Receptores NMDA: fundamentos e implicaciones terapéuticas en el manejo del dolor / NMDA receptors: foundations and therapeutic implications in the management of pain

The NMDA receptors has been described in the development of acute pain and maintenance of chronic pain; the knowledge of physiological processes has led to the growing interest in NMDA receptors antagonists, demonstrating optimal analgesic results. Inhibition of NMDA receptors is an effective therapeutic alternative in the management of pain; with beneficial results in the management of acute postoperative pain, chronic and neuropathic pain. The current scientific challenge is to identify antagonists that perform a selective inhibition of receptor subunits, achieving optimal analgesic results. For this non-systemic review, a search of the available scientific evidence was made in databases (Pubmed/Medline, Science Direct, OVID, SciELO) through the use of keywords (Pain, NMDA receptors, antagonists, ketamine).

Los receptores NMDA han sido descritos en el desarrollo del dolor agudo y mantenimiento del dolor crónico; el conocimiento de los procesos fisiológicos ha llevado al creciente interés en los antagonistas de los receptores NMDA, demostrando resultados analgésicos óptimos. La inhibición de los receptores NMDA es una alternativa terapéutica eficaz en el manejo del dolor; con resultados benéficos en el manejo del dolor agudo postoperatorio, dolor crónico y neuropático. El reto científico actual es identificar antagonistas que realicen una inhibición selectiva de las subunidades del receptor, logrando óptimos resultados analgésicos. Para esta revisión no sistemática se realizó una búsqueda de la evidencia científica disponible en bases de datos (Pubmed/Medline, Science Direct, OVID, SciELO) mediante el uso de palabras clave (dolor, receptores NMDA, antagonistas, ketamina).

Neuroprotección mediada por BDNF y óxido nítrico frente a excitotoxicidad en neuronas corticales e hipocampales / BDNF and nitric oxide-mediated neuroprotection against excitotoxicity in cortical and hippocampal neurons

En la epilepsia del lóbulo temporal (ELT), el hipocampo y estructuras temporales adyacentes se convierten en foco epiléptico, lo que ocurre después de un insulto cerebral, como una convulsión prolongada (o Status Epilepticus [SE]). Posterior al insulto, en el hipocampo ocurre muerte neuronal por excitotoxicidad, es decir, por sobre estimulación de receptores glutamatérgicos tipo NMDA (R-NMDA) y síntesis de óxido nítrico (NO) por la óxido nítrico sintasa neuronal (nNOS), una enzima dependiente de calcio. Sin embargo, otras estructuras cerebrales, como la corteza cerebral, son más resistentes al daño excitotóxico. Postulamos que esta menor susceptibilidad de la corteza cerebral a la excitotoxicidad, se debería a neuroprotección dependiente de la neurotrofina BDNF, que se sabe estimula la sobrevida neuronal. Se utilizaron cultivos neuronales primarios de hipocampo y corteza cerebral. Para evaluar excitotoxicidad, se agregó NMDA 30 uM. Se utilizaron estrategias farmacológicas para poner a prueba esta hipótesis, como el uso de L-NNA (inhibidor NOS), y TrkB-Fc (atrapador de BDNF). Se evaluó el porcentaje de sobrevida celular mediante el test de exclusión de Azul de Tripán. La viabilidad de los cultivos después de agregar NMDA fueron: corticales 71,2 +/- 2,8 por ciento, hipocampales 24,6 +/- 2,2 por ciento (p<0,01). Al inhibir la NOS, la viabilidad fue: corticales 31 +/- 6,5 por ciento, hipocampales 79,2 +/- 5,4 por ciento (p<0,01). En ausencia de BDNF fue: corticales 28,7+/- 7,9 por ciento, hipocampales 88,9 +/- 3 por ciento (p<0,01). Concluimos que después de un insulto excitotóxico, BDNF/NO son neuroprotectores en neuronas corticales pero no hipocampales. La potenciación de mecanismos neuroprotectores podría ser una alternativa terapéutica en patologías que involucran muerte neuronal por excitotoxicidad.

