Hyperactivity is thought to be associated with an alteration of dopamine (DA) neurochemistry in brain. This conventional view became solidified on the basis of observed hyperactivity in DA-lesioned animals and effectiveness of the dopaminomimetics such as amphetamine (AMP) in abating hyperactivity in humans and in animal models of hyperactivity. However, because AMPreleases serotonin (5-HT) as well as DA, we investigated the potential role of 5-HT in an animal model of hyperactivity. We found that a greater intensity of hyperactivity was produced in rats when both DA and 5-HT neurons were damaged at appropriate times in ontogeny. Therefore, previously we proposed this as an animal model of attention deficit hyperactivity disorder (ADHD) - induced by destruction of dopaminergic neurons with 6-hydroxydopamine (6-OHDA (neonatally) and serotoninergic neurons with 5,7-dihydroxytryptamine (5,7-DHT) (in adulthood). In this model effects similar to that of AMP(attenuation of hyperlocomotion) were produced by m-chlorophenylpiperazine (m-CPP) but not by 1-phenylbiguanide (1-PG), respective 5-HT2 and 5-HT3 agonists. The effect of m-CPP was shown to be replicated by desipramine, and was largely attenuated by the 5-HT2 antagonist mianserin. These findings implicate 5-HT neurochemistry as potentially important therapeutic targets for treating human hyperactivity and possibly childhood ADHD.

This thesis aims to review if there is an association between antidepressants and caries in children and adolescents. Previous established evidence exhibits that adults prescribed tricyclic antidepressants have an increased risk of caries. Simultaneously, a global trend of increased prescriptions of antidepressant medications is seen. In Sweden during 2018, 0–17-year old’s on antidepressant medication represented 1,6% percent of the total population. It is of utmost relevance to investigate the association between antidepressants and caries as the increasing population of medicating children may lead to an increased caries prevalence. A systematic literature review was performed in accordance with PRISMAs guidelines. The title-abstract and keywords searches were conducted in the following seven bibliographic databases: PubMed, EMBASE, CINAHL, Scopus, Web of Science, PsycINFO and MedLine. The search consisted of blocks based on “caries”, “children” and “antidepressants”. Unique articles were reviewed from title and abstract. Articles that met the criteria were reviewed in full text. The search generated 1829 unique articles, 1891 were excluded from the predefined criteria. 10 articles were reviewed in full text. None of the articles were eligible within the criteria of inclusion. The conclusion is that further research is needed in this area to assess the possible association between antidepressants and caries in children and adolescents. / Uppsatsen syftar till att sammanställa forskningsläget för sambandet mellan antidepressiv medicinering och karies hos barn och ungdomar. Tidigare evidens visar att vuxna som medicinerar med tricykliska antidepressiva har ökad kariesrisk. Samtidigt kan man globalt se en generell förskrivningsökning av antidepressiva. I Sverige under 2018, utgjorde användarna av antidepressiva i åldersgruppen 0–17 år 1,6% av totalpopulationen. Det är av högsta relevans att undersöka om det finns en potentiell association mellan antidepressiva och karies finns då den ökande populationen av medicinerande barn kan medföra ökad kariesprevalens. En systematisk litteraturöversikt genomfördes enligt PRISMAs riktlinjer. Titel- sammanfattnings och nyckelordssökningen utnyttjade följande sju elektroniska databaser: PubMed, EMBASE, CINAHL, Scopus, Web of Science, PsycINFO och MedLine. Sökningen utfördes i block utifrån “karies”, “barn” och “antidepressiva”. Unika artiklar granskades utifrån titel och abstrakt. Artiklar som uppfyllde förutbestämda kriterier för inklusion granskades i fulltext. Utifrån sökningen påträffades 1829 unika artiklar, varav 1819 exkluderades utifrån från titel och abstrakt. 10 artiklar granskades i fulltext och vi konstaterade att ingen artikel uppfyllde kriterierierna. Slutsatsen för studien är att fler studier och mer forskning behövs inom området. Detta för att kunna svara på om det finns ett samband mellan antidepressiva och karies hos barn.

