Despite evidence of an association between prenatal acetaminophen exposure and attention deficit hyperactivity disorder (ADHD) in offspring, the causal role of prenatal acetaminophen exposure in child ADHD remains unclear owing to limitations of prior studies. Prior studies have relied on maternal self-report, failed to quantify acetaminophen dose, and lacked mechanistic insight. Chapter 1 formally introduces this topic and provides background information summarizing the high prevalence of ADHD, widespread use of acetaminophen during pregnancy, and potential molecular mechanisms through which the drug may harm fetal development. In Chapter 2, we examined the association between prenatal acetaminophen exposure measured in meconium and ADHD in children aged 6 to 7 years, along with the potential for mediation by functional brain connectivity. Data came from a prospective birth cohort study from the Centre Hospitalier Université de Sherbrooke in Sherbrooke, Québec, Canada. We included 393 eligible children, of whom 345 had meconium samples collected at delivery and information on ADHD diagnosis. Mothers were enrolled from September 25, 2007, to September 10, 2009, at their first prenatal care visit or delivery. Acetaminophen levels were measured in meconium, and physician diagnosis of ADHD was determined at follow-up when children were aged 6 to 7 years or from medical records. Additionally, when children were aged 9 to 11 years, resting-state brain connectivity was assessed with magnetic resonance imaging, and attention problems and hyperactivity were assessed with the Behavioral Assessment System for Children Parent Report Scale. Associations between meconium acetaminophen levels and outcomes were estimated with linear and logistic regressions weighted on the inverse probability of treatment to account for potential confounders. Causal mediation analysis was used to test for mediation of the association between prenatal acetaminophen exposure and hyperactivity by resting-state brain connectivity. Among the 345 children included in the analysis (177 boys [51.3%]; mean [SD] age, 6.58 [0.54] years), acetaminophen was detected in 199 meconium samples (57.7%), and ADHD was diagnosed in 33 children (9.6%). Compared with no acetaminophen, detection of acetaminophen in meconium was associated with increased odds of ADHD (odds ratio [OR], 2.43; 95%CI, 1.41-4.21). A dose-response association was detected; each doubling of exposure increased the odds of ADHD by 10% (OR, 1.10; 95%CI, 1.02-1.19). Children with acetaminophen detected in meconium showed increased negative connectivity between frontoparietal and default mode network nodes to clusters in the sensorimotor cortices, which mediated an indirect effect on increased child hyperactivity (14%; 95%CI, 1%-26%). In Chapter 3, we used data from the same Canadian birth cohort to examine whether prenatal acetaminophen exposure is associated with adverse birth outcomes and/or pregnancy complications, and if birth outcomes may mediate the association of prenatal acetaminophen with child ADHD. This study included 393 children for whom acetaminophen was measured in meconium at delivery. We tested associations of prenatal acetaminophen with birthweight, preterm birth, gestational age, small and large for gestational age, gestational diabetes, preeclampsia, and high blood pressure. Using causal mediation analyses, we assessed whether birth outcomes mediated the association of prenatal acetaminophen with ADHD. We imputed missing data via multiple imputation and used inverse probability weighting to account for confounding and selection bias. Prenatal acetaminophen exposure was associated with decreased birthweight by 136 g (β = −136; 95% CI [−229, −43]), 20% increased weekly hazard of delivery (hazard ratio = 1.20; 95% CI [1.00, 1.43]), and over 60% decreased odds of being born large for gestational age (odds ratio = 0.38; 95% CI [0.20, 0.75]). Prenatal acetaminophen was not associated with small for gestational age, preterm birth, or any pregnancy complications. Causal mediation effects were non-significant for all birth outcomes in both unadjusted and adjusted models, indicating no evidence that birth outcomes linked prenatal acetaminophen exposure with child ADHD. In Chapter 4, we examined the effects of developmental acetaminophen exposure on mouse behavior and frontal cortex gene expression. Although prior studies have investigated neurodevelopmental effects of prenatal acetaminophen exposure in rodents, the results of these studies are not always in agreement. Additionally, no mouse studies of prenatal acetaminophen exposure have investigated offspring attention deficits in behavior tasks specifically designed to measure attention, and no prior rodent studies have utilized ‘omics’ technologies for an untargeted exploration of potential mechanisms. We randomly assigned pregnant mice (starting embryonic day 4-10) to receive acetaminophen (150 mg/kg/day) or vehicle control through postnatal day 14. We employed a battery