选择性5-羟色胺再摄取抑制剂的临床应用进展

5-羟色胺(5-hydroxy tryptamine,5-HT)是中枢及外周神经系统中一种重要的神经递质。5-羟色胺转运体(5-HT transporter,5-HTT)可将5-HT再摄取,降低细胞外5-HT浓度,从而调节神经信号传导。5-HTT异常在某些精神疾病的发病中起重要作用。近年来选择性5-羟色胺再摄取抑制剂(selective serotonin reuptake inhibitors,SSRIs)在临床上的应用日趋广泛,如治疗抑郁症、焦虑症、抑郁和焦虑共病等常见的精神疾病。氟西汀、帕罗西汀、舍曲林、氟伏沙明和西酞普兰是目前临床上最常用的五种SSRIs,被誉为抗抑郁药的"五朵金花"。本文详细介绍近年来在临床上药物治疗抑郁症取得的成果以及这类药物的药效学、药动学、不良反应和相互作用等,并简要介绍SSRIs在其它疾病领域取得的应用进展。     

五羟色胺转运体的研究进展

五羟色胺转运体是一种对五羟色胺（5-HT,serotonin）有高度亲和力的跨膜转运蛋白,能够重新摄取细胞间隙内的5-HT,从而调节神经信号的转导。该文简述了五羟色胺转运体的生物学特性、分布以及与人类疾病的关系,通过分析比较发现,五羟色胺转运体的多态性与肠易激综合征、抑郁症、强迫症都有着密切的关系。     

抑郁症的成因及其新药治疗研究进展

抑郁症是一种发病率高、危害大的精神疾病,且发病的人群正在急剧增加。抑郁症的成因复杂,其病因机制尚不十分清楚。目前研究的病因主要包括神经递质受体异常、神经退化及内分泌、炎症细胞因子、表观遗传调节和大脑衍生神经营养因子等。随着新病因的揭开,抑郁症治疗的新药及其作用机理研究也取得了较大的进展。研发的新药主要包括:选择性5-羟色胺(5-HT)、去甲肾上腺素(NE)再摄取抑制剂、选择性NE再摄取抑制剂、肾上腺素能和特异性5-HT抗抑郁药、以及新药氯胺酮。本文就抑郁症发病的成因及主要的新药治疗策略进行了综述,为揭示抑郁症致病机制及其新药研发提供了理论依据。     

抑郁症分子机制中5-羟色胺2C受体的作用

5-羟色胺系统与抑郁症关系密切,阐明5-羟色胺相关受体在抑郁症中的作用,有助于抗抑郁药物的开发与应用,提高抑郁症的治疗效果。在5-羟色胺的受体中,5-羟色胺2C受体(5-hydroxytryptamine type 2C receptor,5-HT2CR)在抑郁症的发病及治疗机制中发挥重要的作用。虽然已有关于5-羟色胺2C受体与抑郁症具有相关性的报道,但近年来,5-羟色胺2C受体参与抑郁症的相关分子机制有了新的进展,本文将抑郁症分子机制中5-羟色胺2C受体的作用加以综述,以期为相关工作提供依据。     

难治性抑郁症治疗前后血浆单胺类神经递质代谢产物的变化

目的：探讨难治性抑郁症患者抗抑郁剂治疗前后的单胺类神经递质代谢产物的改变。方法：随机入组30例难治性抑郁症患者,进行汉密尔顿抑郁量表（HAMD）的临床评定。用酶联免疫吸附方法对这30例患者进行5-HIAA,MHPG检测,并与随机选取的经汉密尔顿抑郁量表（HAMD）临床评定的30名普通抑郁症患者进行比较。综合治疗8周后对难治性抑郁症患者进行治疗前后对比。结果：难治性抑郁症组治疗前血浆5-HIAA,MHPG浓度低于普通对照组（p〈0.05）,经5-羟色胺重摄取抑制剂治疗的难治性抑郁症患者,5-HIAA和MHPG含量与治疗前比较均有所升高,差异有显著性（p〈0.05）;结论：难治性抑郁症患者存在中枢5-羟色胺和去甲肾上腺素功能低下;个体化合理使用SSRIs类药物辅以心理治疗能有效地提高难治性抑郁症患者的外周单胺类递质水平,减轻患者的抑郁程度。     