Introduction: Obsessive-compulsive disorder (OCD) is a complex disorder that is associated with significantly impaired functioning. The current prevailing model of OCD implicates dysfunction of the serotonergic neurotransmitter system and fronto-striatal neural networks, but challenges in replicating findings within OCD samples are often attributed to clinical heterogeneity. OCD symptoms that develop or worsen within the perinatal period appears to reflect a distinct subtype of the disorder, but the genetic and neurobiological factors that contributes to its presentation in women is poorly understood. In this dissertation, we aimed to review the literature on the genetic architecture of OCD, identify potential gene candidates for perinatal OCD and analyze one serotonin system gene according to OCD and possible subtypes using meta-analytic techniques. Based on these findings, we then tested the association of serotonergic candidate gene polymorphisms with the presence of infant-related obsessive-compulsive symptoms (OCS). Lastly, we investigated the cortical morphological features associated with perinatal OCD and OCS symptom severity in postpartum mothers. Results: From prior reports in the literature and our own meta-analytic investigation, polymorphic variants in genes coding for the serotonergic transporter and serotonin 2A receptor subtype (SLC6A4 and HTR2A, respectively) appear to be candidates for perinatal OCD due to their association in female samples. However, upon investigation in our perinatal sample (n=107), we found no evidence to support the association of the 5-HTTLPR polymorphism of SLC6A4 with perinatal-related OCS, but larger samples are needed to confirm this finding. Due to technical challenges, the HTR2A polymorphism remains to be tested. Our novel whole-brain explorations revealed distinct cortical morphology associated with symptom worsening across the perinatal period, irrespective of diagnosis. Cortical parameters were not able to differentiate mothers with and without OCD; however, OCD mothers displayed positive correlations between cortical surface area and symptom severity in widespread regions, including the frontal, parietal, temporal and occipital cortex. Conclusions: Overall, this body of work aimed to fill the gap in the literature by exploring the possible genetic and cortical correlates of perinatal-related OCS and OCD. While 5-HTTLPR or HTR2A are candidates for perinatal OCD, it is not yet clear whether they increase susceptibility for the development of infant-related OCS in the perinatal period. Distinct cortical alterations in surface area appeared alongside OCS exacerbation in the postpartum period in regions that extend beyond the frontoparietal network. This suggests that additional neural networks may be contributing to symptom severity and that the cortical plasticity that occurs across the perinatal period may predispose women for risk of OCD. Future studies should continue to use a multiple perspective approach, that utilizes genetic and neurobiological techniques, in order to provide greater insight into the etiology of perinatal OCD. / Dissertation / Doctor of Philosophy (PhD) / Women are at greater risk for the development of mental illness in the time surrounding pregnancy and postpartum, known as the perinatal period. In the case of perinatal obsessive-compulsive disorder (OCD), mothers may experience unique worries in regard to their parenting or fears that their baby may be harmed. While these worries are common, they can become disruptive when persistent and impact the mother’s mood and ability to bond with the infant. Our current understanding of OCD includes the influence of genetic factors and brain changes, but little is understood about what factors may increase risk for OCD in the perinatal period. In this thesis, we aimed to review whether certain alterations within DNA segments, known as gene variants, may be linked to the development of OCD in females and if these gene changes, as well as differences in brain structures in postpartum mothers, are associated with OCD symptoms during the perinatal period. The genes we examined are important for regulating a chemical signaling substance in the brain known as serotonin. Based on our results, we did not find a relationship between serotonin gene variants and OCD symptoms in perinatal women. We also found no differences when comparing the cortical brain structures between mothers with OCD and healthy mothers; however, we observed that measures of surface area across several cortical brain regions were related to symptom worsening from pregnancy to postpartum, and also with symptom severity in postpartum mothers with OCD. These results suggest that there are widespread brain changes during the postpartum period that may increase a mother’s risk for developing OCD. Overall, the work in this thesis provides the first glimpse into potential risk factors for perinatal OCD.

