Dysfunction of the central noradrenergic and dopaminergic systems is the primary neurobiological characteristic of Parkinson’s disease (PD). Importantly, neuronal loss in the locus coeruleus (LC) that occurs in early stages of PD may accelerate progressive loss of dopaminergic neurons. Therefore, restoring the activity and function of the deficient noradrenergic system may be an important therapeutic strategy for early PD. In the present study, the lentiviral constructions of transcription factors Phox2a/2b, Hand2 and Gata3, either alone or in combination, were microinjected into the LC region of the PD model VMAT2 Lo mice at 12 and 18 month age. Biochemical analysis showed that microinjection of lentiviral expression cassettes into the LC significantly increased mRNA levels of Phox2a, and Phox2b, which were accompanied by parallel increases of mRNA and proteins of dopamine β-hydroxylase (DBH) and tyrosine hydroxylase (TH) in the LC. Furthermore, there was considerable enhancement of DBH protein levels in the frontal cortex and hippocampus, as well as enhanced TH protein levels in the striatum and substantia nigra. Moreover, these manipulations profoundly increased norepinephrine and dopamine concentrations in the striatum, which was followed by a remarkable improvement of the spatial memory and locomotor behavior. These results reveal that over-expression of these transcription factors in the LC improves noradrenergic and dopaminergic activities and functions in this rodent model of PD. It provides the necessary groundwork for the development of gene therapies of PD, and expands our understanding of the link between the LC-norepinephrine and dopamine systems during the progression of PD.

Post-traumatic stress disorder (PTSD) is a heterogenous psychiatric condition that affects thousands of individuals each year. Of those who experience this condition, military members including members of the Canadian Armed Forces (CAF) are particularly vulnerable, demonstrating high prevalence rates of PTSD-related symptoms. Moreover, individuals with PTSD are at increased risk for comorbid conditions and are at greater risk for suicide due to the overwhelming, debilitating nature of PTSD symptoms. In previous research, hyperarousal symptoms associated with PTSD have been linked to dysregulation in the locus coeruleus norepinephrine (LC-NE) system, a vast neuromodulatory system responsible for regulating arousal, attention, autonomic and memory-related functions. Advancements in neuroimaging methods have advanced our ability to study connectivity in vivo such that small structures like the LC can be further studied in human samples. Specifically, neuromelanin-sensitive MRI (NM-MRI), a novel, non-invasive neuroimaging method has been shown to detect changes in neuromelanin (NM)-related signal in both the LC and substantia nigra (SN). NM is a dark pigment that accumulates over the lifespan in catecholamine-dominant centers such as the LC and SN and is the by-product of catecholamine oxidation. NM-MRI can be used to image these centers in vivo due to the paramagnetic properties offered by NM. Furthermore, when excess cytosolic catecholamine levels are present in select neurons, NM production is thought to be increased, resulting in increased NM signal from the LC. This could potentially be a marker for dysregulation as many conditions have been associated with variability of this system. Previously, NM-MRI has been used in other clinical settings such as in Parkinson’s disease (PD), Alzheimer’s disease (AD), schizophrenia and depression; however, this current investigation is the first to utilize this imaging modality in the context of PTSD. Specifically, we hypothesized that increased NM-MRI signal in the LC would correlate with increasing severity of hyperarousal symptoms in individuals with PTSD. We also predicted that the opposite would be true for comorbid depression symptom severity, as reduced LC signal has been previously correlated with clinical measures of comorbid depression using NM-MRI. As per our primary hypothesis, we observed a significant positive correlation between NM-MRI signals in the caudal elements of the LC with hyperarousal symptom severity in 22 PTSD subjects (r= 0.54, p= 0.017; partial correlation controlling for depression symptom severity, age, and sex). In contrast, we did not find any evidence to support our secondary hypothesis, because a non-significant trend correlating LC NM-MRI signal and depression symptom severity was obtained (r= -0.30, p=0.22; partial correlation controlling for hyperarousal severity, age, and sex). Based on these results, we were able to build on previously conducted work to further investigate the utility of NM-MRI in the detection of variability in LC-NE system as it pertains to psychiatric conditions known to show dysregulation of this system such as PTSD. In addition, this thesis provides further evidence to support the automation of NM-MRI analytical methods, thus supporting their potential utility for future clinical research. Our findings also provide support for the use of NM-MRI as a potential measure of NE activity; further, this work provided preliminary evidence supporting the use of NM-MRI in a clinical, psychiatric setting, where the technique may serve as a biomarker of PTSD pathology. With these findings in mind, additional validation studies can be conducted to verify the use of NM-MRI as a biomarker for NE system dysregulation. This would potentially allow for advancements in targeted treatment options for PTSD, particularly those targeting the LC-NE system, thus potentially increasing patient stratification and treatment efficacy.

