1 5600 130 ROLES OF VOLTAGE-DEPENDENT SODIUM CHANNELS IN NEURONAL DEVELOPMENT, PAIN, AND NEURODEGENERATION. BESIDES INITIATING AND PROPAGATING ACTION POTENTIALS IN ESTABLISHED NEURONAL CIRCUITS, VOLTAGE-DEPENDENT SODIUM CHANNELS SCULPT AND BOLSTER THE FUNCTIONAL NEURONAL NETWORK FROM EARLY IN EMBRYONIC DEVELOPMENT THROUGH ADULTHOOD (E.G., DIFFERENTIATION OF OLIGODENDROCYTE PRECURSOR CELLS INTO OLIGODENDROCYTES, MYELINATING AXON; COMPETITION BETWEEN NEIGHBORING EQUIPOTENTIAL NEURITES FOR DEVELOPMENT INTO A SINGLE AXON; ENHANCING AND OPPOSING FUNCTIONAL INTERACTIONS WITH ATTRACTIVE AND REPULSIVE MOLECULES FOR AXON PATHFINDING; EXTENDING AND RETRACTING TERMINAL ARBORIZATION OF AXON FOR CORRECT SYNAPSE FORMATION; EXPERIENCE-DRIVEN COGNITION; NEURONAL SURVIVAL; AND REMYELINATION OF DEMYELINATED AXONS). SURPRISINGLY, DIFFERENT PATTERNS OF ACTION POTENTIALS DIRECT HOMEOSTASIS-BASED EPIGENETIC SELECTION FOR NEUROTRANSMITTER PHENOTYPE, THUS EXCITABILITY BY SODIUM CHANNELS SPECIFYING EXPRESSION OF INHIBITORY NEUROTRANSMITTERS. MECHANISMS FOR THESE PLEIOTROPIC EFFECTS OF SODIUM CHANNELS INCLUDE RECIPROCAL INTERACTIONS BETWEEN NEURONS AND GLIA VIA NEUROTRANSMITTERS, GROWTH FACTORS, AND CYTOKINES AT SYNAPSES AND AXONS. SODIUM CHANNELOPATHIES CAUSING PAIN (E.G., ALLODYNIA) AND NEURODEGENERATION (E.G., MULTIPLE SCLEROSIS) DERIVE FROM 1) ELECTROPHYSIOLOGICAL DISTURBANCES BY INSULTS (E.G., ISCHEMIA/HYPOXIA, TOXINS, AND ANTIBODIES); 2) LOSS-OF-PHYSIOLOGICAL FUNCTION OR GAIN-OF-PATHOLOGICAL FUNCTION OF MUTANT SODIUM CHANNEL PROTEINS; 3) SPATIOTEMPORAL INAPPROPRIATE EXPRESSION OF NORMAL SODIUM CHANNEL PROTEINS; OR 4) DE-REPRESSED EXPRESSION OF OTHERWISE SILENT SODIUM CHANNEL GENES. NA(V)1.7 PROVED TO ACCOUNT FOR PAIN IN HUMAN ERYTHERMALGIA AND INFLAMMATION, BEING THE CONVINCING MOLECULAR TARGET OF PAIN TREATMENT. 2006 2 3968 30 LONG-LASTING ANALGESIA VIA TARGETED IN SITU REPRESSION OF NA(V)1.7 IN MICE. CURRENT TREATMENTS FOR CHRONIC PAIN RELY LARGELY ON OPIOIDS DESPITE THEIR SUBSTANTIAL SIDE EFFECTS AND RISK OF ADDICTION. GENETIC STUDIES HAVE IDENTIFIED IN HUMANS KEY TARGETS PIVOTAL TO NOCICEPTIVE PROCESSING. IN PARTICULAR, A HEREDITARY LOSS-OF-FUNCTION MUTATION IN NA(V)1.7, A SODIUM CHANNEL PROTEIN ASSOCIATED WITH SIGNALING IN NOCICEPTIVE SENSORY AFFERENTS, LEADS TO INSENSITIVITY TO PAIN WITHOUT OTHER NEURODEVELOPMENTAL ALTERATIONS. HOWEVER, THE HIGH SEQUENCE AND STRUCTURAL SIMILARITY BETWEEN NA(V) SUBTYPES HAS FRUSTRATED EFFORTS TO DEVELOP SELECTIVE INHIBITORS. HERE, WE INVESTIGATED TARGETED EPIGENETIC REPRESSION OF NA(V)1.7 IN PRIMARY AFFERENTS VIA EPIGENOME ENGINEERING APPROACHES BASED ON CLUSTERED REGULARLY INTERSPACED SHORT PALINDROMIC REPEATS (CRISPR)-DCAS9 AND ZINC FINGER PROTEINS AT THE SPINAL LEVEL AS A POTENTIAL TREATMENT FOR CHRONIC PAIN. TOWARD THIS END, WE FIRST OPTIMIZED THE EFFICIENCY OF NA(V)1.7 REPRESSION IN VITRO IN NEURO2A CELLS AND THEN, BY THE LUMBAR INTRATHECAL ROUTE, DELIVERED BOTH EPIGENOME ENGINEERING PLATFORMS VIA ADENO-ASSOCIATED VIRUSES (AAVS) TO ASSESS THEIR EFFECTS IN THREE MOUSE MODELS OF PAIN: CARRAGEENAN-INDUCED INFLAMMATORY PAIN, PACLITAXEL-INDUCED NEUROPATHIC PAIN, AND BZATP-INDUCED PAIN. OUR RESULTS SHOW EFFECTIVE REPRESSION OF NA(V)1.7 IN LUMBAR DORSAL ROOT GANGLIA, REDUCED THERMAL HYPERALGESIA IN THE INFLAMMATORY STATE, DECREASED TACTILE ALLODYNIA IN THE NEUROPATHIC STATE, AND NO CHANGES IN NORMAL MOTOR FUNCTION IN MICE. WE ANTICIPATE THAT THIS LONG-LASTING ANALGESIA VIA TARGETED IN VIVO EPIGENETIC REPRESSION OF NA(V)1.7 METHODOLOGY WE DUB PAIN LATER, MIGHT HAVE THERAPEUTIC POTENTIAL IN MANAGEMENT OF PERSISTENT PAIN STATES. 