<p>The brain serotonergic and dopaminergic systems broadly influence our internal experience and the ways in which we interact with the outside environment, with crucial regulatory roles in mood, sleep, appetite and the control of voluntary movement. Serotonin and dopamine neurons are themselves influenced by a wide variety of internal and external factors, many of which remain poorly understood. The central aim of this thesis was to better characterize several of these modulatory influences via exploratory investigations involving pharmaceutical agents or environmental modification. Specifically, I examined the modulatory effects of selective serotonin reuptake inhibitors (SSRIs), atypical neuroleptics and environmental enrichment with exercise on the regulation of brain serotonin and dopamine neurons.</p> <p>This thesis documents, for the first time, that (1) inhibition of the serotonin transporter (SERT) by SSRIs induces a rapid and region-selective reduction of tryptophan hydroxylase (TPH)-immunoreactive neurons in serotonergic brainstem nuclei that persists over a prolonged treatment course; that (2) selective blockade of SERT by SSRIs can rapidly induce a reduction of tyrosine hydroxylase (TH)-positive dopaminergic neurons in the substantia nigra (SN) and the ventral tegmental area (VTA) that, again, persists over a lengthy treatment course; that (3) environmental enrichment with exercise can potentiate the effect of SERT inhibition on SN dopaminergic neurons, but not the dorsal raphe nucleus (DRN) serotonergic neurons; that (4) that SSRI fluoxetine triggers a significant upregulation of microglia in the SN; that (5) environmental enrichment with exercise can reduce TPH immunoreactivity in the DRN and TH immunoreactivity in the SN and VTA, even in the absence of any pharmacological intervention, and finally, that (6) the atypical neuroleptic risperidone significantly reduces TPH in the DRN of both young and aged animals and reduces DRN Nissl counts in aged animals. Taken together, the body of work included in this thesis suggests that SSRIs, atypical neuroleptics and environmental enrichment with exercise can have profound effects on brain serotonergic and dopaminergic neurons, possibly accounting for some of the side effects and therapeutic benefits associated with these interventions.</p> / Doctor of Philosophy (PhD)

Die Tryptophanhydroxylase (TPH) katalysiert den geschwindigkeitsbestimmenden Schritt der Synthese des wichtigen Neurotransmitters Serotonin. Kürzlich wurde ein zweites TPH-Isozym, die TPH2, entdeckt. Es stellte sich heraus, dass dieses Isozym für die Serotoninsynthese im Zentralnervensystem verantwortlich ist, wohingegen die TPH1 lediglich der Ausgangspunkt der Serotoninsynthese in den peripheren Geweben ist. Da Störungen im Serotoninstoffwechsel mit einer Vielzahl von psychiatrischen Erkrankungen in Verbindung gebracht werden, rückt nun die als neuronales Enzym identifizierte TPH2 in den Fokus der Forschung. In dieser Arbeit konnte gezeigt werden, dass TPH1 und 2 sich nicht nur in ihren Expressionsorten sondern auch in ihren grundlegenden biochemischen Eigenschaften voneinander unterscheiden. Die TPH1 stellte sich als aktiveres der beiden Enzyme heraus. Der N- und C-Terminus der TPH2 konnten als auf die Aktivität des Enzyms inhibierend bzw. aktivierend wirkende Strukturen identifiziert werden und stellen damit interessante Angriffspunkte für die pharmakologische Beeinflussung dar, wobei der N-Terminus als TPH2-spezifische Struktur eine gezielte Beeinflussung des serotonergen Systems im Zentralnervensystem ohne Auswirkungen auf das periphere System ermöglichen würde. In weiteren Projekten konnte die Existenz von mindestens zwei, die Enzymaktivität nicht beeinflussenden Proteinkinase A-Phosphorylierungsstellen in der TPH2 nachgewiesen werden, es konnte ein auf einem fluorometrischen Prinzip basierender High-Throughput-Assay zur Bestimmung der TPH-Aktivität entwickelt werden, Tubulin beta2A wurde als Interaktionpartner der TPH2 identifiziert, die Auswirkungen eines in