of behavior tests for 111 mouse offspring, including pup ultrasonic vocalizations, elevated plus maze, open field test, CatWalk, pre-pulse inhibition, and 5-choice serial reaction time task. Frontal cortex was collected at birth from 24 pups for RNA-sequencing. Developmental acetaminophen treatment resulted in increased pup vocalizations after separation from the litter, as well as decreased ambulation and vertical rearings in the open field task among male but not female offspring. Acetaminophen treatment was also associated with altered frontal cortex gene expression relating to glutathione and cytochrome p450 metabolism, DNA damage, and the endocrine and immune systems. Together with the multitude of other cohort studies showing adverse neurodevelopment associated with prenatal acetaminophen exposure, this work suggests caution should be used in administering acetaminophen during pregnancy. In humans, we found that prenatal acetaminophen exposure was associated with child ADHD, altered resting-state brain connectivity, and adverse birth outcomes. Furthermore, our results suggest altered brain connectivity as a potential underlying mechanism linking prenatal acetaminophen use with child hyperactivity. While adverse birth outcomes such as preterm birth and reduced birthweight are known to be associated with ADHD, we found no evidence for mediation by birth outcomes of the association between prenatal acetaminophen exposure and ADHD. In mice, we found that developmental acetaminophen treatment resulted in elevated anxiety-like behaviors in male offspring, as well as gene expression changes in the frontal cortex. Future studies are needed to explore whether the altered molecular pathways revealed by RNA-sequencing directly link acetaminophen exposure with offspring behavior changes.

Despite the lack of robust clinical response, treatment strategies for cancer-induced depression (CID) are currently limited to those developed for non-cancer-related depression. The work presented in this dissertation conceptualizes CID as a pathophysiologically distinct form of depression. To investigate CID at the most basic level, we first developed a preclinical model that was validated by comparison to an established model of stress-induced depressive-like behaviours. The positive control model was developed by chronically treating female BALB/c mice with oral corticosterone (CORT). The CID model was developed using subcutaneous inoculation with 4T1 mammary carcinoma cells. Anhedonia, behavioural despair, and dendritic atrophy in the medial prefrontal cortex (mPFC) were observed in both models. Similar to many human cancer cell lines, 4T1 cells were shown to secrete significant amounts of glutamate, which was markedly attenuated using the system xc- inhibitor sulfasalazine (SSZ). In CID mice, oral treatment with SSZ was at least as effective as fluoxetine, a popular clinical antidepressant, at preventing depressive-like behaviours. This effect was primarily attributable to intact SSZ, rather than its anti-inflammatory metabolite. RNA-sequencing was performed on hippocampal samples from CID and CORT animals. Analysis of differential expressed genes (DEGs) revealed significant overlap between the two models. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways and biological process gene ontologies (GO:BP) terms related to ion homeostasis and neuronal communication were enriched for both models. CID was associated with additional DEGs that were not identified in the CORT model. These DEGs were enriched in KEGG pathways and GO:BP terms related to neuronal development, intracellular signalling cascade, learning, and memory. These studies suggest that CID may involve a distinct aetiology, and that glutamate secretion by cancer cells presents a viable target for antidepressant treatment. The development of mechanism-based therapeutics for CID will dramatically improve the quality of life for cancer patients. / Thesis / Doctor of Philosophy (PhD) / Cancer patients are at a high risk of developing depression. In addition to the psychological stress caused by a cancer diagnosis, there is evidence that cancer causes depression through biological pathways. To investigate these pathways, a mouse model of cancer-induced depression (CID) was developed. This model showed comparable behavioural and structural brain deficits to those observed in a stress model of depression. Cancer cells secrete elevated levels of glutamate, a signalling molecule that is involved in depression. In CID mice, inhibiting glutamate release had an antidepressant effect similar to that of fluoxetine, a standard clinical antidepressant. A genetic analysis on brain samples from the CID model revealed significant overlap with the stress model of depression. CID mice had additional changes relevant to learning, memory, and brain cell development that were not detected in the stress model. A better understanding of CID will lead to better treatment strategies developed specifically for cancer patients.