2021 3 2214 26 EPIGENETIC MODIFICATIONS ASSOCIATED TO NEUROINFLAMMATION AND NEUROPATHIC PAIN AFTER NEURAL TRAUMA. ACCUMULATING EVIDENCE SUGGESTS THAT EPIGENETIC ALTERATIONS LIE BEHIND THE INDUCTION AND MAINTENANCE OF NEUROPATHIC PAIN. NEUROPATHIC PAIN IS USUALLY A CHRONIC CONDITION CAUSED BY A LESION, OR PATHOLOGICAL CHANGE, WITHIN THE NERVOUS SYSTEM. NEUROPATHIC PAIN APPEARS FREQUENTLY AFTER NERVE AND SPINAL CORD INJURIES OR DISEASES, PRODUCING A DEBILITATION OF THE PATIENT AND A DECREASE OF THE QUALITY OF LIFE. AT THE CELLULAR LEVEL, NEUROPATHIC PAIN IS THE RESULT OF NEURONAL PLASTICITY SHAPED BY AN INCREASE IN THE SENSITIVITY AND EXCITABILITY OF SENSORY NEURONS OF THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM. ONE OF THE MECHANISMS THOUGHT TO CONTRIBUTE TO HYPEREXCITABILITY AND THEREFORE TO THE ONTOGENY OF NEUROPATHIC PAIN IS THE ALTERED EXPRESSION, TRAFFICKING, AND FUNCTIONING OF RECEPTORS AND ION CHANNELS EXPRESSED BY PRIMARY SENSORY NEURONS. BESIDES, NEURONAL AND GLIAL CELLS, SUCH AS MICROGLIA AND ASTROCYTES, TOGETHER WITH BLOOD BORNE MACROPHAGES, PLAY A CRITICAL ROLE IN THE INDUCTION AND MAINTENANCE OF NEUROPATHIC PAIN BY RELEASING POWERFUL NEUROMODULATORS SUCH AS PRO-INFLAMMATORY CYTOKINES AND CHEMOKINES, WHICH ENHANCE NEURONAL EXCITABILITY. ALTERED GENE EXPRESSION OF NEURONAL RECEPTORS, ION CHANNELS, AND PRO-INFLAMMATORY CYTOKINES AND CHEMOKINES, HAVE BEEN ASSOCIATED TO EPIGENETIC ADAPTATIONS OF THE INJURED TISSUE. WITHIN THIS REVIEW, WE DISCUSS THE INVOLVEMENT OF THESE EPIGENETIC CHANGES, INCLUDING HISTONE MODIFICATIONS, DNA METHYLATION, NON-CODING RNAS, AND ALTERATION OF CHROMATIN MODIFIERS, THAT HAVE BEEN SHOWN TO TRIGGER MODIFICATION OF NOCICEPTION AFTER NEURAL LESIONS. IN PARTICULAR, THE FUNCTION ON THESE PROCESSES OF EZH2, JMJD3, MECP2, SEVERAL HISTONE DEACETYLASES (HDACS) AND HISTONE ACETYL TRANSFERASES (HATS), G9A, DNMT, REST AND DIVERSE NON-CODING RNAS, ARE DESCRIBED. DESPITE THE EFFORT ON DEVELOPING NEW THERAPIES, CURRENT TREATMENTS HAVE ONLY PRODUCED LIMITED RELIEF OF THIS PAIN IN A PORTION OF PATIENTS. THUS, THE PRESENT REVIEW AIMS TO CONTRIBUTE TO FIND NOVEL TARGETS FOR CHRONIC NEUROPATHIC PAIN TREATMENT. 2018 4 6139 29 THE ETIOLOGICAL CONTRIBUTION OF GABAERGIC PLASTICITY TO THE PATHOGENESIS OF NEUROPATHIC PAIN. NEUROPATHIC PAIN DEVELOPING AFTER PERIPHERAL OR CENTRAL NERVE INJURY IS THE RESULT OF PATHOLOGICAL CHANGES GENERATED THROUGH COMPLEX MECHANISMS. DISRUPTION IN THE HOMEOSTASIS OF EXCITATORY AND INHIBITORY NEURONS WITHIN THE CENTRAL NERVOUS SYSTEM IS A CRUCIAL FACTOR IN THE FORMATION OF HYPERALGESIA OR ALLODYNIA OCCURRING WITH NEUROPATHIC PAIN. THE CENTRAL GABAERGIC PATHWAY HAS RECEIVED ATTENTION FOR ITS EXTENSIVE DISTRIBUTION AND FUNCTION IN NEURAL CIRCUITS, INCLUDING THE GENERATION AND DEVELOPMENT OF NEUROPATHIC PAIN. GABAERGIC INHIBITORY CHANGES THAT OCCUR IN THE INTERNEURONS ALONG DESCENDING MODULATORY AND NOCICEPTIVE PATHWAYS IN THE CENTRAL NERVOUS SYSTEM ARE BELIEVED TO GENERATE NEURONAL PLASTICITY, SUCH AS SYNAPTIC PLASTICITY OR FUNCTIONAL PLASTICITY OF THE RELATED GENES OR PROTEINS, THAT IS THE FOUNDATION OF PERSISTENT NEUROPATHIC PAIN. THE PRIMARY GABAERGIC PLASTICITY OBSERVED IN NEUROPATHIC PAIN INCLUDES GABAERGIC SYNAPSE HOMO- AND HETEROSYNAPTIC PLASTICITY, DECREASED SYNTHESIS OF GABA, DOWN-EXPRESSION OF GLUTAMIC ACID DECARBOXYLASE AND GABA TRANSPORTER, ABNORMAL EXPRESSION OF NKCC1 OR KCC2, AND DISTURBED FUNCTION OF GABA RECEPTORS. IN THIS REVIEW, WE DESCRIBE POSSIBLE MECHANISMS ASSOCIATED WITH GABAERGIC PLASTICITY, SUCH AS CENTRAL SENSITIZATION AND GABAERGIC INTERNEURON APOPTOSIS, AND THE EPIGENETIC ETIOLOGIES OF GABAERGIC PLASTICITY IN NEUROPATHIC PAIN. MOREOVER, WE SUMMARIZE POTENTIAL THERAPEUTIC TARGETS OF GABAERGIC PLASTICITY THAT MAY ALLOW FOR SUCCESSFUL RELIEF OF HYPERALGESIA FROM NERVE INJURY. FINALLY, WE COMPARE THE EFFECTS OF THE GABAERGIC SYSTEM IN NEUROPATHIC PAIN TO OTHER TYPES OF CHRONIC PAIN TO UNDERSTAND THE CONTRIBUTION OF GABAERGIC PLASTICITY TO NEUROPATHIC PAIN. 2019 5 2066 25 EPIGENETIC CONTROL OF ION CHANNEL EXPRESSION AND CELL-SPECIFIC SPLICING IN NOCICEPTORS: CHRONIC PAIN MECHANISMS AND POTENTIAL THERAPEUTIC TARGETS. ION CHANNELS UNDERLIE ALL FORMS FOR ELECTRICAL SIGNALING INCLUDING THE TRANSMISSION OF INFORMATION ABOUT HARMFUL EVENTS. VOLTAGE-GATED CALCIUM ION CHANNELS HAVE DUAL FUNCTION, THEY SUPPORT ELECTRICAL SIGNALING AS WELL AS INTRACELLULAR CALCIUM SIGNALING THROUGH EXCITATION-DEPENDENT CALCIUM ENTRY ACROSS THE PLASMA MEMBRANE. MECHANISMS THAT REGULATE ION CHANNEL FORMS AND ACTIONS ARE ESSENTIAL FOR MYRIAD CELL FUNCTIONS AND THESE ARE TARGETED