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.

The role that norepinephrine plays in regulating the concentration of different proteins in the parietal cortex, hippocampus and cerebellum was assessed by investigating the effects of either a bilateral lesion of the locus coeruleus or neonatal administration of 6-hydroxydopamine. Two weeks after lesioning the locus coeruleus, the concentration of two different proteins was elevated in the hippocampus; a third protein was reduced in concentration in this brain area as a result of the lesion. Three proteins were affected in concentration in the cerebellum after the locus coeruleus lesion - two were elevated in concentration and one was reduced in concentration. No proteins were altered in concentration in the parietal cortex as a result of the lesion. Seventy days after neonatal treatment with 6-hydroxydopamine, a total of 6 proteins were found to be changed. Four of these (one in the hippocampus and 3 in the parietal cortex) were reduced in concentration while two proteins (both in the cerebellum) were elevated in concentration after neonatal treatment with the catecholamine neurotoxin. There was little overlap between those proteins affected in concentration by the bilateral lesion of the locus coeruleus and those changed by neonatal treatment with 6-hydroxydopamine. These results suggest that the concentration of a number of different proteins may, under normal physiological conditions, be regulated in vivo by norepinephrine in the brain.

No description available.

No description available.

Major depression is a serious mood disorder affecting more than 120 million people worldwide, irrespective of their race or socio-economic status. This psychiatric disorder is predicted to become the second leading cause of disability by the year 2020, second only to heart diseases in the global population, without distinguishing differences in the incidence within defined age groups. Depression is known to affect people across all age groups, including children, adolescents, adults and geriatrics, although older age is associated with an increased susceptibility to major depression and other psychiatric conditions. Until the 1970‘s depression during childhood and adolescence was thought to be uncommon or non-existent. Recent epidemiological studies have demonstrated that there is a persistent escalation in the prevalence of depression in children and adolescents. Accordingly, the number of prescriptions for drugs to treat this disorder in juveniles has escalated significantly. With our current limited understanding of the safety and long-term effects of treatment with antidepressants, the clinician is left making decisions without sound evidence of safety. In addition, psychotropic drugs may affect neurodevelopment during childhood and adolescence and may consequently modulate susceptibility to psychiatric disorders later in life. The objective of the current study was to investigate the effects of early-life (pre-natal and postnatal) chronic treatment with venlafaxine, a dual action serotonin-noradrenalin reuptake inhibitor, during the developmental phase of the serotonin and norepinephrine pathways in stress-sensitive rats on measures of cognition, anxiety-like and depressive-like behaviour later in life. The study also investigated which age shows optimal behavioural changes later in life, following the above mentioned administration of venlafaxine. In addition we also determined the effects that the administration of venlafaxine has on the levels of monoamines l-norepinephrine (l-NE) and serotonin (5-HT) in the prefrontal cortex and the hippocampus. A number of translational animal models of psychiatric disorders have been described and validated, and is suitable for such investigations. For the current study we used stress-sensitive Flinders Sensitive Line (FSL) rats and their controls, Flinders Resistant Line (FRL) rats. Pregnant dams were injected subcutaneously for 14 days with 10 mg/kg venlafaxine or saline from pre-natal day 15 (ND-15) to ND-01. New-born pups were then injected subcutaneously with 3 mg/kg venlafaxine or saline for 14 days from postnatal day 3 (ND+03) to ND+17. These doses were determined from previous studies reported in literature. Four rat treatment groups of both FSL and FRL rats received injections during pre-natal + postnatal ages as follows: saline + saline, venlafaxine + saline, saline + venlafaxine and venlafaxine + venlafaxine. Following the drug treatments, all rat groups were housed under normal conditions until the indicated time to be subjected to a battery of behavioural tests, including the novel object recognition test (nORT), locomotor activity test (Digiscan®), elevated plus maze (EPM) and forced-swim test (FST), scheduled on either ND+35, ND+60 or ND+90. Separate treatment groups were used for each age group. After the behavioural tests animals were decapitated, the brains removed and the prefrontal cortex and hippocampus dissected out. These were analysed at a later stage using an HPLC with electrochemical detection to determine the levels of the monoamines l-NE and 5-HT. All animal procedures were approved by the Ethics Committee of the North-West University (approval number: NWU-00045-10-S5), and are in accordance with the recommendations of the National Institutes of Health guide for the care and use of laboratory animals. The data from the current study suggest that in general FRL rats were not influenced by the early-life treatment with venlafaxine, as observed in the nORT, EPM or FST on ND+35, ND+60 or ND+90. There was minimal changes seen in the immobile behaviour in the FST of FRL rats that received prenatal venlafaxine. As expected, depressive-like behaviour in the FST was significantly enhanced in FSL rats relative to corresponding FRL rat groups as observed at ND+35 and ND+60, but not ND+90. Importantly, depressive-like behaviour was reversed following pre- and postnatal treatment with venlafaxine in FSL rats at ND+60, relative to the corresponding FRL rat groups. Reversal of depressive-like behaviour in FSL rats were not observed at ND+35 or ND+90, suggesting a delayed response that is reversed later in adulthood. The data from the nORT, Digiscan® or EPM did not reveal any significant differences between the various FSL treatment groups, including at ND+60. The current study therefore demonstrated that the treatment regimen employed had a transient effect on depressive-like behaviour later in life and suggested that genetic susceptibility plays an important role in the treatment of depression. This was suggested by the venlafaxine-induced decrease in immobile behaviour exhibited by FSL rats at ND+60 in the FST, and the subsequent increase in immobile behaviour at ND+90. In general, the most significant venlafaxine-induced effects were seen in FSL rats, suggesting genetic susceptibility plays an important role. / MSc (Pharmacology), North-West University, Potchefstroom Campus, 2014

