Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010. / Härtill 5 uppsatser.

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INTRODUÇÃO: O transtorno obsessivo-compulsivo (TOC) apresenta prevalência ao longo da vida ao redor de 2%. O tratamento farmacológico de primeira linha para o TOC é feito com inibidores da recaptura de serotonina (IRS). Aproximadamente metade dos pacientes tratados adequadamente com um IRS não apresenta resposta satisfatória. Resultados de estudos de neuroimagem, genéticos e de análise do líquido cefalorraquidiano de portadores de TOC sugerem o envolvimento da disfunção da atividade glutamatérgica na fisiopatologia do TOC. Medicamentos com efeito modulador da atividade glutamatérgica vem sendo testados em pacientes com TOC e alguns deles mostraram-se eficazes. A N-Acetilcisteína (NAC) é um agente modulador da atividade glutamatérgica e antioxidante. Este estudo tem como objetivo principal testar a eficácia da potencialização de IRS com NAC, em comparação com placebo, em pacientes com TOC resistente ao tratamento. MÉTODOS: Estudo duplo cego, randomizado e controlado com placebo, com duração de 16 semanas, conduzido num ambulatório especializado de um hospital terciário (maio/2012 - outubro/2014). Critérios de inclusão: 18-65 anos; diagnóstico principal de TOC, de acordo com os critérios do DSM-IV; falha terapêutica a pelo menos um tratamento farmacológico adequado para o TOC; escore inicial da escala Yale-Brown de Sintomas Obsessivo-Compulsivos (Y-BOCS) >= 16 ou >= 10, se apenas compulsões; e gravidade inicial do TOC pelo menos moderada, de acordo com a escala de gravidade da Impressão Clínica Global. Os medicamentos em uso no momento da randomização foram mantidos nas mesmas doses. A intervenção consistiu na associação de NAC (até 3000 mg/dia) ou placebo. Avaliações cegas foram realizadas antes e ao final da intervenção. Utilizamos como desfecho primário os escores da Y-BOCS. Utilizamos análise de variância não-paramétrica para medidas repetidas. Como desfechos secundários, consideramos a redução dos escores iniciais dos Inventários de Depressão e Ansiedade de Beck, da Y-BOCS Dimensional e da Escala Brown de Avaliação de Crenças. Registro do estudo: clinicaltrials.gov identifier: NCT01555970. RESULTADOS: Foram realizadas 145 consultas de triagem, 129 indivíduos preencheram os critérios de inclusão, 40 foram randomizados (NAC até 3000 mg/dia, n= 18; placebo, n= 22), 39 iniciaram a intervenção e 35 terminaram o estudo. Não houve diferença significativa entre os grupos quanto à taxa de perda (NAC: 1 em 17 [5,9%]; placebo: 3 em 22 [13,6%]; ?2 = 0,63; P= 0,43). Todos os indivíduos melhoraram significativamente ao longo do tempo, de acordo com a redução do escore da Y-BOCS, mas não houve diferenças significativas entre os grupos (NAC: 25,6 [DP= 4,4] para 21,3 [DP= 8,1]; placebo: 24,8 [DP= 3,8] para 21,8 [DP= 6,0]; F= 0,33; P= 0,92). A associação com NAC foi superior ao placebo em relação à melhora da gravidade dos sintomas ansiosos, indicada pela redução do escore do Inventário de Ansiedade de Beck (média [DP]: NAC= 7,8 [11,7]; placebo: -0,55 [7,9]; U= 89; P= 0,02). Não houve diferenças significativas entre os grupos quanto à melhora dos sintomas depressivos, das diferentes dimensões de sintomas de TOC e do nível de insight. CONCLUSÕES: A potencialização de IRS com NAC foi superior ao placebo em relação à melhora da gravidade dos sintomas ansiosos. Entretanto, não houve diferença entre os grupos na melhora da gravidade dos sintomas do TOC / INTRODUCTION: Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder with a lifetime prevalence of 2-3%. Treatment guidelines recommend serotonin reuptake inhibitors (SRIs) as the first-line pharmacological treatment for OCD. However, approximately half of patients treated with an adequate trial of SRIs fail to fully respond to treatment. OCD is associated with hyperactivity in cortical-striatum-thalamus-cortical (CSTC) circuits. Cortico-striatal and thalamo-striatal afferents use the excitatory neurotransmitter glutamate, and there is evidence suggesting