BY DRUGS AND THERAPEUTICS. WHEN DISRUPTED, THE CELLULAR MECHANISMS THAT CONTROL ION CHANNEL ACTIVITY CAN CONTRIBUTE TO DISEASE PATHOPHYSIOLOGY. FOR EXAMPLE, ALTERNATIVE PRE-MRNA SPLICING IS A MAJOR STEP IN DEFINING THE PRECISE COMPOSITION OF THE TRANSCRIPTOME ACROSS DIFFERENT CELL TYPES FROM EARLY CELLULAR DIFFERENTIATION TO PROGRAMMED APOPTOSIS. AN ESTIMATED 30% OF DISEASE-CAUSING MUTATIONS ARE ASSOCIATED WITH ALTERED ALTERNATIVE SPLICING, AND MIS-SPLICING IS A FEATURE OF NUMEROUS HIGHLY PREVALENT DISEASES INCLUDING NEURODEGENERATIVE, CANCER, AND CHRONIC PAIN. HERE WE DISCUSS THE IMPORTANT ROLE OF EPIGENETIC REGULATION OF GENE EXPRESSION AND CELL-SPECIFIC ALTERNATIVE SPLICING OF CALCIUM ION CHANNELS IN NOCICEPTORS, WITH EMPHASIS ON HOW THESE PROCESSES ARE DISRUPTED IN CHRONIC PAIN, THE POTENTIAL THERAPEUTIC BENEFIT OF CORRECTING OR COMPENSATING FOR ABERRANT ION CHANNEL SPLICING IN CHRONIC PAIN. 2021 6 4614 29 NERVE EXCITABILITY AND NEUROPATHIC PAIN IS REDUCED BY BET PROTEIN INHIBITION AFTER SPARED NERVE INJURY. NEUROPATHIC PAIN IS A COMMON DISABILITY PRODUCED BY ENHANCED NEURONAL EXCITABILITY AFTER NERVOUS SYSTEM INJURY. THE PATHOPHYSIOLOGICAL CHANGES THAT UNDERLIE THE GENERATION AND MAINTENANCE OF NEUROPATHIC PAIN REQUIRE MODIFICATIONS OF TRANSCRIPTIONAL PROGRAMS. IN PARTICULAR, THERE IS AN INDUCTION OF PRO-INFLAMMATORY NEUROMODULATORS LEVELS, AND CHANGES IN THE EXPRESSION OF ION CHANNELS AND OTHER FACTORS INTERVENING IN THE DETERMINATION OF THE MEMBRANE POTENTIAL IN NEURONAL CELLS. WE HAVE PREVIOUSLY FOUND THAT INHIBITION OF THE BET PROTEINS EPIGENETIC READERS REDUCED NEUROINFLAMMATION AFTER SPINAL CORD INJURY. WITHIN THE PRESENT STUDY WE AIMED TO DETERMINE IF BET PROTEIN INHIBITION MAY ALSO AFFECT NEUROINFLAMMATION AFTER A PERIPHERAL NERVE INJURY, AND IF THIS WOULD BENEFICIALLY ALTER NEURONAL EXCITABILITY AND NEUROPATHIC PAIN. FOR THIS PURPOSE, C57BL/6 FEMALE MICE UNDERWENT SPARED NERVE INJURY (SNI), AND WERE TREATED WITH THE BET INHIBITOR JQ1, OR VEHICLE. ELECTROPHYSIOLOGICAL AND ALGESIMETRY TESTS WERE PERFORMED ON THESE MICE. WE ALSO DETERMINED THE EFFECTS OF JQ1 TREATMENT AFTER INJURY ON NEUROINFLAMMATION, AND THE EXPRESSION OF NEURONAL COMPONENTS IMPORTANT FOR THE MAINTENANCE OF AXON MEMBRANE POTENTIAL. WE FOUND THAT TREATMENT WITH JQ1 AFFECTED NEURONAL EXCITABILITY AND MECHANICAL HYPERALGESIA AFTER SNI IN MICE. BET PROTEIN INHIBITION REGULATED CYTOKINE EXPRESSION AND REDUCED MICROGLIAL REACTIVITY AFTER INJURY. IN ADDITION, JQ1 TREATMENT ALTERED THE EXPRESSION OF SCN3A, SCN9A, KCNA1, KCNQ2, KCNQ3, HCN1 AND HCN2 ION CHANNELS, AS WELL AS THE EXPRESSION OF THE NA(+)/K(+) ATPASE PUMP SUBUNITS. IN CONCLUSION, BOTH, ALTERATION OF INFLAMMATION, AND NEURONAL TRANSCRIPTION, COULD BE THE RESPONSIBLE EPIGENETIC MECHANISMS FOR THE REDUCTION OF EXCITABILITY AND HYPERALGESIA OBSERVED AFTER BET INHIBITION. INHIBITION OF BET PROTEINS IS A PROMISING THERAPY FOR REDUCING NEUROPATHIC PAIN AFTER NEURAL INJURY. PERSPECTIVE: NEUROPATHIC PAIN IS A COMMON DISABILITY PRODUCED BY ENHANCED NEURONAL EXCITABILITY AFTER NERVOUS SYSTEM INJURY. THE UNDERLYING PATHOPHYSIOLOGICAL CHANGES REQUIRE MODIFICATIONS OF TRANSCRIPTIONAL PROGRAMS. THIS STUDY NOTES THAT INHIBITION OF BET PROTEINS IS A PROMISING THERAPY FOR REDUCING NEUROPATHIC PAIN AFTER NEURAL INJURY. 2021 7 4619 22 NERVE TRAUMA-CAUSED DOWNREGULATION OF OPIOID RECEPTORS IN PRIMARY AFFERENT NEURONS: MOLECULAR MECHANISMS AND POTENTIAL MANAGEMENTS. NEUROPATHIC PAIN IS THE MOST COMMON CLINICAL DISORDER DESTROYING THE QUALITY OF PATIENT LIFE AND LEADING TO A MARKED ECONOMIC AND SOCIAL BURDEN. OPIOIDS ARE STILL LAST OPTION FOR PHARMACOLOGICAL TREATMENT OF THIS DISORDER, BUT THEIR ANTINOCICEPTIVE EFFECTS ARE LIMITED IN PART DUE TO THE DOWNREGULATION OF OPIOID RECEPTORS IN THE PRIMARY AFFERENT NEURONS AFTER PERIPHERAL NERVE TRAUMA. HOW THIS DOWNREGULATION OCCURS IS NOT COMPLETELY UNDERSTOOD, BUT RECENT STUDIES HAVE DEMONSTRATED THAT PERIPHERAL NERVE TRAUMA DRIVES THE ALTERATIONS IN EPIGENETIC MODIFICATIONS (INCLUDING DNA METHYLATION, HISTONE METHYLATION AND MCIRORNAS), EXPRESSION OF TRANSCRIPTION