vitro aktivitätssenkenden Tph2-SNPs auf die Serotoninlevel und das Verhalten verschiedener Mausstämme konnte durch die Generierung und Untersuchung von congenen Mäusen als unbedeutend eingestuft werden und die Expression von TPH1-mRNA wurde als Marker für endometriale Karzinome identifiziert. / Tryptophan hydroxylase (TPH) catalyzes the rate limiting step of the synthesis of the important neurotransmitter serotonin. Recently a new TPH isoenzyme, TPH2, was discovered. It turned out that this isoenzyme is responsible for the serotonin synthesis within the central nervous system, whereas the TPH1 is merely the starting point of serotonin synthesis in peripheral tissues. Since dysfunction in the metabolism of serotonin is related to a large number of psychiatric diseases, the neuronal TPH2 moved into the centre of interest. As a basis for the pharmacological manipulation of the central nervous serotonergic system, without influencing the periphery, the identification of differences between the two isoenzymes is essential. In this thesis it was shown that TPH1 and 2 not only differ in their expression sites but also in their basic biochemical characteristics. TPH1 turned out to be the more active enzyme. Furthermore it was shown that the N- and C-termini of TPH2 have an inhibitory respectively activating influence on the enzymatic activity. Therefore they became interesting targets for pharmacological interference, whereas the N-terminus as a TPH2 specific structure would facilitate the manipulation of the central nervous serotonergic system without exerting influence on the peripheral system. In further projects the existence of at least two protein kinase A phosphorylation sites could be verified, whereas the phosphorylation doesn’t seem to have any influence on the enzymatic activity, a high throughput assay for determination of TPH activity, based on a fluorometric principle, was developed, Tubulin beta2A was identified as a TPH2 interaction partner, the effect of a SNP in the Tph2 gene that decreases the TPH2 activity in vitro on the serotonin level and the behaviour of different mouse strains could be rated as insignificant by the generation of congenic mice und the expression of TPH1 mRNA was identified as a marker for endometrial cancer.

Serotonin (5-HT) nimmt eine wichtige Rolle in der Regulation von Nahrungsaufnahme ein. Erhöhte 5-HT-Freisetzung hemmt die Nahrungsaufnahme. Der 5-HT1A-Rezeptor liegt sowohl somatodendritisch als auch postsynaptisch vor. Seine Stimulation mit 8-OH-DPAT vermindert die 5-HT-Freisetzung. Die in-vivo-Mikrodialyse ermöglichte uns eine kontinuierliche Messung von extrazellulärem 5-HT im lateralen Hypothalamus an der frei beweglichen Ratte. Unsere Ergebnisse zeigen einen Abfall der 5-HT-Freisetzung bei satten Ratten, nicht jedoch wenn diesen nach Substanzgabe Futter angeboten wurde. Bei hungrigen Ratten war nach Substanzgabe keine signifikante Veränderung in der 5-HT-Freisetzung zu messen. Zusammenfassend wird mit der vorliegenden Studie erstmals die Wirkung von 8-OH-DPAT auf die 5-HT-Freisetzung im LHA in Abhängigkeit von unterschiedlichen Motivationszuständen in Verbindung mit Nahrungsaufnahme gezeigt. / Serotonin (5-HT) is an important mediator of satiety. Increase of 5-HT release inhibits food intake. 8-OH-DPAT, an agonist at the somatodendritic 5-HT1A autoreceptor, reduces serotonergic activity and induces food intake. With the technique of in vivo microdialysis we were able to measure continuously extracellular 5-HT in the lateral hypothalamic area (LHA) in freely moving rats under different feeding conditions. The present results show a decrease of 5-HT release in freely feeding rats after administration of 8-OH-DPAT. This effect was not obtained when offering food after drug application. In contrast, no significant effect in 5-HT release after application of 8-OH-DPAT in food deprived rats was measured. In summery this study demonstrates the effect of 8-OH-DPAT on the 5-HT release in LHA of freely moving rat depending on the different feeding conditions.