抑郁症发生中γ-氨基丁酸与其它相关递质的关系

γ-氨基丁酸(γ-aminobutyric acid,GABA)是哺乳动物中枢神经系统中主要的抑制性神经递质,与焦虑、抑郁、精神分裂等多种神经和精神疾病有关。近年来,越来越多的研究提示,抑郁症的发生与中枢GABA功能缺陷密切相关。但目前基于单胺类递质失调及谷氨酸能神经的研究较多,而对GABA的研究相对较少且比较分散。本文主要通过介绍GABA受体及其作用,以及GABA与5-羟色胺(5-hydroxytryptamine,5-HT)、多巴胺(dopamine,DA)和谷氨酸(glutamic acid,Glu)的相互作用,讨论GABA与抑郁症发生的关系,以期为抑郁症的发生机制与治疗的深入研究提供思路。     

5-羟色胺转运体敲除小鼠的分子和细胞改变

5-羟色胺转运体(5-HTT)在神经精神心理正常功能的维持及疾病的发生和发展中起重要作用。5-HTT的表达能力减低或消失的小鼠(称为:5-HTT敲除小鼠)表现出许多行为的改变,例如:焦虑类似行为增多、对应激更加敏感和攻击性行为减少。这些行为的改变有的与携带5-HTTLPR短等位基因的人很相似。因此5-HTT敲除小鼠被作为研究5-HTTLPR多态性导致情感性精神障碍发病机制的动物模型。本文主要就5-HTT敲除小鼠的5-HT浓度和代谢、下丘脑-垂体-肾上腺皮质轴以及对其他神经递质转运体影响的分子和细胞改变进行综述。     

应激诱发抑郁的潜在机制和新治疗靶点——LBP抑制单胺生物合成

<正>抑郁症是一种常见的高复发、高致残性精神疾病,其主要表现是情绪低落、丧失兴趣或享受感,并可伴有焦虑症状、认知功能损害、睡眠和食欲紊乱等,已成为一种不容被忽视的全球健康危机^[1].据世界卫生组织调查显示,全球抑郁症患者高达3.5亿.我国成年人群抑郁症的终生患病率是6.8%,总体呈上升趋势,已成为我国第二大疾病负担^[2].经典的单胺假说认为,单胺类神经递质(包括5-羟色胺(5-hydroxytryptamine,5-HT)、去甲肾上腺素(norepinephrine, NE)和多巴胺)的缺乏是导致抑郁发生的重要病因^[3].目前临床上常用的抗抑郁药物的机制也主要是抑制单胺降解或者阻止单胺再摄取,但存在起效时间缓慢、对约30%～50%的患者无效或疗效不佳的局限性,这提示可能存在其他病理机制参与单胺失调和抑郁发生.     

5-HT2和5-HT3受体在外周初级感觉神经末梢痛反应和痛调制中的相互作用

目的：探讨5-HT2和5-HT3受体亚型在5-HT引起外周痛反应和痛调制中的相互作用及其机制;方法：在大鼠三又神经节神经元标本上应用全细胞膜片钳技术记录5-羟色胺激活电流（15_HT）,并结合痛行为实验进行观察。结果：在大多数受检细胞（54／88,61．4％）特别是中、小型细胞外加5-HT可引起一快去敏感的内向电流,此内向电流能被5-HT,受体特异性激动剂2-甲基-5-羟色胺所模拟,被5-HT3受体拮抗剂ICS250-930可逆性阻断,而5-HT2受体激动剂α-甲基-5-羟色胺则有明显增强15-HT的作用,5-HT1受体激动剂R-（＋）-UH301无明显反应。在进一步的整体清醒动物的行为学试验中我们观察到,大鼠后肢掌底皮下注射5-HT（10-5,10-4和10-3mol／L）引起浓度依赖性的痛行为反应,而用5-HT2和5-HT3受体特异性拮抗剂Cyproheptadine和ICS250-930分别阻断相应受体亚型后,5-HT引起的痛行为反应的强度序列为：5-HT〉5-HT＋ICS〉5-HT＋Cyp。结论：本文结果提示：5-HT所引起的痛反应中,在初级感觉神经元水平5-HT3受体可能仅起着启始作用,而5-HT,受体则在伤害性信息的维持和调制过程中发挥更大的作用。     

