Chemotherapy-induced peripheral neurotoxicity (CIPN) is a severe dose-limiting adverse event of chemotherapy. Presently, the mechanism underlying the induction of CIPN remains unclear, and no effective treatment is available. In this study, through metabolomics analyses, we found that nab-paclitaxel therapy markedly increased serum serotonin [5-hydroxtryptamine (5-HT)] levels in both cancer patients and mice compared to the respective controls. Furthermore, nab-paclitaxel-treated enterochromaffin (EC) cells showed increased 5-HT synthesis, and serotonin-treated Schwann cells showed damage, as indicated by the activation of CREB3L3/MMP3/FAS signaling. Venlafaxine, an inhibitor of serotonin and norepinephrine reuptake, was found to protect against nerve injury by suppressing the activation of CREB3L3/MMP3/FAS signaling in Schwann cells. Remarkably, venlafaxine was found to significantly alleviate nab-paclitaxel-induced CIPN in patients without affecting the clinical efficacy of chemotherapy. In summary, our study reveals that EC cell-derived 5-HT plays a critical role in nab-paclitaxel-related neurotoxic lesions, and venlafaxine co-administration represents a novel approach to treating chronic cumulative neurotoxicity commonly reported in nab-paclitaxel-based chemotherapy.
Paclitaxel/toxicity* ; Animals ; Albumins/adverse effects* ; Serotonin/metabolism* ; Mice ; Humans ; Male ; