom provocation. Our results indicate that PTSD symptoms correlates with areas involved in memory, emotion, attention, and motor control and that SSRI treatment normalizes provocation-induced rCBF in these areas.

In this study, we have addressed the serotonergic and the opioid system within the CNS. Both systems are of outmost importance in the etiology of disease states, especially mental disorders. In our investigation of the serotonergic system, we have synthesized novel enantiomerically pure 6-aryl-3-amino- and 8-aryl-3-aminochromans as ligands for the 5-HT7 receptor. One reason for the lack of understanding of the physiological functionality of the serotonin 5-HT7 receptor, the most recently discovered member of the serotonin receptor family, is the absence of partial agonists and agonists. In this series, we have identified partial agonists with more than189 fold selectivity over the 5-HT1A receptor and one agonist with 29 fold greater selectivity over the serotonin 5-HT1A receptor. Thus the present series constitutes a starting point for developing highly selective ligands for the 5-HT7 receptor. In our investigation of the opioid system, our focus has been on the natural product salvinorin A, which is a highly selective kappa opioid receptor agonist. In the total synthesis of salvinorin A, we have accomplished the synthesis of a key intermediate, 6-(3-furyl)-4-methyl-5,6-dihydro-pyran-2-one via ring closing metathesis. Furthermore, synthetic methodologies have been developed as a part of the total synthesis. Several lipases have been screeened for their ability to generate enantiomerically pure 1-(3-Furyl)-3-buten-1-ol via bio-catalyzed hydrolysis of the corresponding acetate. The lipase from Pseudomonas fluorescens was identified as having stereoselectivity high enough to generate a % ee value above 98%. We have also developed a route for the introduction of a hydroxyl functionality in the γ position of α,β-unsaturated cyclic ketones by the regioselective oxidation of 1-silyloxy-1,3-dienes using dimethyldioxirane. We have initiated the investigation of the pharmacophore responsible for the kappa opioid activity by synthesizing simplified analogues of salvinorin A. A synthetic route providing easy access to simplified analogues of salvinorin A have been established.

The process of respiration is a pattern of spontaneity and automatic motor control that originate in the brainstem. The mechanism by which the brainstem detects CO2 is termed central CO2 chemoreception (CCR). Since the early 1960’s there have been tremendous efforts placed on identification of central CO2 chemoreceptors (molecules that detect CO2). Even with these efforts, what a central CO2 chemoreceptor looks like remain unknown. To test the hypothesis that inward rectifier K+ (Kir) channels are CO2 sensing molecules in CCR, a series of experiments were carried out. 1) The first question asked was whether the Kir4.1-Kir5.1 channel is expressed in brainstem chemosensitive nuclei. Immunocytochemistry was performed on transverse medullary and pontine sections using antibodies raised against Kir4.1 and Kir5.1. Positive immunoassays for both Kir4.1 and Kir5.1 subunits were found in CO2 chemosensitive neurons. In the LC the Kir4.1 and Kir5.1 were co-expressed with the neurokinin-1 receptor that is the natural receptor for substance P. 2) The second question asked was whether the Kir4.1-Kir5.1 channel is subject to modulation by neurotransmitters critical for respiratory control. My studies demonstrated that indeed the Kir4.1-Kir5.1 channel is subject to modulation by substance P, serotonin and thyrotropin releasing hormone. 3) I performed studies to demonstrate the intracellular signaling system underlying the Kir4.1-Kir5.1 channel modulation by these neurotransmitters. The modulation by all three neurotransmitters was dependent upon the activation of protein kinase C (PKC). The Kir4.1-Kir5.1 but not the Kir4.1 channel was modulated by PKC. Both the Kir4.1 and Kir5.1 subunits can be phosphorylated by PKC in vitro. However, systematic mutational analysis failed to reveal the phosphorylation site. 4) The fourth question asked was whether Kir channels share a common pH gating mechanism that can be identified. Experiments were performed to understand the gating of the Kir6.2+SUR1 channel as specific sites for ligand binding and gating have been demonstrated. I identified a functional gate that was shared by multiple ligands that is Phe168 in the Kir6.2. Other Kir channels appear to share a similar gating mechanism. Taken together, these studies demonstrate the modulation of Kir channels in central CO2 chemoreception.