5—羟色胺介导的豚鼠肠系膜下神经节突触传递

本实验通过豚鼠离体肠系膜下神经节(IMG)的细胞内生物电记录方法观察到:(1)5-羟色胺(5-HT 1-100μmol/L)灌流可在部分 IMG 细胞引起与非胆碱能迟慢兴奋性突触后电位(Is-EPSP)相似的缓慢去极化;(2)持续灌流5-HT 可使对5-HT 敏感的 IMG 细胞的Is-EPSP 明显阻抑;(3)5-HT 去极化及5-HT 敏感细胞的 Is-EPSP 均可为5-HT 再摄取抑制剂氟苯氧丙胺(50μmol/L)所增大,而对5-HT 不敏感细胞的 Is-EPSP 则不受这种药物的影响,(4)5-HT 合成抑制剂对氯苯丙氨酸(PCPA)预处理可使 IMG 细胞的 Is-EPSP 的出现率和去极幅度均明显减低。上述结果表明:5-HT 可能参与介导豚鼠部分 IMG 细胞的Is-EPSP。     

Dynamic changes of brain serotonergic and dopaminergic activities during development of anxious depression: experimental study

Chronic psychoemotional stress of social defeats produces development of experimental anxious depression in male mice similar to this disorder in humans. 5-HT and 5-HIAA levels, TPH and MAO A activities, 5-HT1A-receptors in different brain areas were investigated at different stages of development of experimental disorder. It has been shown that initial stage (3 days of social stress) is accompanied by increase of 5-HT level in some brain areas. Decreased 5-HIAA levels in the hippocampus, amygdala and nucleus accumbens were discovered at the stage of forming depression (10 days of social stress). Pharmacological desensitisation and decreased number of 5-HT1A-receptors were shown in frontal cortex and amygdala. At the stage of pronounced depression (20 days of stress), there were no differences in 5-HT and 5-HIAA levels in all brain areas (excluding hypothalamus) of depressive animals. However increased number of 5-HT1A-receptors and decreased affinity in amygdala and decreased TPH and MAOA activities in hippocampus were found in depressive mice. Hypofunction of serotonergic system is suggested at the stage of pronounced depression state in animals. Similar processes had place in brain dopaminergic systems. It is concluded that dynamic changes of brain monoaminergic activities accompany the development of anxious depression in animals. Various parameters of monoaminergic systems are differently changed depending on brain area, mediator system and stage of disorder.     

Skeletal effects of serotonin (5-hydroxytryptamine) transporter inhibition: evidence from in vitro and animal-based studies

The regulation of bone metabolism continues to be an area of intense investigation, with recent evidence indicating a potential contribution from the neural system. In particular, the neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) has been hypothesized to play a role in skeletal metabolism via its transporter (5-HTT). The 5-HTT is a plasma membrane transporter that is highly specific for the uptake of extracellular 5-HT, thereby facilitating the intracellular storage and/or degradation of 5-HT. The 5-HTT is clinically important as it is the key target of pharmaceutical agents aimed at treating affective disorders, such as major depressive disorder. By antagonizing the 5-HTT, selective serotonin reuptake inhibitors (SSRIs) potentiate 5-HT activity and effectively relieve the symptoms of depression. However, questions have been raised regarding the potential skeletal effects of SSRIs given the recent identification of a functional 5-HTT and functional 5-HT receptors in bone cells. This paper discusses the preclinical evidence for the skeletal effects of 5-HT and the inhibition of the 5-HTT. In particular, it discusses the: (1) role of 5-HT and the function of the 5-HTT; (2) presence of functional 5-HTTs in bone; (3) potential sources and response mechanisms for 5-HT in bone, and; (4) in vitro and in vivo skeletal effects of 5-HT and 5-HTT inhibition.     