La dépression est une pathologie grave qui, malgré de multiples stratégies thérapeutiques, demeure résistante chez un tiers des patients. Les techniques de stimulation cérébrale sont devenues une alternative intéressante pour les patients résistants à diverses pharmacothérapies. La stimulation du nerf vague (SNV) a ainsi fait preuve de son efficacité en clinique et a récemment été approuvée comme traitement additif pour la dépression résistante. Cependant, les mécanismes d’action de la SNV en rapport avec la dépression n’ont été que peu étudiés. Cette thèse a donc eu comme premier objectif de caractériser l’impact de la SNV sur les différents systèmes monoaminergiques impliqués dans la pathophysiologie de la dépression, à savoir la sérotonine (5-HT), la noradrénaline (NA) et la dopamine (DA), grâce à l’utilisation de techniques électrophysiologiques et de la microdialyse in vivo chez le rat. Des études précliniques avaient déjà révélé qu’une heure de SNV augmente le taux de décharge des neurones NA du locus coeruleus, et que 14 jours de stimulation sont nécessaires pour observer un effet comparable sur les neurones 5-HT. Notre travail a démontré que la SNV modifie aussi le mode de décharge des neurones NA qui présente davantage de bouffées, influençant ainsi la libération terminale de NA, qui est significativement augmentée dans le cortex préfrontal et l’hippocampe après 14 jours. L’augmentation de la neurotransmission NA s’est également manifestée par une élévation de l’activation tonique des récepteurs postsynaptiques α2-adrénergiques de l’hippocampe. Après lésion des neurones NA, nous avons montré que l’effet de la SNV sur les neurones 5-HT était indirect, et médié par le système NA, via l’activation des récepteurs α1-adrénergiques présents sur les neurones du raphé. Aussi, tel que les antidépresseurs classiques, la SNV augmente l’activation tonique des hétérorécepteurs pyramidaux 5-HT1A, dont on connait le rôle clé dans la réponse thérapeutique aux antidépresseurs. Par ailleurs, nous avons constaté que malgré une diminution de l’activité électrique des neurones DA de l’aire tegmentale ventrale, la SNV induit une augmentation de la DA extracellulaire dans le cortex préfrontal et particulièrement dans le noyau accumbens, lequel joue un rôle important dans les comportements de récompense et l’hédonie. Un deuxième objectif a été de caractériser les paramètres optimaux de SNV agissant sur la dépression, en utilisant comme indicateur le taux de décharge des neurones 5-HT. Des modalités de stimulation moins intenses se sont avérées aussi efficaces que les stimulations standards pour augmenter l’activité électrique des neurones 5-HT. Ces nouveaux paramètres de stimulation pourraient s’avérer bénéfiques en clinique, chez des patients ayant déjà répondu à la SNV. Ils pourraient minimiser les effets secondaires reliés aux périodes de stimulation et améliorer ainsi la qualité de vie des patients. Ainsi, ces travaux de thèse ont caractérisé l’influence de la SNV sur les trois systèmes monoaminergiques, laquelle s’avère en partie distincte de celle des antidépresseurs classiques tout en contribuant à son efficacité en clinique. D’autre part, les modalités de stimulation que nous avons définies seraient intéressantes à tester chez des patients recevant la SNV, car elles devraient contribuer à l’amélioration des bénéfices cliniques de cette thérapie. / Depression is a severe psychiatric disorder, in which a third of patients do not achieve remission, despite the wide variety of therapeutic strategies that are currently available. Brain stimulation has emerged as a promising alternative therapy in cases of treatment resistance. Vagus nerve stimulation (VNS) has shown promise in treating resistant-depressed patients, and it has been approved as an adjunctive treatment for resistant depression. However, the mechanism of action by which VNS exerts its antidepressant effects has remained elusive. The first goal of this thesis was therefore to characterize the impact of VNS on monoaminergic systems known to be implicated in the pathophysiology of depression such as serotonin (5-HT), norepinephrine (NE) and dopamine (DA), by means of electrophysiologic techniques and microdialysis in the rat brain. Previous research has indicated that one hour of VNS increased the basal firing activity of locus coeruleus NE neurons and, secondarily, that of 5-HT neurons, but only after 14 days of stimulation. Our work demonstrated that VNS also modified the firing pattern of NE neurons towards a bursting mode of discharge. This mode of firing was shown to lead to enhanced NE release in the prefrontal cortex and hippocampus after 14 days. Increased NE neurotransmission was also evidenced by enhanced tonic activation of postsynaptic α2-adrenoceptors in the hippocampus. Selective lesioning of NE neurons was then used to demonstrate that the effects of VNS on the 5-HT system were indirect, and mediated by the activation of α1-adrenoceptors located on the dorsal raphe 5-HT neurons. Similar to classical antidepressants, VNS also enhanced the tonic activation of pyramidal 5-HT1A heteroreceptors, which are known to play a key role in the antidepressant response. We also found that in spite of a diminished firing activity of ventral tegmental area DA neurons after VNS, extracellular DA levels were significantly elevated in the prefrontal cortex, and particularly in the nucleus accumbens which plays an important role in reward behavior and hedonia. A second objective was to characterize the optimal VNS parameters to treat depression using the firing activity of 5-HT neurons as an indicator. It was found that less stimulation was as effective as the standard levels to increase 5-HT neurons firing rate. These novel parameters could be helpful for clinical application in VNS responsive patients, to potentially minimize and/or even prevent stimulation-related side effects, thus improving their quality of life. In brief, these studies reveal an influence of VNS on all three central monoamine systems, which differs in part from that of classical antidepressants while contributing to the clinical efficacy of this approach. It will also be interesting to determine whether the proposed lower stimulation parameters are as effective in providing antidepressant response in patients receiving VNS, which should contribute to improve the clinical benefits of that therapy.