In temporal-lobe epilepsy (TLE), the hippocampus and adjacent temporal structures become an epileptic focus following a brain insult, such as a prolonged seizure (or Status Epilepticus). After the insult, neuronal death by excitotoxicity ocurrs, this is, by over stimulation of NMDA-type glutamate receptors (R-NMDA) and nitric oxide sinthesis by neuronal nitric oxide synthase (nNOS), a calcium-dependant enzyme. However, other brain structures, such as the cerebral cortex, are much more resistant to an excitotoxic challenge. We propose that the decreased susceptibility of the cerebral cortex could be explained by neuroprotection mediated by the neurotrophin BDNF, which is known to stimulate neuronal survival. Primary hippocampal and cortical neuronalcultures were used. To evaluate excitotoxicity, 30 uM NMDA was added. The signaling pathways to be tested were inhibited by using pharmacological inhibitors: L-NNA (NOS inhibitor), and TrkB-Fc, a BDN-scavenger. Percentages of cellular survival were evaluated using the Trypan Blue exclusion test. The viability of the cultures after adding NMDA was: larger in cortical than in hippocampal cultures, 71,2 +/- 2,8 percent for cortical and 24,6 +/- 2,2 percent hippocampal cells (p<0,01). When inhibiting NOS, the viability was: 31 +/- 6,5 percent for cortical and 79,2 +/- 5,4 percent for hippocampal cells (p<0,01). In absence of BDNF, 28,7 +/- 7,9 percent of the cortical cells survived, while in the hippocampal cultures it was of 88,9 +/- 3 percent (p<0,01). We conclude that after an excitotoxic insult, BDNF/NO are neuroprotective in cortical but not hippocampal neurons. The potentiation of such neuroprotective mecanisms could be used as a therapeutic alternative in pathologies that involve neuronal death by excitotoxicity.

Glutamate-N-methyl-D-aspartate receptor modulation and minocycline for the treatment of patients with schizophrenia: an update: [review]

Growing consistent evidence indicates that hypofunction of N-methyl-D-aspartate (NMDA) transmission plays a pivotal role in the neuropathophysiology of schizophrenia. Hence, drugs which modulate NMDA neurotransmission are promising approaches to the treatment of schizophrenia. The aim of this article is to review clinical trials with novel compounds acting on the NMDA receptor (NMDA-R). This review also includes a discussion and translation of neuroscience into schizophrenia therapeutics. Although the precise mechanism of action of minocycline in the brain remains unclear, there is evidence that it blocks the neurotoxicity of NMDA antagonists and may exert a differential effect on NMDA signaling pathways. We, therefore, hypothesize that the effects of minocycline on the brain may be partially modulated by the NMDA-R or related mechanisms. Thus, we have included a review of minocycline neuroscience. The search was performed in the PubMed, Web of Science, SciELO, and Lilacs databases. The results of glycine and D-cycloserine trials were conflicting regarding effectiveness on the negative and cognitive symptoms of schizophrenia. D-serine and D-alanine showed a potential effect on negative symptoms and on cognitive deficits. Sarcosine data indicated a considerable improvement as adjunctive therapy. Finally, minocycline add-on treatment appears to be effective on a broad range of psychopathology in patients with schizophrenia. The differential modulation of NMDA-R neurosystems, in particular synaptic versus extrasynaptic NMDA-R activation and specific subtypes of NMDA-R, may be the key mediators of neurogenesis and neuroprotection. Thus, psychotropics modulating NMDA-R neurotransmission may represent future monotherapy or add-on treatment strategies in the treatment of schizophrenia.

