Episode length and mixed features as predictors of ECT nonresponse in patients with medication-resistant major depression.

OBJECTIVES: This study aimed to ascertain predictors of nonresponse to electroconvulsive therapy (ECT) in a large sample of major depressive patients resistant to pharmacologic treatment. METHODS: A total of 208 depressive patients (31 with major depression [UP], 101 with bipolar disorder II [BP II], and 76 with bipolar disorder I [BP I] according to DSM-IV criteria) were included in the study and treated with bilateral ECT on a twice-a-week schedule. The patients were assessed before (baseline) and a week after the ECT course (final score) using the Hamilton Rating Scale for Depression-17 items (HAM-D-17), the Young Mania Rating Scale (YMRS), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Improvement (CGI). Responders were defined as those patients with a reduction of at least 50% in HAM-D-17 score and a rating of 2 ("much improved") or 1 ("very much improved") in the CGI-Improvement subscale. RESULTS: At the end of the ECT course, 152 patients (64%) were classified as responders and 56 patients (36%) were classified as nonresponders. On backward stepwise logistic regression, bipolar subtype (odds ratio [OR]=17.85; 95% confidence level [CL]=1.786-178.407), higher mean baseline YMRS scores (OR=1.094; 95% CL=1.025-1.166), lower mean baseline HAM-D-17 scores (OR=0.928; 95% CL=0.860-1.002), and length of current episode (OR=1.047; 95% CL=1.009-1.086) were identified as statistically significant predictors of nonresponse. CONCLUSIONS: ECT was an effective treatment for approximately two-thirds of the patients with medication-resistant depression who were included in this study. ECT nonresponse was associated with bipolar subtype, presence of manic symptoms during depression, slightly less severe depressive symptomatology, and protracted duration of the episode.

Response to ECT in bipolar I, bipolar II and unipolar depression.

OBJECTIVES: A significant body of evidence indicates the efficacy of electroconvulsive therapy (ECT) in unipolar depression but mixed results have been reported in bipolar depression. We explored difference of response to ECT in unipolar (UP), bipolar I (BP I) and bipolar II (BP II) depression, in a sample of patients resistant to pharmacological treatment. METHODS: One hundred and thirty depressive patients (17 with Major Depression (UP), 67 with bipolar disorder II (BP II) and 46 with bipolar disorder I (BP I) according to DSM-IV criteria) were included in the study and treated with bilateral ECT, on a twice-a-week schedule. The patients were assessed before (baseline) and a week after the ECT course (final score), using the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Improvement (CGI). RESULTS: The three groups (UP, BP II, BP I) showed a significant improvement after the ECT course. Global response rate (CGI<2) was 94.1% for UP, 79.1% for BP II and 67.4% for BP I. Concerning depressive symptomatology, the remission rate (HAM-D <8) was respectively 70.5 for UP, 56.7% for BP II and 65.3% for BP I. The best results were achieved by UP patients, while BP I group showed the worst results with a lower remission rate and higher scores in YMRS and BPRS psychotic cluster at the final evaluation. CONCLUSION: ECT turns out to be a viable option for the treatment of both unipolar and bipolar depressive patients resistant to pharmacological treatment. Nevertheless, while the UP group showed the best response and clinical outcomes, the BP I patients tended to exhibit residual manic and psychotic symptomatology.

Differential cellular localization of estrogen receptor alpha in uterine and mammary cells.