Osteoporosis and depression are prevalent among older postmenopausal women 65 years or older. Bisphosphonates (BPs) and selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used medications to treat these conditions. Inhibitory effects of BPs on osteoclasts are responsible for the reduction in fracture risk. SSRIs, however, are associated with increased fracture risk through decreasing osteoblasts and increasing osteoclastic activity. These effects of SSRIs could attenuate the beneficial effects of BPs. This dissertation describes the concomitant use of BPs and SSRIs among postmeopausa women and reports findings from examining the association between concomitant use of BPs and SSRIs and fracture risk. Separate cross-sectional analyses were performed using data from the 2004-2008 Medical Expenditure Panel Survey (MEPS) and Medicare Part D prescriptions claims data (2008-2010) to examine usage patterns of BPs and SSRIs/SNRIs for women aged ≥45 years and ≥65 years, respectively. For our second objective, a nested-case control was conducted using Medicare claims data (2008-2010). Data from Medicare inpatient claims were linked to Medicare Part D data for all female BP users 65 years or older. We used Cox proportional hazards model to assess the increased risk of osteoporotic-related fractures among propensity score matched (1:1 ratio) cohorts of concomitant users of BPs and SSRIs and BP alone users. Concomitant use of BPs and SSRIs was prevalent and increased with age for each timeframe examined. Findings showed that approximately 12% (using MEPS) and 28% (using Medicare data) of women on BPs were also on SSRIs. For the second objective, 4,214 propensity score matched pairs (average age=80.4 years) of subjects were analyzed. Findings showed that concomitant use of BPs and SSRIs was associated with statistically significant increased risk for any fracture (HR=1.29, 95% CI, 1.07-1.57), but statistically non-significant increased risk for hip (HR=1.16, 95% CI, 0.92-1.47) and vertebral fractures (HR=1.55, 95% CI, 0.97-2.48). Current findings indicate that concomitant use of BPs and SSRIs is not uncommon among postmenopausal women and suggest potential attenuation of antifracture efficacy of BPs by SSRIs. Further studies are needed to understand the clinical impact of concomitant use of these medications among older postmenopausal women.