FACTORS, POST-TRANSCRIPTIONAL MODIFICATIONS (E.G., RNA METHYLATION) AND PROTEIN TRANSLATION INITIATION IN THE NEURONS OF NERVE TRAUMA-RELATED DORSAL ROOT GANGLION (DRG) AND THAT THESE ALTERNATIONS MAY BE ASSOCIATED WITH NERVE TRAUMA-CAUSED DOWNREGULATION OF DRG OPIOID RECEPTORS. THIS REVIEW PRESENTS HOW OPIOID RECEPTORS ARE DOWNREGULATED IN THE DRG AFTER PERIPHERAL NERVE TRAUMA, SPECIFICALLY FOCUSING ON DISTINCT MOLECULAR MECHANISMS UNDERLYING TRANSCRIPTIONAL AND TRANSLATIONAL PROCESSES. THIS REVIEW ALSO DISCUSSES HOW THIS DOWNREGULATION CONTRIBUTES TO THE INDUCTION AND MAINTENANCE OF NEUROPATHIC PAIN. A DEEPER UNDERSTANDING OF THESE MOLECULAR MECHANISMS LIKELY PROVIDES A NOVEL AVENUE FOR PREVENTION AND/OR TREATMENT OF NEUROPATHIC PAIN. 2021 8 2176 19 EPIGENETIC MECHANISMS OF CHRONIC PAIN. NEUROPATHIC AND INFLAMMATORY PAIN PROMOTE A LARGE NUMBER OF PERSISTING ADAPTATIONS AT THE CELLULAR AND MOLECULAR LEVEL, ALLOWING EVEN TRANSIENT TISSUE OR NERVE DAMAGE TO ELICIT CHANGES IN CELLS THAT CONTRIBUTE TO THE DEVELOPMENT OF CHRONIC PAIN AND ASSOCIATED SYMPTOMS. THERE IS EVIDENCE THAT INJURY-INDUCED CHANGES IN CHROMATIN STRUCTURE DRIVE STABLE CHANGES IN GENE EXPRESSION AND NEURAL FUNCTION, WHICH MAY CAUSE SEVERAL SYMPTOMS, INCLUDING ALLODYNIA, HYPERALGESIA, ANXIETY, AND DEPRESSION. RECENT FINDINGS ON EPIGENETIC CHANGES IN THE SPINAL CORD AND BRAIN DURING CHRONIC PAIN MAY GUIDE FUNDAMENTAL ADVANCES IN NEW TREATMENTS. HERE, WE PROVIDE A BRIEF OVERVIEW OF EPIGENETIC REGULATION IN THE NERVOUS SYSTEM AND THEN DISCUSS THE STILL-LIMITED LITERATURE THAT DIRECTLY IMPLICATES EPIGENETIC MODIFICATIONS IN CHRONIC PAIN SYNDROMES. 2015 9 2179 21 EPIGENETIC MECHANISMS OF NEURAL PLASTICITY IN CHRONIC NEUROPATHIC PAIN. NEUROPATHIC PAIN IS A CHALLENGING CLINICAL PROBLEM AND REMAINS DIFFICULT TO TREAT. ALTERED GENE EXPRESSION IN PERIPHERAL SENSORY NERVES AND NEURONS DUE TO NERVE INJURY IS WELL DOCUMENTED AND CONTRIBUTES CRITICALLY TO THE SYNAPTIC PLASTICITY IN THE SPINAL CORD AND THE INITIATION AND MAINTENANCE OF CHRONIC PAIN. HOWEVER, OUR UNDERSTANDING OF THE EPIGENETIC MECHANISMS REGULATING THE TRANSCRIPTION OF PRO-NOCICEPTIVE (E.G., NMDA RECEPTORS AND ALPHA2DELTA-1) AND ANTINOCICEPTIVE (E.G., POTASSIUM CHANNELS AND OPIOID AND CANNABINOID RECEPTORS) GENES ARE STILL LIMITED. IN THIS REVIEW, WE SUMMARIZE RECENT STUDIES DETERMINING THE ROLES OF HISTONE MODIFICATIONS (INCLUDING METHYLATION, ACETYLATION, AND UBIQUITINATION), DNA METHYLATION, AND NONCODING RNAS IN NEUROPATHIC PAIN DEVELOPMENT. WE REVIEW THE EPIGENETIC WRITER, READER, AND ERASER PROTEINS THAT PARTICIPATE IN THE TRANSCRIPTIONAL CONTROL OF THE EXPRESSION OF KEY ION CHANNELS AND NEUROTRANSMITTER RECEPTORS IN THE DORSAL ROOT GANGLION AFTER TRAUMATIC NERVE INJURY, WHICH IS COMMONLY USED AS A PRECLINICAL MODEL OF NEUROPATHIC PAIN. A BETTER UNDERSTANDING OF EPIGENETIC REPROGRAMMING INVOLVED IN THE TRANSITION FROM ACUTE TO CHRONIC PAIN COULD LEAD TO THE DEVELOPMENT OF NEW TREATMENTS FOR NEUROPATHIC PAIN. 2022 10 6531 32 TRANSCRIPTIONAL REGULATION OF BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) BY METHYL CPG BINDING PROTEIN 2 (MECP2): A NOVEL MECHANISM FOR RE-MYELINATION AND/OR MYELIN REPAIR INVOLVED IN THE TREATMENT OF MULTIPLE SCLEROSIS (MS). MULTIPLE SCLEROSIS (MS) IS A CHRONIC PROGRESSIVE, NEUROLOGICAL DISEASE CHARACTERIZED BY THE TARGETED IMMUNE SYSTEM-MEDIATED DESTRUCTION OF CENTRAL NERVOUS SYSTEM (CNS) MYELIN. AUTOREACTIVE CD4+ T HELPER CELLS HAVE A KEY ROLE IN ORCHESTRATING MS-INDUCED MYELIN DAMAGE. ONCE ACTIVATED, CIRCULATING TH1-CELLS SECRETE A VARIETY OF INFLAMMATORY CYTOKINES THAT FOSTER THE BREAKDOWN OF BLOOD-BRAIN BARRIER (BBB) EVENTUALLY INFILTRATING INTO THE CNS. INSIDE THE CNS, THEY BECOME REACTIVATED UPON EXPOSURE TO THE MYELIN STRUCTURAL PROTEINS AND CONTINUE TO PRODUCE INFLAMMATORY CYTOKINES SUCH AS TUMOR NECROSIS FACTOR ALPHA (TNFALPHA) THAT LEADS TO DIRECT ACTIVATION OF ANTIBODIES AND MACROPHAGES THAT ARE INVOLVED IN THE PHAGOCYTOSIS OF MYELIN. PROLIFERATING OLIGODENDROCYTE PRECURSORS (OPS) MIGRATING TO THE LESION SITES ARE CAPABLE OF ACUTE REMYELINATION BUT UNABLE TO COMPLETELY REPAIR OR