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The influence of experience during brain development was investigated on juvenile behavior, adult amphetamine sensitization, and neuronal structural plasticity in rats. Two experiential factors (i.e., tactile stimulation and stress) were studied either before or soon after birth. Early experience feminized social behavior in males; however, only stress enhanced anxiety-like behavior in males. Repeated amphetamine administration resulted in the development and persistence of behavioral sensitization. However, tactile stimulation attenuated the drug-induced behavioral sensitization whereas stress failed to influence the degree of sensitization. Neuroanatomical findings revealed that early experience altered the cortical and subcortical structures. Furthermore, drug exposure reorganized the brain structures involved in addiction but early experience prevented the drug-associated changes. Early adverse experience influences the subsequent exposure to a drug of abuse at anatomical level whereas a favorable experience has an effect both at behavioral and anatomical levels and thus may play a protective role against drug-induced sensitization and addiction. / xii, 263 leaves : ill. ; 29 cm

Le cortex préfrontal (PFC) est le principal locus des perturbations dans l’activité des réseaux de neurones chez les schizophrènes. Ces perturbations résultent d’une dérégulation des interactions entre le système dopaminergique et le système glutamatergique dont l’origine demeure inconnue. Il est acquis que les cellules gliales détectent et intègrent les signaux synaptiques, et libèrent différentes substances neuroactives comme la D-sérine. Cet acide aminé est aujourd’hui reconnu comme le coagoniste endogène des récepteurs au glutamate de type NMDA dans de nombreuses aires cérébrales. Mon travail de thèse est centré sur le rôle de la d-sérine dans la transmission synaptique excitatrice glutamatergique dans le PFC du rongeur adulte et dans la gouvernance des interactions entre systèmes glutamatergique et dopaminergiques J’ai tout d’abord montré en utilisant des enregistrements électrophysiologiques sur tranches que la d-sérine est le coagoniste des récepteurs NMDA synaptiques dans les couches V/VI du PFC. Cet acide aminé est synthétisé par les astrocytes et contrôle l’induction de la potentialisation à long terme. D’autre part, j’ai montré que la dopamine exerce un effet biphasique sur l’activité des récepteurs NMDA synaptiques et sur l’excitabilité des neurones pyramidaux des couches V/VI du PFC et ce en contrôlant la libération de d-sérine. Une approche pharmacologique sélective a permis de mettre en évidence le rôle des récepteurs D1 dans les effets potentialisateurs et le rôle des récepteurs D2/D3 dans les effets inhibiteurs de la dopamine. Mon travail démontre que les astrocytes arborent des récepteurs à la dopamine qui contrôlent la libération de la d-sérine. / The prefontal cortex (PFC) is the main locus where dysfunctions of neuronal networks are evident in schizophrenia. These dysfunctions are caused by an impairment of cross-talk between dopaminergic and glutamatergic systems whose origin is unknown. It is now accepted that glia detect and integrate synaptic signals and then release many neuroactive substances such as D-serine. This amino acid is now considered to be the endogenous coagonist of the NMDA subtype receptors for glutamate in many brain areas. My PhD work focuses on the functions of d-serine in glutamatergic excitatory synaptic transmission in the PFC of adult rodent and in governing the interactions between dopaminergic and glutamatergic systems. First, using electrophysiological recordings on brain slices, I have shown that d-serine is the coagonist of synaptic NMDA receptors in layers V/VI of PFC. This amino acid is synthesized by glia and is crucial for the induction of long term potentiation. In addition, I have shown that dopamine has a bell-shape effect on the activity of synaptic NMDA receptors and on the excitability of excitatory pyramidal neurons by controlling the release of d-serine. The use of specific pharmacological tools allowed me to show the potentiating effects of dopamine are mediated by D1 receptors whereas the inhibitory effects are due to the activation of D2/D3 receptors. Finally, my work highlights the presence of functional dopaminergic receptors on astrocytes that modulate the release of d-serine in the PFC, thus impacting NMDA receptor activity.