Hipótese glutamatérgica da esquizofrenia / Glutamatergic hypothesis of schizophrenia

A esquizofrenia é um transtorno psiquiátrico devastador cuja fisiopatologia ainda está para ser esclarecida. Apesar de uma disfunção dopaminérgica estar bem estabelecida na esquizofrenia, há uma série de evidências sugerindo o envolvimento do sistema glutamatérgico na fisiopatologia do transtorno. Este artigo faz uma breve revisão de alguns aspectos básicos do funcionamento dos receptores glutamatérgicos com ênfase nos receptores N-metil-D-aspartato (NMDA). Apresenta evidências científicas sugerindo uma disfunção do sistema glutamatérgico na esquizofrenia (hipofunção de receptores NMDA). E discute as interações entre os sistemas dopaminérgico e glutamatérgico; mais especificamente como os estados hiperdopaminérgicos encontrados na esquizofrenia podem estar associados a uma alteração glutamatérgica

Induction of N-methyl-D-asparate receptor mediated c-fos protein in the rat brain by incomplete ischaemia.

The expression of c-fos protein was examined by means of immunocytochemistry in the rat brain following incomplete ischaemia, to elucidate the molecular mechanisms of post-ischaemic neuronal death and of the modulated neurotransmission of surviving neurons. Incomplete ischaemia was produced by permanent unilateral or bilateral common carotid artery (CCA) occlusion. After 1 h of unilateral occlusion, the level of c-fos protein-like nuclear immunoreactivity increased in cortical neurons ipsilateral to the insult, especially in cingulate and piriform cortices. The reactivity peaked at 3-6 h, and was undetectable after 3 days. A number of scattered immunostained neurons in the ipsilateral subiculum, CA 1 and dentate gyrus became visible after 1 day. The effect reached a peak between 1-3 days, then returned to basal levels by 7 days. Bilateral CCA occlusion showed a similar distribution of immunoreactivity, but on both hemispheres. Immunoreactive neurons were more numerous and intensely stained but more transient. The induction of c-fos was completely blocked or reduced by treatment with MK-801. Our results suggest that c-fos expression after CCA occlusion is NMDA receptor mediated, and that it has a specific role in neurons after ischaemic insult.

Role of the amygdala, hippocampus and entorhinal cortex in memory consolidation and expression

1. Experiments using localized microinfusions of specific agonists and antagonists of neurotransmitter receptors have shown that the amygdala, hippocampus, medial septum and entorhinal cortex are involved in memory consolidation, storage and expression. The data are consistent with observations derived from lesion studies suggesting a role for these structures in memory processes, but permit many additional conclusions concerning the mechanisms involved and their timing. 2. Memories are initially processed by glutamatergic N-methyl-D-aspartate (NMDA) receptors in amygdala, hippocampus and medial septum, which are sensitive to amino-phosphono valerate (AP5). Memory of inhibitory avoidance is processed by the three structures; memory of habituation to a novel environment is processed only by the hippocampus. At the time of consolidation, immediately after training, gamma-aminobutyrate type A (GABA-A) receptors, modulated by endogenous benzodiazepines, play an inhibitory role, and cholinergic muscarinic and beta-noradrenergic transmission play a modulatory role. 3. From 90 to 180 min after training, memories are blocked by cyano-nitro-quinoxalinedione (CNQX) given into the amygdala, septum and hippocampus. CNQX blocks non-NMDA glutamatergic receptors. Also between 90 and 180 min after training, memory of the habituation and inhibitory avoidance tasks is blocked by the infusion of AP5 or of the GABA-A agonist, muscimol, into the entorhinal cortex. This late post-training intervention of the entorhinal cortex is essential for the integration of successively acquired memories, and occurs in response to the simultaneous activation of CNQX-sensitive synapses in amygdala and hippocampus. 4. The expression of memory is blocked by the infusion of CNQX, at the time of testing, into the amygdala and hippocampus (inhibitory avoidance), into the hippocampus but not the amygdala (habituation), or into the entorhinal cortex (for the two tasks). Since consolidation is blocked by AP5 infused into these structures (see above), the data agree with the hypothesis that memories are mediated by (or actually consist of) long-term potentiation (LTP) in these areas of the brain. LTP induction is blocked by AP5 and LTP expression is blocked by CNQX. It is possible that, at the time of memory expression, the entorhinal cortex is an output of the amygdala and hippocampus