RESTORE THE IMMUNE SYSTEM-MEDIATED MYELIN DAMAGE. THIS RESULTS IN VARIOUS PERMANENT CLINICAL NEUROLOGICAL DISABILITIES SUCH AS COGNITIVE DYSFUNCTION, FATIGUE, BOWEL/BLADDER ABNORMALITIES, AND NEUROPATHIC PAIN. AT PRESENT, THERE IS NO CURE FOR MS. RECENT REMYELINATION AND/OR MYELIN REPAIR STRATEGIES HAVE FOCUSED ON THE ROLE OF THE NEUROTROPHIN BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) AND ITS UPSTREAM TRANSCRIPTIONAL REPRESSOR METHYL CPG BINDING PROTEIN (MECP2). RESEARCH IN THE FIELD OF EPIGENETIC THERAPEUTICS INVOLVING HISTONE DEACETYLASE (HDAC) INHIBITORS AND LYSINE ACETYL TRANSFERASE (KAT) INHIBITORS IS BEING EXPLORED TO REPRESS THE DETRIMENTAL EFFECTS OF MECP2. THIS REVIEW WILL ADDRESS THE ROLE OF MECP2 AND BDNF IN REMYELINATION AND/OR MYELIN REPAIR AND THE POTENTIAL OF HDAC AND KAT INHIBITORS AS NOVEL THERAPEUTIC INTERVENTIONS FOR MS. 2016 11 710 27 C-TERMINAL DOMAIN SMALL PHOSPHATASE 1 (CTDSP1) REGULATES GROWTH FACTOR EXPRESSION AND AXONAL REGENERATION IN PERIPHERAL NERVE TISSUE. PERIPHERAL NERVE INJURY (PNI) REPRESENTS A MAJOR CLINICAL AND ECONOMIC BURDEN. DESPITE THE ABILITY OF PERIPHERAL NEURONS TO REGENERATE THEIR AXONS AFTER AN INJURY, PATIENTS ARE OFTEN LEFT WITH MOTOR AND/OR SENSORY DISABILITY AND MAY DEVELOP CHRONIC PAIN. SUCCESSFUL REGENERATION AND TARGET ORGAN REINNERVATION REQUIRE COMPREHENSIVE TRANSCRIPTIONAL CHANGES IN BOTH INJURED NEURONS AND SUPPORT CELLS LOCATED AT THE SITE OF INJURY. THE EXPRESSION OF MOST OF THE GENES REQUIRED FOR AXON GROWTH AND GUIDANCE AND FOR SYNAPSIS FORMATION IS REPRESSED BY A SINGLE MASTER TRANSCRIPTIONAL REGULATOR, THE REPRESSOR ELEMENT 1 SILENCING TRANSCRIPTION FACTOR (REST). SUSTAINED INCREASE OF REST LEVELS AFTER INJURY INHIBITS AXON REGENERATION AND LEADS TO CHRONIC PAIN. AS TARGETING OF TRANSCRIPTION FACTORS IS CHALLENGING, WE TESTED WHETHER MODULATION OF REST ACTIVITY COULD BE ACHIEVED THROUGH KNOCKDOWN OF CARBOXY-TERMINAL DOMAIN SMALL PHOSPHATASE 1 (CTDSP1), THE ENZYME THAT STABILIZES REST BY PREVENTING ITS TARGETING TO THE PROTEASOME. TO TEST WHETHER KNOCKDOWN OF CTDSP1 PROMOTES NEUROTROPHIC FACTOR EXPRESSION IN BOTH SUPPORT CELLS LOCATED AT THE SITE OF INJURY AND IN PERIPHERAL NEURONS, WE TRANSFECTED MESENCHYMAL PROGENITOR CELLS (MPCS), A TYPE OF SUPPORT CELLS THAT ARE PRESENT AT HIGH CONCENTRATIONS AT THE SITE OF INJURY, AND DORSAL ROOT GANGLION (DRG) NEURONS WITH REST OR CTDSP1 SPECIFIC SIRNA. WE QUANTIFIED NEUROTROPHIC FACTOR EXPRESSION BY RT-QPCR AND WESTERN BLOT, AND BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) RELEASE IN THE CELL CULTURE MEDIUM BY ELISA, AND WE MEASURED NEURITE OUTGROWTH OF DRG NEURONS IN CULTURE. OUR RESULTS SHOW THAT CTDSP1 KNOCKDOWN PROMOTES NEUROTROPHIC FACTOR EXPRESSION IN BOTH DRG NEURONS AND THE SUPPORT CELLS MPCS, AND PROMOTES DRG NEURON REGENERATION. THERAPEUTICS TARGETING CTDSP1 ACTIVITY MAY, THEREFORE, REPRESENT A NOVEL EPIGENETIC STRATEGY TO PROMOTE PERIPHERAL NERVE REGENERATION AFTER PNI BY PROMOTING THE REGENERATIVE PROGRAM REPRESSED BY INJURY-INDUCED INCREASED LEVELS OF REST IN BOTH NEURONS AND SUPPORT CELLS. 2021 12 6895 20 [SYSTEMIC CONTROL OF THE MOLECULAR, CELL, AND EPIGENETIC MECHANISMS OF LONG-LASTING CONSEQUENCES OF STRESS]. BASED ON M.E. LOBASHEV'S VIEWS OF THE SYSTEMIC CONTROL OF GENETIC AND CYTOGENEITC PROCESSES AND A SUBSTANTIAL EFFECT OF EXCITABILITY ON PLASTIC CHANGES IN THE CENTRAL NERVOUS SYSTEM (CNS), THE EFFECT OF PROLONGED EMOTIONAL AND PAIN STRESS (PEPS) ON THE MOLECULAR, CELL, AND EPIGENETIC MECHANISMS OF INJURY MEMORY WAS STUDIED IN RAT STRAINS BRED FOR A CERTAIN EXCITABILITY OF THE NERVOUS SYSTEM. PEPS WAS FOR THE FIRST TIME FOUND TO CAUSE LONG-LASTING (2 MONTHS) MORPHOLOGICAL ALTERATIONS OF THE CA3 REGION OF THE HIPPOCAMPUS AND TO MODIFY THE GENOME ACTIVITY OF ITS PYRAMIDAL NEURONS. THE TWO PHENOMENA WERE POTENTIATED BY A GENETICALLY DETERMINED LOW FUNCTIONAL STATE OF THE CNS. THE POST-STRESS REGULATION OF THE GENOME FUNCTION IN HIPPOCAMPAL NEURONS WAS MEDIATED BY CHANGES IN HETEROCHROMATIN CONFORMATION, ACTIVATION OF METHYL-CPG-BINDING PROTEIN (MECP2) SYNTHESIS, AND SUBSEQUENT CHANGES IN ACETYLATION OF HISTONE H4. GENETICALLY DETERMINED HIGH EXCITABILITY OF THE NERVOUS SYSTEM PROVED TO BE A RISK FACTOR THAT AFFECTS THE SPECIFICS AND TIME COURSE OF THE OBSERVED MOLECULAR, CELL, AND GENETIC TRANSFORMATIONS OF NEURONS. THE RESULTS PROVIDE FOR A BETTER UNDERSTANDING OF THE EPIGENETIC MECHANISMS OF INJURY MEMORY, WHICH FORMS A PATHOGENETIC BASIS FOR POSTTRAUMATIC STRESS DISORDER AND OTHER HUMAN PSYCHOGENIC CONDITIONS CHARACTERIZED BY A PROLONGED DURATION. 