Pour comprendre comment le cerveau inhibe l'appétit en dépit d'un besoin énergétique, nous avons étudié les mécanismes neuronaux qui sous-tendent l'effet hypophagique induit par la 3,4-N-méthylén édioxyméthamphétamine (MDMA : « ecstasie ») et le stress (immobilisation forcée) car ces facteurs réduisent la faim d'un animal, même s'il est affamé. Nous montrons que la stimulation intracérébrale des récepteurs 5-HT4 de la sérotonine (R5-HT4), ou leur plus forte expression (ectopique, physiologique) dans une aire de la récompense (noyau accumbens : NAc), réduit la faim en augmentant l'action anorexigène d'un peptide de l'addiction : CART. A l'encontre de l'équilibre énergétique, l'effet anorexigène induit par la stimulation des R5-HT4 dans le NAc s'accompagne d'une hyperactivité motrice, souvent décrite chez l'humain souffrant d'anorexie mentale. En supposant qu'un effet récompensant prévaut sur le danger d'un déséquilibre énergétique, nous montrons, qu'effectivement, l'injection d'un antagoniste des R5-HT4 dans le NAc réduit les effets anorexigène, hyperlocomoteur et récompensant de la MDMA. S'il est alors récompensant de se priver d'aliments, une souris surexprimant les R5-HT4 dans le NAc, devrait, après une faible et transitoire restriction alimentaire, continuer à s'auto-priver d'aliments même si l'aliment est fourni ensuite ad libitum. La réponse est positive. En revanche, les R5-HT4 du NAc ne contribuent pas, à priori, à l'hypophagie due au stress. Puisque le système de la récompense est inclut dans celui de la prise de décision contrôlée par le cortex préfrontal médian (CPFm), nous avons supposé que l'effet hypophagique provoqué par le stress utilise les R5-HT4 corticaux. L'injection de traitements nucléiques (siRNA, virus), dans le CPFm de souris sauvages et privées des R5-HT4, montre que seule l'activation des R5-HT4 du CPFm est à l'origine de l'effet hypophagique du stress. Nos résultats suggèrent que [1] le stress active les R5-HT4 du CPFm et réduit la densité du transporteur de capture de la 5-HT, favorisant [2] l'augmentation du taux de la 5-HT extracellulaire dans le noyau d u raphé dorsal d'où, [3] un contrôle inhibiteur de l'activité des neurones 5-HT par le R5-HT1A permettant d'éviter que l'hypophagie ne se prolonge en conduite anorexigène. L'ensemble de nos résultats étayent la possibilité que le réseau neuronal de l'addiction et de la prise de décision de manger après stress inclut celui de la conduite anorexigène, avec jusqu'alors, une contribution évidente des R5-HT4. / To understand how the brain inhibits appetite despite an energy demand, we study the neuronal mechanisms, which underlie the hypophagic effect induced by the 3,4-N-methylenedioxymethamphetamine (MDMA: « Ecstasy ») and stress (forced immobilization) because these factors reduce appetite in animals, even starved. We show that stimulating serotonin 4 receptors (5-HTR4), or their overexpression (ectopic, physiological) in a brain reward area (nucleus accumbens: NAc), reduced hunger in increasing the appetite-suppressant effect of an addiction peptide: CART. Against the energy balance, the appetite-suppressant effect induced by stimulating 5-HTR4 in the NAc comes along with hyperactivity, often described in human suffering from anorexia nervosa. Supposing that a rewarding effect prevails over the danger of an energy imbalance, we show indeed that injecting 5-HTR4 antagonist in the NAc reduced the appetite-suppressant effect, the hyperactivity and the rewarding effect provoked by MDMA. If food deprivation is rewarding, mouse overexpressing 5-HTR4 in the NAc, after a low and transient diet period, should continue to self-imposed food refusal even in the presence of food ad libitum. The answer is positive. In contrast, 5-HTR4 in the NAc does not contribute, à priori, to stress-induced hypophagia. Because the reward system is included in the neuronal network of the decision-making, mainly controlled by the medial prefrontal cortex (mPFC), we postulated that hypophagia following stress uses cortical 5-HTR4. Injecting nucleic treatments (siRNA, virus), in the mPFC of wild-type or 5-HTR4 null mice, shows that only the stimulation of 5-HTR4 in the mPFC sparks off the hypophagic effect of stress. Our results suggest that [1] stress activates 5-HTR4 in the mPFC and reduces density of the 5-HT transporter, promoting [2] increase of the extracellular 5-HT level in the dorsal raphe nucleus and thus [3] an inhibitory control of t he activity of 5-HT neurons by 5-HTR1A allowing to avoid that the period of food restriction persists (anorexia-like behavior). Colectively, our findings support the the neuronal network of addiction and decision-making to eat after stress include the neuronal pathway related to anorexia, with so far, a clear contribution of 5-HTR4.