Serotonin (5-Hydroxytryptamin, 5-HT) ist ein wichtiger Neurotransmitter im Zentralnervensystem (ZNS). Seine Biosynthese erfolgt unter Beteiligung des Enzyms Tryptophanhydroxylase 2 (TPH2). Polymorphismen im TPH2 Gen beim Menschen sind Risikofaktoren bei der Entstehung von Depressionen und Angstverhalten. Die gängigsten Antidepressiva und Anxiolytika wirken auf das Serotonin System. Unklar ist, ob das komplette oder teilweise Fehlen von Serotonin im Gehirn zu Entwicklungsstörungen und neurochemischen oder psychologischen Veränderungen führt. In dieser Arbeit werden Mauslinien mit unterschiedlichen TPH2 Aktivitäten im ZNS verglichen und der Einfluss verringerter 5-HT Konzentrationen auf Entwicklung und Verhalten der Tiere untersucht. Zentrales Serotonin ist nur für die postnatale Entwicklung notwendig. Das verzögerte Wachstum von Tph2-/- Tieren ist nicht auf eine Störung der Hypothalamus-Hypophysen-Nebennieren-Achse oder auf metabolische Veränderungen zurückzuführen, sondern kann aus verringerter Vokalisation im Ultraschallbereich resultieren. Tph2-/- Mäuse wurden mit generierten Mausmodellen mit niedriger TPH2 Aktivität vergleichen. Die Ergebnisse zeigen, dass 20% weniger zentrales Serotonin nicht ausreichen, um Depression oder Angst-Verhalten herbeizuführen. Möglicherweise greifen kompensatorische Mechanismen wie ein verringerter Serotoninmetabolismus oder eine gesteigerte 5-HT1A-Rezeptorsensitivität. Der komplette Verlust von Serotonin im Gehirn führt zu einem starken depressiven und weniger ängstlich Verhalten, mit erhöhter Aggression - ohne Veränderung in Aktivität, Geruchsinn, Gedächnis und adulter Neurogenese. Fluoxetine Behandlung von Tph2-defizienten Mäusen zeigte einen Serotonin-unabhängigen Effekt dieses Antodepressivums auf Angst-Verhalten und Depression. Fluoxeine reduzieren den Serotoningehalt im Gehirn von Mäusen mit geringen TPH2-Aktivität, was zeigt, dass TPH-Aktivität die Effizienz von Serotonin beeinflussenAntidepressiva bestimmen, / Serotonin (5-HT) is a major neurotransmitter in the brain biosynthesis of which is initiated by tryptophan hydroxylase 2 (TPH2). Polymorphisms in the TPH2 gene are suggested as risk factors associated with depression and anxiety in humans. Furthermore, the most frequently prescribed antidepressants and anxiolytics target the serotonergic system. However, the question whether a complete ablation or partial reduction in brain serotonin leads to the developmental, neurochemical, or psychological abnormalities remains unresolved. In this study, I took advantage of mouse lines with various degree of decrease in TPH2 activity in order to dissect the impact of 5-HT loss on development, brain neurochemistry and behavior. Using Tph2-deficient mice I showed that central serotonin is essential for normal postnatal, but not prenatal development. Growth retardation of Tph2-/- mice was not a result of a disruption of the hypothalamo-pituitary-adrenal axis, metabolic abnormalities, or impaired thermoregulation, but could result from reduced ultrasonic vocalization. I tested Tph2-/- mice along with other newly generated mouse models with partial TPH2 reduction, and showed that 20% reduction in central serotonin is not enough to cause changes in anxiety- and depression-like behaviors most likely due to compensatory mechanisms including reduced serotonin metabolism and increased 5-HT1A receptor sensitivity. However, complete loss of central serotonin leads to a depression-like phenotype, reduced anxiety-like behavior, and exaggerated aggression, but no differences in activity, olfaction, memory, and adult neurogenesis. Fluoxetine treatment of Tph2-/- mice revealed serotonin-independent action of this antidepressant on anxiety- and depression-like behavior. Furthermore, fluoxetine drastically reduced the brain 5-HT content in mice with low TPH2 activity indicating that TPH2 activity may determine the efficiency of antidepressants targeting the serotonergic system.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

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