abnormal glutamate levels and/or homeostasis in OCD patients. Researchers have been testing glutamate-modulating medications in OCD, with some evidence for efficacy. N-Acetylcysteine (NAC), a glutamate-modulating agent, is being considered as an add-on strategy for treatment-resistant OCD. The main objective of this study was to determine if NAC is effective in treatment-resistant OCD patients after 16 weeks of SRI augmentation. METHODS: We conducted a randomized, double blind, placebo-controlled, 16-week trial in an OCD-specialized outpatient clinic at a tertiary hospital (May 2012-October 2014). Inclusion criteria: age between 18-65 years; DSM-IV primary diagnosis of OCD; failure to respond to at least one previous adequate pharmacological treatment for OCD; baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) global score >= 16 or >= 10 if only compulsions are present; OCD symptoms of at least moderate severity on the Clinical Global Impression-Severity subscale. Medications in use at randomization were maintained at the same dose. Assessments were conducted at baseline and end of the study. The primary outcome measure was the Y-BOCS scores. To evaluate the variables group, time, and interaction effects for Y-BOCS scores at all time points, we used nonparametric analysis of variance (ANOVA) with repeated measures. The secondary outcomes were the mean reduction of the baseline Beck Anxiety and Depression Inventories, Dimensional Yale-Brown Obsessive-Compulsive Scale and Brown Assessment of Beliefs Scale scores. Trial registration: clinicaltrials.gov identifier NCT01555970. RESULTS: We assessed 145 patients for eligibility, 129 were eligible, 40 were randomized (NAC up to 3000 mg/day, n= 18; placebo, n= 22), 39 initiated the intervention and 35 completed the trial. Dropout did not significantly differ by treatment group (NAC: 1 of 17 [5.9%]; placebo: 3 of 22 [13.6%]; ?2 = .63; P= .43). Both groups significantly improved over the 16 weeks, as indicated by the reduction of baseline Y-BOCS scores, but there were no significant differences between groups (NAC: 25.6 [SD= 4.4] to 21.3 [DP= 8.1]; placebo: 24.8 [SD= 3.8] to 21.8 [SD= 6.0]; F= .33; P = .92). Adding NAC to SRI was superior to placebo in improving anxiety symptoms, as measured by the reduction of baseline Beck Anxiety Inventory score (mean [SD]: NAC= 7.8 [11.7]; placebo: -.55 [7.9]; U= 89; P= .02). There were no significant differences between groups in regards to the improvement of depressive symptoms, different dimensions of OCD symptoms and insight level. CONCLUSIONS: NAC augmentation of SRI was more effective than placebo in reducing the severity of anxiety symptoms in this sample of treatment-resistant OCD individuals. However, it was not better than placebo in reducing OCD severity

http://www.pharmacol.usyd.edu.au/thesis This thesis is primarily concerned with a class of chemical compounds known as pyridazinediones, being 6-membered aromatic rings containing two adjacent nitrogen atoms (pyridazine), doubly substituted with oxygen. In particular, the work focuses on pyridazine-3,6-diones, derivatives of maleic hydrazide (1). Understanding of the chemistry of these compounds is extended, using theoretical and synthetic techniques. This thesis is also concerned with two very important classes of receptors which bind amino acids in the brain: firstly, the inhibitory GABA receptor, which binds g-aminobutyric acid (GABA) (2) in vivo, and for which muscimol (3) is an agonist of the GABAA subclass; secondly, Excitatory Amino Acid (EAA) receptors, which bind glutamate (4) in vivo, and in particular the AMPA subclass, for which (S)-2-amino-3-(3-hydroxy-5-methylisoxazol-4-yl)propionic acid (AMPA) (5) is an agonist. The connection between pyridazinediones and amino acid receptors is the design, synthesis, and evaluation of structures based on pyridazinediones as potential GABA and EAA receptor ligands. Techniques of theoretical chemistry, molecular modelling, synthetic chemistry, and in vitro pharmacology are used to explore pyridazine-3,6-dione derivatives as ligands.