2009 13 5369 19 RECENT ADVANCES IN UNDERSTANDING NEUROPATHIC PAIN: GLIA, SEX DIFFERENCES, AND EPIGENETICS. NEUROPATHIC PAIN RESULTS FROM DISEASES OR TRAUMA AFFECTING THE NERVOUS SYSTEM. THIS PAIN CAN BE DEVASTATING AND IS POORLY CONTROLLED. THE PATHOPHYSIOLOGY IS COMPLEX, AND IT IS ESSENTIAL TO UNDERSTAND THE UNDERLYING MECHANISMS IN ORDER TO IDENTIFY THE RELEVANT TARGETS FOR THERAPEUTIC INTERVENTION. IN THIS ARTICLE, WE FOCUS ON THE RECENT RESEARCH INVESTIGATING NEURO-IMMUNE COMMUNICATION AND EPIGENETIC PROCESSES, WHICH GAIN PARTICULAR ATTENTION IN THE CONTEXT OF NEUROPATHIC PAIN. SPECIFICALLY, WE ANALYZE THE ROLE OF GLIAL CELLS, INCLUDING MICROGLIA, ASTROCYTES, AND OLIGODENDROCYTES, IN THE MODULATION OF THE CENTRAL NERVOUS SYSTEM INFLAMMATION TRIGGERED BY NEUROPATHY. CONSIDERING EPIGENETICS, WE ADDRESS DNA METHYLATION, HISTONE MODIFICATIONS, AND THE NON-CODING RNAS IN THE REGULATION OF ION CHANNELS, G-PROTEIN-COUPLED RECEPTORS, AND TRANSMITTERS FOLLOWING NEURONAL DAMAGE. THE GOAL WAS NOT ONLY TO HIGHLIGHT THE EMERGING CONCEPTS BUT ALSO TO DISCUSS CONTROVERSIES, METHODOLOGICAL COMPLICATIONS, AND INTRIGUING OPINIONS. 2016 14 6097 10 THE EFFECTS OF STRESS ON GLUTAMATERGIC TRANSMISSION IN THE BRAIN. STRESS LEADS TO DETRIMENTAL EFFECTS ON BRAIN FUNCTIONS AND RESULTS IN VARIOUS DISEASES. RECENT STUDIES HIGHLIGHT THE INVOLVEMENT OF GLUTAMATERGIC TRANSMISSION IN PATHOGENESIS OF DEPRESSIVE BEHAVIORS AND FEARS. ACUTE STRESS GENERATES DIFFERENT IMPACTS ON THE EXCITATORY TRANSMISSION COMPARED TO CHRONIC STRESS. DIFFERENT NEUROMODULATORS AND EPIGENETIC FACTORS ALSO PARTICIPATE IN THE ALTERATION OF SYNAPTIC TRANSMISSION AND THE REGULATION OF SYNAPTIC PLASTICITY. RESTORATION OF THE GLUTAMATERGIC TRANSMISSION IN STRESS-AFFECTED BRAIN AREAS THEREFORE PROVIDES NOVEL DIRECTIONS OF THERAPEUTIC INTERVENTIONS AGAINST STRESS. 2015 15 2194 23 EPIGENETIC MODIFICATION IN NEUROPATHIC PAIN. NEUROPATHIC PAIN IS CHARACTERIZED BY COMPLICATED COMBINATION OF POSITIVE (E.G., HYPERALGESIA AND ALLODYNIA) AND NEGATIVE (E.G., HYPOESTHESIA AND HYPOALGESIA) SYMPTOMS, AND IS OFTEN REFRACTORY TO CONVENTIONAL PHARMACOLOGICAL AGENTS, INCLUDING MORPHINE. ALTHOUGH THE MOLECULAR MECHANISMS FOR POSITIVE SYMPTOMS ARE EXTENSIVELY STUDIED, THOSE FOR NEGATIVE SYMPTOMS ARE POORLY UNDERSTOOD. THERE IS CONVINCING EVIDENCE THAT ALTERED GENE EXPRESSION WITHIN PERIPHERAL AND CENTRAL NERVOUS SYSTEMS IS A KEY MECHANISM FOR NEUROPATHIC PAIN; HOWEVER, ITS TRANSCRIPTIONAL MECHANISMS ARE POORLY UNDERSTOOD. EPIGENETIC MODIFICATIONS, SUCH AS DNA METHYLATION AND HISTONE MODIFICATIONS (E.G., ACETYLATION, METHYLATION, AND PHOSPHORYLATION), ARE KNOWN TO CAUSE STABLE GENE EXPRESSION VIA CHROMATIN REMODELING. THESE MECHANISMS HAVE A ROLE NOT ONLY IN THE DETERMINATION OF DEVELOPMENTAL CELL FATES, BUT ALSO IN THE PHYSIOLOGICAL AND PATHOLOGICAL PROCESSES IN NERVOUS SYSTEM. MOREOVER, EPIGENETIC THERAPIES USING EPIGENETIC MODIFYING COMPOUNDS ARE PROGRESSIVELY ADVANCED IN THE TREATMENTS OF DIVERSE DISEASES, INCLUDING CANCER AND NEUROLOGICAL DISEASES. IMPORTANTLY, THERE IS EMERGING EVIDENCE THAT A VARIETY OF GENES UNDERGO EPIGENETIC REGULATION VIA DNA METHYLATION AND HISTONE MODIFICATIONS WITHIN PERIPHERAL AND CENTRAL NERVOUS SYSTEMS, THEREBY CONTRIBUTING TO THE ALTERATIONS IN BOTH PAIN SENSITIVITY AND PHARMACOLOGICAL EFFICACY IN NEUROPATHIC PAIN. IN THIS REVIEW, WE WILL HIGHLIGHT THE EPIGENETIC GENE REGULATION UNDERLYING NEUROPATHIC PAIN, ESPECIALLY FOCUSING ON THE NEGATIVE SYMPTOMS. MOREOVER, WE WILL DISCUSS WHETHER EPIGENETIC MECHANISMS CAN SERVE AS A POTENTIAL TARGET TO TREAT NEUROPATHIC PAIN. 2015 16 764 19 CBP/P300 ACTIVATION PROMOTES AXON