The classical alpha isoform of the estrogen receptor (ER) has been reported to localize almost exclusively in the nucleus. However, studies on non-genomic steroid effects have also suggested the existence of ERs residing at the cell surface. In this work, we present immunological data supporting extra-nuclear ERalpha localization in uterine (SHM) and mammary (MCF-7) cell lines. Immunocytological studies performed on SHM cells revealed that native ERs mainly localize as a perinuclear cytoplasmic ring. The receptors were rapidly translocated to the nucleus by 17beta-estradiol. In addition to nuclear ERs, a peripheral reservoir of ERalpha immunoreactivity, most probably associated with the plasma membrane, was detected in MCF-7 cells. These results were confirmed by the detection of membrane estrogen binding sites using fluorescent estrogen-BSA derivatives and ligand binding assays to intact cells, where [3H]-estradiol could be partly displaced by impeded estrogen conjugates. Partial inhibition of radioligand binding by an antibody against the steroid binding domain of the ERalpha suggests that the isoform faces the extracellular media in MCF-7 cells. Moreover, ERalpha-like proteins ( approximately 67 kDa) were found to be associated in isolated membrane subfractions from the cells. However, immunocytology of COS-1 (ER-negative) and SHM cells transfected with the complete cDNA coding for the cloned ERalpha and beta isoforms showed exclusive nuclear localization of the overexpressed ERs. The non-classical distribution of native ERalpha-like proteins in each cell line, suggests an alternative mode of ERalpha cellular localization/function. Cell type-dependent processing may account for the differential localization shown by native and expressed receptors in the systems considered.

Expression of the circadian clock genes clock and period1 in human skin.

The circadian clock is a cellular machine composed of proteins with regulated expression that gives rise to circadian rhythms. Two main new concepts have arisen from recent research in the field in the last few years: (i) at least three to five key genes are involved in maintaining the basic circadian cellular rhythms, and (ii) their expression is fairly ubiquitous, extending beyond the traditionally considered pacemaker in mammals, the suprachiasmatic nucleus. We have demonstrated the expression of two circadian clock genes, clock and period1, in human skin cells. Reverse transcriptase polymerase chain reaction revealed the presence of clock and period1 mRNA in cultured human keratinocytes, melanocytes, and dermal fibroblasts, as well as in the human keratinocyte cell line HaCaT and the human melanoma line A375. In addition, antibodies to these two proteins produced immuno-positive staining in these cell types. Our investigations demonstrate for the first time that skin cells express circadian clock proteins constitutively although regulation of their expression and activity has not been elucidated. These proteins may have a role in cutaneous and/or systemic circadian biology and the skin and skin cells may provide an attractive model for the study of circadian rhythms.

Condition-dependent presence of beta-lipotropin-like peptide in human keratinocytes.

This study aimed to characterize the beta-endorphin-immunoreactive material (betaE-IR) detectable in normal human keratinocytes (NHK). The effects of different culturing conditions and UV-irradiation on production of betaE-IR by NHK were assessed by radioimmunoassay and HPLC. All culture systems contained low levels of betaE-IR that was increased in conditioned media after UV-irradiation under certain conditions. NHK grown in nutrient-poor medium contained highest levels of betaE-IR that exhibited beta-lipotropin-like properties after HPLC analysis. The other culturing conditions displayed no authentic betaE-related peptides. Our results indicate that under certain culturing conditions NHK can produce POMC peptides like beta-lipotropin, which can be induced by UV-radiation.

An immunocytochemical approach to the study of beta-endorphin production in human keratinocytes using confocal microscopy.

Proopiomelanocortin (POMC) is a protein that is posttranslationally processed to yield POMC peptides. The main site of POMC expression is the anterior pituitary lobe but many other sources have been identified. There is evidence that the skin produces POMC peptides, although their roles have not yet been defined. In the skin, regulation of POMC gene expression is known to be hair-cycle dependent, and it is localized to the sebaceous gland. In particular, beta-endorphin, a POMC peptide, has been shown to be modulated by TPA, IL-1 alpha, and ultraviolet radiation in keratinocytes. These results were obtained by examination of POMC mRNA levels using the Northern blot method; beta-endorphin protein production by the Western blot method on cultured cells; and immunocytochemistry for tissue preparations. This report represents an approach to use immunocytochemistry to quantify beta-endorphin production in cultured human keratinocytes. Additionally, we examined whether exposure to 20 mJ ultraviolet B radiation (UVB) and/or UVA could influence beta-endorphin production in these cells. Keratinocytes were grown in monolayers, in serum-free medium, fixed, and incubated with antiserum to whole synthetic beta-endorphin. Fluorescence microscopy was performed with a confocal laser scanning microscope. The integrated level of fluorescence was evaluated in n = 18 +/- 8 individual cells, and this was assumed to be proportional to beta-endorphin content. High variability was observed in the fluorescence intensity among cells. No significant differences between control and UVB- or UVA + UVB-treated cells was found. Similar results were produced by using brefeldin A, a compound that disrupts the secretory pathway, eliminating the possibility that the absence of a difference between beta-endorphin content in the treated and control cells was due to secretion of the peptide into the medium. We conclude that: (1) beta-endorphin or beta-endorphin-like peptides are produced in human keratinocytes and are readily detected by immunocytochemistry; (2) under the conditions tested, UVA and/or UVB did not increase beta-endorphin-like immunoreactivity in these cells.