La schizophrénie est une pathologie sévère et fréquente. Elle constitue un problème majeur de santé publique. Les traitements disponibles présentent des problèmes de tolérance non négligeables et leur efficacité reste modérée. La recherche en pharmacogénétique des antipsychotiques a pour objectif d’aider les prescripteurs à choisir les traitements de façon plus rationnelle. Les carences méthodologiques des premières études réalisées expliquent sans doute le peu de résultat répliqué à ce jour. Dans une cohorte de patients schizophrènes caucasiens traités par olanzapine ou rispéridone et évaluée prospectivement pour l’efficacité et la tolérance du traitement, nous avons d’abord recherché des critères cliniques permettant de prédire la réponse au traitement. L’age précoce de début des troubles et la durée de la maladie sont des prédicteurs individuels de la mauvaise réponse au traitement. Nous avons également étudié l’implication de variants génétiques du transporteur de la noradrénaline dans l’efficacité des traitements. Nous avons observé l’implication de deux polymorphismes dans la décroissance des symptômes positifs sous traitement. L’analyse de l’impact du variant C825T de la GNB3 dans la prise de poids sous antipsychotique n’a pas retrouvé d’association significative. Enfin, nous avons étudié l’ensemble des variants alléliques du cytochrome P450 2D6 dans cette cohorte de patients schizophrènes comparée à des témoins. L’allèle CYP2D6*2 était associé à un effet protecteur vis à vis de la schizophrénie. Les associations retrouvées devraient aider à mieux comprendre les mécanismes physiopathologiques impliqués dans la schizophrénie et la réponse au traitement / Schizophrenia is a frequent and severe disease. It constitutes a major public health problem. All the available treatments however, have significant adverse side-effects and their efficacy remains moderate. The aim of pharmacogenetic research is to help practitioners to choose treatments in a more rational way. The methodological limits of the first published studies probably explain the lack of replication of such studies. In a prospective study of a sample of Caucasian schizophrenic patients treated with olanzapine or risperidone, clinical criteria were assessed as factors that may predict drug response. Early onset and duration of the disease, individually predicted an unfavourable drug response. We also studied genetic variants of the norepinephrine transporter to see how they may affect antipsychotic drug efficacy. Two polymorphisms were associated with a reduction in positive symptoms in treated schizophrenic patients. No association between the GBN3 C825T variant and weight gain in patients treated by antispychotic drugs was observed. Finally, we genotyped all the cytochrome P450 2D6 allelic variants in the same Caucasian schizophrenic sample and a Caucasian origin control cohort. The CYP2D6*2 allele was strongly associated with protection towards schizophrenia. The two observed associations may help to better understand the still unwell known physiopathological mechanisms implicated in schizophrenia aetiology and antipsychotic drug response