GROWTH, SPROUTING, AND SYNAPTIC PLASTICITY IN CHRONIC EXPERIMENTAL SPINAL CORD INJURY WITH SEVERE DISABILITY. THE INTERRUPTION OF SPINAL CIRCUITRY FOLLOWING SPINAL CORD INJURY (SCI) DISRUPTS NEURAL ACTIVITY AND IS FOLLOWED BY A FAILURE TO MOUNT AN EFFECTIVE REGENERATIVE RESPONSE RESULTING IN PERMANENT NEUROLOGICAL DISABILITY. FUNCTIONAL RECOVERY REQUIRES THE ENHANCEMENT OF AXONAL AND SYNAPTIC PLASTICITY OF SPARED AS WELL AS INJURED FIBRES, WHICH NEED TO SPROUT AND/OR REGENERATE TO FORM NEW CONNECTIONS. HERE, WE HAVE INVESTIGATED WHETHER THE EPIGENETIC STIMULATION OF THE REGENERATIVE GENE EXPRESSION PROGRAM CAN OVERCOME THE CURRENT INABILITY TO PROMOTE NEUROLOGICAL RECOVERY IN CHRONIC SCI WITH SEVERE DISABILITY. WE DELIVERED THE CBP/P300 ACTIVATOR CSP-TTK21 OR VEHICLE CSP WEEKLY BETWEEN WEEK 12 AND 22 FOLLOWING A TRANSECTION MODEL OF SCI IN MICE HOUSED IN AN ENRICHED ENVIRONMENT. DATA ANALYSIS SHOWED THAT CSP-TTK21 ENHANCED CLASSICAL REGENERATIVE SIGNALLING IN DORSAL ROOT GANGLIA SENSORY BUT NOT CORTICAL MOTOR NEURONS, STIMULATED MOTOR AND SENSORY AXON GROWTH, SPROUTING, AND SYNAPTIC PLASTICITY, BUT FAILED TO PROMOTE NEUROLOGICAL SENSORIMOTOR RECOVERY. THIS WORK PROVIDES DIRECT EVIDENCE THAT CLINICALLY SUITABLE PHARMACOLOGICAL CBP/P300 ACTIVATION CAN PROMOTE THE EXPRESSION OF REGENERATION-ASSOCIATED GENES AND AXONAL GROWTH IN A CHRONIC SCI WITH SEVERE NEUROLOGICAL DISABILITY. 2022 17 5778 25 SPINAL CORD INJURY INDUCED NEUROPATHIC PAIN: MOLECULAR TARGETS AND THERAPEUTIC APPROACHES. NEUROPATHIC PAIN, ESPECIALLY THAT RESULTING FROM SPINAL CORD INJURY, IS A TREMENDOUS CLINICAL CHALLENGE. A MYRIAD OF BIOLOGICAL CHANGES HAVE BEEN IMPLICATED IN PRODUCING THESE PAIN STATES INCLUDING CELLULAR INTERACTIONS, EXTRACELLULAR PROTEINS, ION CHANNEL EXPRESSION, AND EPIGENETIC INFLUENCES. PHYSIOLOGICAL CONSEQUENCES OF THESE CHANGES ARE VARIED AND INCLUDE FUNCTIONAL DEFICITS AND PAIN RESPONSES. DEVELOPING THERAPIES THAT EFFECTIVELY ADDRESS THE CAUSE OF THESE SYMPTOMS REQUIRE A DEEPER KNOWLEDGE OF ALTERATIONS IN THE MOLECULAR PATHWAYS. MATRIX METALLOPROTEINASES AND TISSUE INHIBITORS OF METALLOPROTEINASES ARE TWO PROMISING THERAPEUTIC TARGETS. MATRIX METALLOPROTEINASES INTERACT WITH AND INFLUENCE MANY OF THE STUDIED PAIN PATHWAYS. GENE EXPRESSION OF ION CHANNELS AND INFLAMMATORY MEDIATORS CLEARLY CONTRIBUTES TO NEUROPATHIC PAIN. LOCALIZED AND TIME DEPENDENT TARGETING OF THESE PROTEINS COULD ALLEVIATE AND EVEN PREVENT NEUROPATHIC PAIN FROM DEVELOPING. CURRENT THERAPEUTIC OPTIONS FOR NEUROPATHIC PAIN ARE LIMITED PRIMARILY TO ANALGESICS TARGETING THE OPIOID PATHWAY. THERAPIES DIRECTED AT MOLECULAR TARGETS ARE HIGHLY DESIRABLE AND IN EARLY STAGES OF DEVELOPMENT. THESE INCLUDE TRANSPLANTATION OF EXOGENOUSLY ENGINEERED CELL POPULATIONS AND TARGETED GENE MANIPULATION. THIS REVIEW DESCRIBES SPECIFIC MOLECULAR TARGETS AMENABLE TO THERAPEUTIC INTERVENTION USING CURRENTLY AVAILABLE DELIVERY SYSTEMS. 2015 18 5626 21 SELECTIVE REPRESSION OF GENE EXPRESSION IN NEUROPATHIC PAIN BY THE NEURON-RESTRICTIVE SILENCING FACTOR/REPRESSOR ELEMENT-1 SILENCING TRANSCRIPTION (NRSF/REST). NEUROPATHIC PAIN OFTEN DEVELOPS FOLLOWING NERVE INJURY AS A RESULT OF MALADAPTIVE CHANGES THAT OCCUR IN THE INJURED NERVE AND ALONG THE NOCICEPTIVE PATHWAYS OF THE PERIPHERAL AND CENTRAL NERVOUS SYSTEMS. MULTIPLE CELLULAR AND MOLECULAR MECHANISMS LIKELY ACCOUNT FOR THESE CHANGES; HOWEVER, THE EXACT NATURE OF THESE MECHANISMS REMAIN LARGELY UNKNOWN. A GROWING NUMBER OF STUDIES SUGGEST THAT ALTERATION IN GENE EXPRESSION IS AN IMPORTANT STEP IN THE PROGRESSION FROM ACUTE TO CHRONIC PAIN STATES AND EPIGENETIC REGULATION HAS BEEN PROPOSED TO DRIVE THIS CHANGE IN GENE EXPRESSION. IN THIS REVIEW, WE DISCUSS RECENT EVIDENCE THAT THE DNA-BINDING PROTEIN NEURON-RESTRICTIVE SILENCING FACTOR/REPRESSOR ELEMENT-1 SILENCING TRANSCRIPTION FACTOR (NRSF/REST) IS AN IMPORTANT COMPONENT IN THE DEVELOPMENT AND MAINTENANCE OF NEUROPATHIC PAIN THROUGH ITS ROLE AS A TRANSCRIPTIONAL REGULATOR FOR A SELECT SUBSET OF GENES THAT IT NORMALLY REPRESSES DURING DEVELOPMENT. 