http://www.pharmacol.usyd.edu.au/thesis This thesis is primarily concerned with a class of chemical compounds known as pyridazinediones, being 6-membered aromatic rings containing two adjacent nitrogen atoms (pyridazine), doubly substituted with oxygen. In particular, the work focuses on pyridazine-3,6-diones, derivatives of maleic hydrazide (1). Understanding of the chemistry of these compounds is extended, using theoretical and synthetic techniques. This thesis is also concerned with two very important classes of receptors which bind amino acids in the brain: firstly, the inhibitory GABA receptor, which binds g-aminobutyric acid (GABA) (2) in vivo, and for which muscimol (3) is an agonist of the GABAA subclass; secondly, Excitatory Amino Acid (EAA) receptors, which bind glutamate (4) in vivo, and in particular the AMPA subclass, for which (S)-2-amino-3-(3-hydroxy-5-methylisoxazol-4-yl)propionic acid (AMPA) (5) is an agonist. The connection between pyridazinediones and amino acid receptors is the design, synthesis, and evaluation of structures based on pyridazinediones as potential GABA and EAA receptor ligands. Techniques of theoretical chemistry, molecular modelling, synthetic chemistry, and in vitro pharmacology are used to explore pyridazine-3,6-dione derivatives as ligands.

INTRODUÇÃO: O transtorno obsessivo-compulsivo (TOC) apresenta prevalência ao longo da vida ao redor de 2%. O tratamento farmacológico de primeira linha para o TOC é feito com inibidores da recaptura de serotonina (IRS). Aproximadamente metade dos pacientes tratados adequadamente com um IRS não apresenta resposta satisfatória. Resultados de estudos de neuroimagem, genéticos e de análise do líquido cefalorraquidiano de portadores de TOC sugerem o envolvimento da disfunção da atividade glutamatérgica na fisiopatologia do TOC. Medicamentos com efeito modulador da atividade glutamatérgica vem sendo testados em pacientes com TOC e alguns deles mostraram-se eficazes. A N-Acetilcisteína (NAC) é um agente modulador da atividade glutamatérgica e antioxidante. Este estudo tem como objetivo principal testar a eficácia da potencialização de IRS com NAC, em comparação com placebo, em pacientes com TOC resistente ao tratamento. MÉTODOS: Estudo duplo cego, randomizado e controlado com placebo, com duração de 16 semanas, conduzido num ambulatório especializado de um hospital terciário (maio/2012 - outubro/2014). Critérios de inclusão: 18-65 anos; diagnóstico principal de TOC, de acordo com os critérios do DSM-IV; falha terapêutica a pelo menos um tratamento farmacológico adequado para o TOC; escore inicial da escala Yale-Brown de Sintomas Obsessivo-Compulsivos (Y-BOCS) >= 16 ou >= 10, se apenas compulsões; e gravidade inicial do TOC pelo menos moderada, de acordo com a escala de gravidade da Impressão Clínica Global. Os medicamentos em uso no momento da randomização foram mantidos nas mesmas doses. A intervenção consistiu na associação de NAC (até 3000 mg/dia) ou placebo. Avaliações cegas foram realizadas antes e ao final da intervenção. Utilizamos como desfecho primário os escores da Y-BOCS. Utilizamos análise de variância não-paramétrica para medidas repetidas. Como desfechos secundários, consideramos a redução dos escores iniciais dos Inventários de Depressão e Ansiedade de Beck, da Y-BOCS Dimensional e da Escala Brown de Avaliação de Crenças. Registro do estudo: clinicaltrials.gov identifier: NCT01555970. RESULTADOS: Foram realizadas 145 consultas de triagem, 129 indivíduos preencheram os critérios de inclusão, 40 foram randomizados (NAC até 3000 mg/dia, n= 18; placebo, n= 22), 39 iniciaram a intervenção e 35 terminaram o estudo. Não houve diferença significativa entre os grupos quanto à taxa de perda (NAC: 1 em 17 [5,9%]; placebo: 3 em 22 [13,6%]; ?2 = 0,63; P= 0,43). Todos os indivíduos melhoraram significativamente ao longo do tempo, de acordo com a redução