Vitamin D receptor expression in chicken muscle tissue and cultured myoblasts.

Muscle has long been recognized as a target tissue for 1,25-dihydroxy-vitamin D3 (1,25[OH]2D3). Evidence of the presence of VDR is provided here, thus supporting the existence of a receptor-mediated mechanism of action of 1,25(OH)2D3. Vitamin D receptor (VDR) expression is evidenced by detection of VDR-mRNA, through reverse transcription and polymerase chain reaction (RT/PCR), in chicken muscle and muscle cells (myoblasts) as well as in a variety of tissues such as intestine, kidney, heart and brain. VDR presence is also demonstrated by Southern blot of PCR products with a specific VDR-cDNA probe and by immunocytochemistry carried out on myoblasts and cardiac myocytes. Localization of VDR is mainly nuclear and more faintly detected in the cytosol.

Differing shapes of 1 alpha,25-dihydroxyvitamin D3 function as ligands for the D-binding protein, nuclear receptor and membrane receptor: a status report.

1 alpha,25-dihydroxyvitamin D3 [1 alpha,25(OH)2D3] is the principal mediator of a wide array of biological responses through the far reaching network of the vitamin D endocine system (VDE). The steroid hormone 1 alpha,25(OH)2D3 is delivered to the various target organs of the VDE via a specific plasma transport protein, the vitamin D binding protein (DBP). Also 1 alpha,25(OH)2D3 is known to initiate biological responses through a nuclear receptor, the nVDR (50 kDa) which regulates selected gene transcription and, in addition in some target tissues, through a second receptor located in the cell membrane, the mVDR (approximately 60 kDa), which is linked to protein kinase C and/or voltage-gated Ca2+ channels so as to generate biological responses very rapidly. 1 alpha,25(OH)2D3 as a ligand is unusually conformationally flexible due to the eight carbon side chain, the seco B-ring which permits rotation about the 6-7 single carbon bond, and the A-ring which undergoes chair-chair conformational interconversion characteristic of cyclohexane rings. This paper reviews the evidence that different shapes of the 1 alpha,25(OH)2D3 satisfy the optimal requirements of the ligand binding domains of the DBP, nVDR and mVDR. The presence of a relatively rigid side chain (composed by the presence of an aromatic ring) enhances ligand interaction 2-3 fold with the DBP, but diminishes ligand affinity for the nVDR by 100 fold. The mVDR responds effectively to analogs of 1 alpha,25(OH)2D3 which are 6-s-cis locked [e.g. 1 alpha,25(OH)2-previtamin D3 or 1 alpha,25(OH)2-provitamin D3], but these same analogs have only 1-2% of the activity of 1 alpha,25(OH)2D3 in regulating gene transcription. Finally the 6-s-trans analog, 1 alpha,25(OH)2-tachysterol3, had <0.1% of the activity of 1 alpha,25(OH)2D3 in regulating gene transcription.

cDNA sequence identity of a vitamin D-dependent calcium-binding protein in the chick to calbindin D-9K.

1,25-dihydroxy-vitamin D3 [1,25(OH)2D3] is a steroid hormone that modulates the expression of specific proteins by a genomic mechanism of action. Calbindin D-9K is a calcium-binding protein that heretofore has only been found in mammalian tissues and whose gene expression is regulated by 1,25(OH)2D3 in a tissue specific fashion. By combined reverse transcription and polymerase chain reaction, calbindin D-9K gene expression was demonstrated for the first time to be present in several chicken tissues. Subcloning and sequencing of a partial 160 bp-cDNA PCR product revealed that the cDNA corresponds to calbindin D-9K-cDNA. This constitutes the first evidence of calbindin D-9K gene presence and expression in the avian class.