Although deep brain stimulation (DBS) is an established treatment choice for Parkinson's disease (PD), essential tremor and movement disorders, its effectiveness for the management of treatment-resistant depression (TRD) remains unclear. Herein, we conducted an integrative review on major neuroanatomical targets of DBS pursued for the treatment of intractable TRD. The aim of this review article is to provide a critical discussion of possible underlying mechanisms for DBS-generated antidepressant effects identified in preclinical studies and clinical trials, and to determine which brain target(s) elicited the most promising outcomes considering acute and maintenance treatment of TRD. Major electronic databases were searched to identify preclinical and clinical studies that have investigated the effects of DBS on depression-related outcomes. Overall, 92 references met inclusion criteria, and have evaluated six unique DBS targets namely the subcallosal cingulate gyrus (SCG), nucleus accumbens (NAc), ventral capsule/ventral striatum or anterior limb of internal capsule (ALIC), medial forebrain bundle (MFB), lateral habenula (LHb) and inferior thalamic peduncle for the treatment of unrelenting TRD. Electrical stimulation of these pertinent brain regions displayed differential effects on mood transition in patients with TRD. In addition, 47 unique references provided preclinical evidence for putative neurobiological mechanisms underlying antidepressant effects of DBS applied to the ventromedial prefrontal cortex, NAc, MFB, LHb and subthalamic nucleus. Preclinical studies suggest that stimulation parameters and neuroanatomical locations could influence DBS-related antidepressant effects, and also pointed that modulatory effects on monoamine neurotransmitters in target regions or interconnected brain networks following DBS could have a role in the antidepressant effects of DBS. Among several neuromodulatory targets that have been investigated, DBS in the neuroanatomical framework of the SCG, ALIC and MFB yielded more consistent antidepressant response rates in samples with TRD. Nevertheless, more well-designed randomized double-blind, controlled trials are warranted to further assess the efficacy, safety and tolerability of these more promising DBS targets for the management of TRD as therapeutic effects have been inconsistent across some controlled studies.
We investigated the effect of cocaine-and amphetamine-regulated transcript (CART) peptide on depression-like behavior in socially isolated and olfactory bulbectomized (OBX) rats. Administration of CART (54-102) into the lateral ventricle (50-100 ng) or central nucleus of amygdala (CeA) (10-20 ng) caused significant decrease in immobility time in the forced swim test (FST) without influencing locomotion, suggesting antidepressant-like effect. Social isolation as well as OBX models were undertaken to produce depression-like conditions. Although isolation reared (6 weeks) rats showed significant increase in immobility time in FST, OBX animals exhibited hyperactivity (increase in the ambulation, rearing, grooming, and defecation scores) on day 14 in the open-field test. The isolation-or OBX-induced depression-like phenotypes were reversed following acute or subchronic treatment of CART, respectively, given via intracerebroventricular and intra-CeA routes. Drastic reduction in CART-immunoreactivity was observed in most cells in the paraventricular (PVN), arcuate and Edinger-Westphal nuclei of the socially isolated and OBX animals. Although the fibers in the PVN showed variable response, those in ARC and prefrontal cortex did not change. The CART-immunoreactive fibers in the locus coeruleus also showed highly significant reduction. However, dramatic increase in CART-immunoreactive fibers was noticed in the CeA in both the experimental models. The response by the cells and fibers in the periventricular area and perifornical nucleus in the OBX and socially isolated rats was variable. The study underscores the possibility that endogenous CART system might play a major role in mediating symptoms of depression.
We studied the involvement of cocaine-and amphetamine-regulated transcript peptide (CART) in the central nucleus of amygdala (CeA), lateral bed nucleus of the stria terminalis (BNSTl) and nucleus accumbens shell (AcbSh) in generation of ethanol withdrawal symptoms, with particular focus on anxiety-like behavior using a social interaction test. Administration of CART (54-102) into the lateral ventricle (50 and 100 ng) and bilaterally in the CeA (10 and 20 ng) caused a significant reduction in social interaction, suggesting an anxiogenic action of the peptide. Chronic ethanol treatment for 15 days followed by withdrawal precipitated an anxiogenic response at 24 h that was attenuated by intracerebroventricular (5 ml) and intra-CeA (1 ml) administration of antibodies against CART (1 : 500 dilution). An immunocytochemistry protocol was employed to study the response of the endogenous CART system in the CeA following chronic ethanol withdrawal. At 0 h ethanol withdrawal, CART immunoreactivity was apparent in few fibers and the profile was similar to that in the pair-fed control rats. Twenty-four hours following ethanol withdrawal, a highly significant increase (Po0.001) in CART immunoreactivity was noticed in the CeA, which returned to normal 48 and 72 h post-withdrawal. Similar doses of CART or CART antibody injected bilaterally into the BNSTl or AcbSh produced no response in the social interaction test. Furthermore, the CART immunoreactivity profile did not change at the post-withdrawal time points in each of these brain sites. We suggest that CART may mediate the early signs of anxiety-like behavior induced by ethanol withdrawal within the neuroanatomical framework of the CeA.
Modern lifestyle, changing eating habits and reduced physical work have been known to culminate into making
diabetes a global pandemic. Hyperglycemia during the course of diabetes is an important causative factor for the
development of both microvascular (retinopathy, nephropathy and neuropathy) and macrovascular (coronary artery
disease, stroke and peripheral artery disease) complications. In this article, we summarize several mechanisms
accountable for the development of both microvascular and macrovascular complications of diabetes. Several metabolic
and cellular events are linked to the augmentation of oxidative stress like the activation of advanced glycation endproducts
(AGE) pathway, polyol pathway, protein kinase C (PKC) pathway, poly-ADP ribose polymerase (PARP) and hexosamine
pathway. Oxidative stress also leads to production of reactive oxygen species (ROS) like hydroxyl radical, superoxide
anion and peroxides. Enhanced levels of ROS rescind the anti-oxidant defence mechanisms associated with superoxide
dismutase, glutathione and ascorbic acid. Moreover, ROS triggers oxidative damages at the level of DNA, protein and
lipids which eventually cause cell necrosis or apoptosis. These physiological insults may be related to the microvascular
complications of diabetes by negatively impacting the eyes, kidneys and brain. While underlying pathomechanism of the
macrovascular complications is quite complex, hyperglycemia associated atherosclerotic abnormalities like changes in the
coagulation system, thrombin formation, fibrinolysis, platelet and endothelial function and vascular smooth muscle is well
proven. Since hyperglycemia also modulates the vascular inflammation, cytokines, macrophage activation and gene
expression of growth factors, elevated blood glucose level may play a central role in the development of macrovascular
complications of diabetes. Taken collectively, chronic hyperglycemia and increased production of ROS are the miscreants
for the development of microvascular and macrovascular complications of diabetes.
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