Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba 260-8670, Japan; Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, Sichuan, China.
2 papers in the library · 179 citations · publishing 2020-2024
The antidepressant effects of (R,S)-ketamine, a mixture of (R)-ketamine and (S)-ketamine, are a major advance in mood research. Off-label use for treatment-resistant depression has grown in the US, and in 2019 the FDA and European authorities approved (S)-ketamine nasal spray for this condition, but only in certified medical settings. Preclinical evidence indicates that (R)-ketamine may be more potent and longer-lasting as an antidepressant than (S)-ketamine, with fewer side effects. Clinical trials of (R)-ketamine in humans are now underway. This article reviews the history of these compounds and discusses the mechanisms behind ketamine's antidepressant actions.
In mice susceptible to chronic social defeat stress, removing the spleen reduces arketamine's antidepressant-like effects. RNA sequencing of the prefrontal cortex revealed that the oxidative phosphorylation (OXPHOS) pathway mediates this effect. Inhibiting OXPHOS with oligomycin A reversed the spleen removal's suppressive effect. Specific OXPHOS genes—COX11, UQCR11, and ATP5e—may be involved. Transforming growth factor β1 (TGF-β1) and COX11 appear to modulate the suppression; activating the TGF-β1 receptor with SRI-01138 alleviated it. Cutting the subdiaphragmatic vagus nerve also counteracted the inhibitory effect of splenectomy. These results suggest that arketamine's antidepressant-like effects involve the OXPHOS pathway and TGF-β1 in the prefrontal cortex, communicated through a spleen-brain axis via the vagus nerve.