2016 19 2993 23 GENETIC PAIN LOSS DISORDERS. GENETIC PAIN LOSS INCLUDES CONGENITAL INSENSITIVITY TO PAIN (CIP), HEREDITARY SENSORY NEUROPATHIES AND, IF AUTONOMIC NERVES ARE INVOLVED, HEREDITARY SENSORY AND AUTONOMIC NEUROPATHY (HSAN). THIS HETEROGENEOUS GROUP OF DISORDERS HIGHLIGHTS THE ESSENTIAL ROLE OF NOCICEPTION IN PROTECTING AGAINST TISSUE DAMAGE. PATIENTS WITH GENETIC PAIN LOSS HAVE RECURRENT INJURIES, BURNS AND POORLY HEALING WOUNDS AS DISEASE HALLMARKS. CIP AND HSAN ARE CAUSED BY PATHOGENIC GENETIC VARIANTS IN >20 GENES THAT LEAD TO DEVELOPMENTAL DEFECTS, NEURODEGENERATION OR ALTERED NEURONAL EXCITABILITY OF PERIPHERAL DAMAGE-SENSING NEURONS. THESE GENETIC VARIANTS LEAD TO HYPERACTIVITY OF SODIUM CHANNELS, DISTURBED HAEM METABOLISM, ALTERED CLATHRIN-MEDIATED TRANSPORT AND IMPAIRED GENE REGULATORY MECHANISMS AFFECTING EPIGENETIC MARKS, LONG NON-CODING RNAS AND REPETITIVE ELEMENTS. THERAPIES FOR PAIN LOSS DISORDERS ARE MAINLY SYMPTOMATIC BUT THE FIRST TARGETED THERAPIES ARE BEING TESTED. CONVERSELY, CHRONIC PAIN REMAINS ONE OF THE GREATEST UNRESOLVED MEDICAL CHALLENGES, AND THE GENES AND MECHANISMS ASSOCIATED WITH PAIN LOSS OFFER NEW TARGETS FOR ANALGESICS. GIVEN THE PROGRESS THAT HAS BEEN MADE, THE COMING YEARS ARE PROMISING BOTH IN TERMS OF TARGETED TREATMENTS FOR PAIN LOSS DISORDERS AND THE DEVELOPMENT OF INNOVATIVE PAIN MEDICINES BASED ON KNOWLEDGE OF THESE GENETIC DISEASES. 2022 20 6174 26 THE HIPPOCAMPUS, NEUROTROPHIC FACTORS AND DEPRESSION: POSSIBLE IMPLICATIONS FOR THE PHARMACOTHERAPY OF DEPRESSION. DEPRESSION IS A PREVALENT, HIGHLY DEBILITATING MENTAL DISORDER AFFECTING UP TO 15% OF THE POPULATION AT LEAST ONCE IN THEIR LIFETIME, WITH HUGE COSTS FOR SOCIETY. NEUROBIOLOGICAL MECHANISMS OF DEPRESSION ARE STILL NOT WELL KNOWN, ALTHOUGH THERE IS CONSENSUS ABOUT INTERPLAY BETWEEN GENETIC AND ENVIRONMENTAL FACTORS. ANTIDEPRESSANT MEDICATIONS ARE FREQUENTLY USED IN DEPRESSION, BUT AT LEAST 50% OF PATIENTS ARE POOR RESPONDERS, EVEN TO MORE RECENTLY DISCOVERED MEDICATIONS. FURTHERMORE, CLINICAL RESPONSE ONLY OCCURS FOLLOWING WEEKS TO MONTHS OF TREATMENT AND ONLY CHRONIC TREATMENT IS EFFECTIVE, SUGGESTING THAT ACTIONS BEYOND THE RAPIDLY OCCURRING EFFECT OF ENHANCING MONOAMINERGIC SYSTEMS, SUCH AS ADAPTATION OF THESE SYSTEMS, ARE RESPONSIBLE FOR THE EFFECTS OF ANTIDEPRESSANTS. RECENT STUDIES INDICATE THAT AN IMPAIRMENT OF SYNAPTIC PLASTICITY (NEUROGENESIS, AXON BRANCHING, DENDRITOGENESIS AND SYNAPTOGENESIS) IN SPECIFIC AREAS OF THE CNS, PARTICULARLY THE HIPPOCAMPUS, MAY BE A CORE FACTOR IN THE PATHOPHYSIOLOGY OF DEPRESSION. THE ABNORMAL NEURAL PLASTICITY MAY BE RELATED TO ALTERATIONS IN THE LEVELS OF NEUROTROPHIC FACTORS, NAMELY BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF), WHICH PLAY A CENTRAL ROLE IN PLASTICITY. AS BDNF IS REPRESSED BY STRESS, EPIGENETIC REGULATION OF THE BDNF GENE MAY PLAY AN IMPORTANT ROLE IN DEPRESSION. THE HIPPOCAMPUS IS SMALLER IN DEPRESSED PATIENTS, ALTHOUGH IT IS UNCLEAR WHETHER SMALLER SIZE IS A CONSEQUENCE OF DEPRESSION OR A PRE-EXISTING, VULNERABILITY MARKER FOR DEPRESSION. ENVIRONMENTAL STRESSORS TRIGGERING ACTIVATION OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS CAUSE THE BRAIN TO BE EXPOSED TO CORTICOSTEROIDS, AFFECTING NEUROBEHAVIOURAL FUNCTIONS WITH A STRONG DOWNREGULATION OF HIPPOCAMPAL NEUROGENESIS, AND ARE A MAJOR RISK FACTOR FOR DEPRESSION. ANTIDEPRESSANT TREATMENT INCREASES BDNF LEVELS, STIMULATES NEUROGENESIS AND REVERSES THE INHIBITORY EFFECTS OF STRESS, BUT THIS EFFECT IS EVIDENT ONLY AFTER 3-4 WEEKS OF ADMINISTRATION, THE TIME COURSE FOR MATURATION OF NEW NEURONS. THE ABLATION OF HIPPOCAMPAL NEUROGENESIS BLOCKS THE BEHAVIOURAL EFFECTS OF ANTIDEPRESSANTS IN ANIMAL MODELS. THE ABOVE FINDINGS SUGGEST NEW POSSIBLE TARGETS FOR THE PHARMACOTHERAPY OF DEPRESSION SUCH AS NEUROTROPHIC FACTORS, THEIR RECEPTORS AND RELATED INTRACELLULAR SIGNALLING CASCADES; AGENTS COUNTERACTING THE EFFECTS OF STRESS ON HIPPOCAMPAL NEUROGENESIS (INCLUDING ANTAGONISTS OF CORTICOSTEROIDS, INFLAMMATORY CYTOKINES AND THEIR RECEPTORS); AND AGENTS FACILITATING THE ACTIVATION OF GENE EXPRESSION AND INCREASING THE TRANSCRIPTION OF NEUROTROPHINS IN THE BRAIN. 2011