Platelet serotonin concentration in alcoholic subjects

Serotonin (5-hydroxytryptamine, 5-HT) is assumed to play a role in the pathophysiology of different psychiatric disorders including alcoholism. Since platelets and central serotonergic synaptosomes share similar pharmacodynamics of 5-HT, this study determined platelet 5-HT concentration in 148 male and 42 female drug-free subjects with alcohol dependency, according to the DSM-IV criteria, and in sex-and age-matched controls. Male and female alcoholics had significantly lower platelet 5-HT concentration than 110 male and 123 female healthy controls. Sex differences, i.e. higher platelet 5-HT concentration in men than in women, were found both in healthy and alcoholic subjects. Platelet 5-HT concentration differed significantly in male and female alcoholic subjects with or without different psychiatric comorbidities. Platelet 5-HT concentration was higher in male alcoholics with comorbid posttraumatic stress disorder (PTSD) than in male alcoholics with comorbid anxious-depressive disorder, or depression, or male alcoholics without any psychiatric comorbidities. Comorbid depression in female alcoholics slightly elevated platelet 5-HT levels but these values were still reduced compared to values in healthy women. Smoking status did not affect platelet 5-HT concentration either in healthy or in alcoholic subjects. The data from our study show sex differences, and reduced platelet 5-HT values, regardless of the nicotine dependence, in the large groups of male and female alcoholic subjects. Among male alcoholics the presence of comorbid PTSD partly normalized the decreased platelet 5-HT values. The results of the present study support the hypothesis that alterations in 5-HT system might be related to alcoholism.     

Skeletal effects of serotonin (5-hydroxytryptamine) transporter inhibition: evidence from clinical studies

The discovery of a functional serotonin (5-hydroxytryptamine; 5-HT) transporter (5-HTT) in bone has given rise to questions about the physiologic role of 5-HT in bone, and the possible clinical implications for humans. 5-HT is known to play a role in the pathophysiology of depression, and many antidepressant medications function by inhibiting the 5-HTT. Among the antidepressants, those that selectively block the 5-HTT (namely, selective serotonin reuptake inhibitors; SSRIs) appear to have skeletal effects. Several studies have demonstrated lower bone density, increased rates of bone loss at the hip, and increased rates of fracture among older individuals taking SSRIs. However, there remains uncertainty about whether it is the antidepressant medications themselves or the reason for their use (depression) that is responsible for these observed bone changes. This paper reviews the epidemiologic literature that explores the role of the 5-HTT in bone health, by looking at questions about how depression, antidepressant therapy and SSRIs impact bone health in humans. Further research will be important to better understand how these factors interact to influence skeletal status, and to characterize the biochemical mechanism through which 5-HT may mediate bone turnover and metabolism.     

The 5-HT deficiency theory of depression: perspectives from a naturalistic 5-HT deficiency model, the tryptophan hydroxylase 2Arg439His knockin mouse

A decreased level of brain 5-hydroxytryptamine (5-HT) has been theorized to be a core pathogenic factor in depression for half a century. The theory arose from clinical observations that drugs enhancing extracellular levels of 5-HT (5-HT(Ext)) have antidepressant effects in many patients. However, whether such drugs indeed correct a primary deficit remains unresolved. Still, a number of anomalies in putative biomarkers of central 5-HT function have been repeatedly reported in depression patients over the past 40 years, collectively indicating that 5-HT deficiency could be present in depression, particularly in severely ill and/or suicidal patients. This body of literature on putative 5-HT biomarker anomalies and depression has recently been corroborated by data demonstrating that such anomalies indeed occur consequent to severely reduced 5-HT(Ext) levels in a mouse model of naturalistic 5-HT deficiency, the tryptophan hydroxylase 2 His(439) knockin (Tph2KI) mouse. In this review, we will critically assess the evidence for 5-HT deficiency in depression and the possible role of polymorphisms in the Tph2 gene as a causal factor in 5-HT deficiency, the latter investigated from a clinical as well as preclinical angle.     