do escore da Y-BOCS, mas não houve diferenças significativas entre os grupos (NAC: 25,6 [DP= 4,4] para 21,3 [DP= 8,1]; placebo: 24,8 [DP= 3,8] para 21,8 [DP= 6,0]; F= 0,33; P= 0,92). A associação com NAC foi superior ao placebo em relação à melhora da gravidade dos sintomas ansiosos, indicada pela redução do escore do Inventário de Ansiedade de Beck (média [DP]: NAC= 7,8 [11,7]; placebo: -0,55 [7,9]; U= 89; P= 0,02). Não houve diferenças significativas entre os grupos quanto à melhora dos sintomas depressivos, das diferentes dimensões de sintomas de TOC e do nível de insight. CONCLUSÕES: A potencialização de IRS com NAC foi superior ao placebo em relação à melhora da gravidade dos sintomas ansiosos. Entretanto, não houve diferença entre os grupos na melhora da gravidade dos sintomas do TOC / INTRODUCTION: Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder with a lifetime prevalence of 2-3%. Treatment guidelines recommend serotonin reuptake inhibitors (SRIs) as the first-line pharmacological treatment for OCD. However, approximately half of patients treated with an adequate trial of SRIs fail to fully respond to treatment. OCD is associated with hyperactivity in cortical-striatum-thalamus-cortical (CSTC) circuits. Cortico-striatal and thalamo-striatal afferents use the excitatory neurotransmitter glutamate, and there is evidence suggesting abnormal glutamate levels and/or homeostasis in OCD patients. Researchers have been testing glutamate-modulating medications in OCD, with some evidence for efficacy. N-Acetylcysteine (NAC), a glutamate-modulating agent, is being considered as an add-on strategy for treatment-resistant OCD. The main objective of this study was to determine if NAC is effective in treatment-resistant OCD patients after 16 weeks of SRI augmentation. METHODS: We conducted a randomized, double blind, placebo-controlled, 16-week trial in an OCD-specialized outpatient clinic at a tertiary hospital (May 2012-October 2014). Inclusion criteria: age between 18-65 years; DSM-IV primary diagnosis of OCD; failure to respond to at least one previous adequate pharmacological treatment for OCD; baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) global score >= 16 or >= 10 if only compulsions are present; OCD symptoms of at least moderate severity on the Clinical Global Impression-Severity subscale. Medications in use at randomization were maintained at the same dose. Assessments were conducted at baseline and end of the study. The primary outcome measure was the Y-BOCS scores. To evaluate the variables group, time, and interaction effects for Y-BOCS scores at all time points, we used nonparametric analysis of variance (ANOVA) with repeated measures. The secondary outcomes were the mean reduction of the baseline Beck Anxiety and Depression Inventories, Dimensional Yale-Brown Obsessive-Compulsive Scale and Brown Assessment of Beliefs Scale scores. Trial registration: clinicaltrials.gov identifier NCT01555970. RESULTS: We assessed 145 patients for eligibility, 129 were eligible, 40 were randomized (NAC up to 3000 mg/day, n= 18; placebo, n= 22), 39 initiated the intervention and 35 completed the trial. Dropout did not significantly differ by treatment group (NAC: 1 of 17 [5.9%]; placebo: 3 of 22 [13.6%]; ?2 = .63; P= .43). Both groups significantly improved over the 16 weeks, as indicated by the reduction of baseline Y-BOCS scores, but there were no significant differences between groups (NAC: 25.6 [SD= 4.4] to 21.3 [DP= 8.1]; placebo: 24.8 [SD= 3.8] to 21.8 [SD= 6.0]; F= .33; P = .92). Adding NAC to SRI was superior to placebo in improving anxiety symptoms, as measured by the reduction of baseline Beck Anxiety Inventory score (mean [SD]: NAC= 7.8 [11.7]; placebo: -.55 [7.9]; U= 89; P= .02). There were no significant differences between groups in regards to the improvement of depressive symptoms, different dimensions of OCD symptoms and insight level. CONCLUSIONS: NAC augmentation of SRI was more effective than placebo in reducing the severity of anxiety symptoms in this sample of treatment-resistant OCD individuals. However, it was not better than placebo in reducing OCD severity

Autism is a lifelong neurodevelopmental disorder. The etiology of autism still remains unclear due to the heterogeneous and complex nature of the disorder, however synergistic actions between genetic components and environmental factors have been suggested. Acetaminophen (APAP) is one of the most popular over-the-counter drugs that possess antipyretic and analgesic effects. It is considered a relatively safe and effective within therapeutic doses. Recently, early exposure to APAP has been suggested to be one of the underlying cause of autism. Children are often prescribed APAP to lessen fever or irritability after vaccination during the first year, and APAP may adversely affect the normal brain development. In order to better understand the association with APAP and autism, we used an inbred mouse strain BTBR T+tf/J (BTBR). BTBR exhibits behavioral deficits that mimic the core behavioral deficits of human autism. In the study, investigated 1) if BTBR mice showed differences in thiol biochemistry and EAAT3 levels in brain compared with C57BL/6J (C57) mice, 2) if early exposure to APAP induced behavioral changes worsening the autistic phenotypes of BTBR in adolescence, and 3) if APAP exposure in neonatal mice induced possible toxicity at various doses. As a result, we observed that BTBR mice have significantly lower plasma sulfate levels and EAAT expression levels in the frontal cortex compared to C57 mice. Surprisingly, neonatal therapeutic dose of APAP administration did not induce behavioral changes in both C57 and BTBR in adolescence. However, we showed that a supratheraputic dose of APAP significantly elevated levels of oxidative stress marker in the brain. Overall, the results suggested that BTBR mice would be a useful mouse model to investigate effects of various environmental factors that have been associated with autism. In addition, early exposure to APAP at supratherapeutic doses may negatively affect normal brain development.

No / The L-glutamate transporter GLT-1 is an abundant central nervous system (CNS) membrane protein of the excitatory amino acid transporter (EAAT) family that controls extracellular L-glutamate levels and is important in limiting excitotoxic neuronal death. Using reverse transcription-polymerase chain reaction, we have determined that four mRNAs encoding GLT-1 exist in mouse brain, with the potential to encode four GLT-1 isoforms that differ in their N and C termini. We expressed all four isoforms (termed MAST-KREK, MPK-KREK, MAST-DIETCI, and MPK-DIETCI according to amino acid sequence) in a range of cell lines and primary astrocytes and show that each isoform can reach the cell surface. In transfected human embryonic kidney (HEK) 293 or COS-7 cells, all four isoforms support high-affinity sodium-dependent L-glutamate uptake with identical pharmacological and kinetic properties. Inserting a viral epitope (tagged with V5, hemagglutinin, or FLAG) into the second extracellular domain of each isoform allowed coimmunoprecipitation and time-resolved Forster resonance energy transfer (tr-FRET) studies using transfected HEK-293 cells. Here we show for the first time that each of the four isoforms is able to combine to form homomeric and heteromeric assemblies, each of which is expressed at the cell surface of primary astrocytes. After activation of protein kinase C by phorbol ester, V5-tagged GLT-1 is rapidly removed from the cell surface of HEK-293 cells and degraded. This study provides direct biochemical evidence for oligomeric assembly of GLT-1 and reports the development of novel tools to provide insight into the trafficking of GLT-1.