综述与专论：甘丙肽对抑郁症状的调控作用及其机制的研究进展

甘丙肽(galanin, GAL)作为治疗抑郁症的可能靶点被关注已久,但目前仍未有广泛应用的GAL类抗抑郁药物。GAL可与3种G蛋白偶联受体(GalR1～3)结合,GalR1和GalR3介导促进抑郁的作用,GalR2介导抗抑郁的作用。GAL的N端有生物活性的片段GAL (1-15),通过其受体GalR1-GalR2异聚体(heteromer),介导比GAL更强的调节抑郁效应。GAL (1-15)还可以通过GalR1-GalR2异聚体与5-羟色胺1A受体(5-HT1AR)相互作用形成GalR1-GalR2-5-HT1AR异聚体的方式,加强5-HT1AR激动剂的抗抑郁效果。此外,GAL及其受体还与去甲肾上腺素、神经肽Y、脑源性神经营养因子、多巴胺等递质或因子交互作用调节抑郁。本文梳理GAL及其受体对抑郁的调节作用及其可能机制,并对以GAL及其受体为靶点开发的药物应用于临床治疗抑郁症的可能性进行探讨。     

甘丙肽对抑郁症状的调控作用及其机制的研究进展

甘丙肽(galanin, GAL)作为治疗抑郁症的可能靶点被关注已久,但目前仍未有广泛应用的GAL类抗抑郁药物。GAL可与3种G蛋白偶联受体(GalR1~3)结合,GalR1和GalR3介导促进抑郁的作用,GalR2介导抗抑郁的作用。GAL的N端有生物活性的片段GAL (1-15),通过其受体GalR1-GalR2异聚体(heteromer),介导比GAL更强的调节抑郁效应。GAL (1-15)还可以通过GalR1-GalR2异聚体与5-羟色胺1A受体(5-HT1AR)相互作用形成GalR1-GalR2-5-HT1AR异聚体的方式,加强5-HT1AR激动剂的抗抑郁效果。此外,GAL及其受体还与去甲肾上腺素、神经肽Y、脑源性神经营养因子、多巴胺等递质或因子交互作用调节抑郁。本文梳理GAL及其受体对抑郁的调节作用及其可能机制,并对以GAL及其受体为靶点开发的药物应用于临床治疗抑郁症的可能性进行探讨。     

脊髓外科手术术后精神障碍患者发病影响因素及抑制性神经递质水平、神经营养因子表达变化情况分析

摘要 目的：探讨与分析脊髓外科手术术后精神障碍患者发病影响因素及抑制性神经递质水平、神经营养因子表达变化情况。方法：选择2016年9月到2021年5月本院完成脊髓外科手术的患者83例作为研究对象,检测血清抑制性神经递质水平、神经营养因子（NTFs）表达水平。所有患者都给予抑郁自评量表（SDS）调查、执行功能行为评定量表成人版自评问卷（BRIEF-A）评分并进行相关性分析。结果：83例患者术后平均SDS评分为45.10±2.87分,判定为精神障碍23例（精神障碍组）,占比27.7 %。精神障碍组的性别、年龄、手术时间、术中出血量与非精神障碍组对比无差异（P>0.05）,精神障碍组的饮酒、术后清醒时间与非精神障碍组对比有差异（P<0.05）。精神障碍组的BRI自我控制、情感控制、转移、抑制等评分与MI任务启动、任务监督、工作记忆、计划、组织评分都高于非精神障碍组（P<0.05）。精神障碍组的血清NTFs含量低于非精神障碍组,血清HA与5-HT含量高于非精神障碍组（P<0.05）。在83例患者中,Pearson分析显示SDS评分与饮酒、术后清醒时间、血清NTFs、NA、5-HT含量都存在相关性（P<0.05）;二分类logistic逐步回归显示术后清醒时间、血清NTFs、NA、5-HT含量都为导致脊髓外科手术术后精神障碍患者发病的重要因素（P<0.05）。结论：脊髓外科手术术后精神障碍的发生较常见,可导致患者认知与执行功能降低,多伴随有抑制性神经递质水平表达上升与神经营养因子表达下降,血清NTFs、NE、5-HT含量都为导致精神障碍发病的重要因素。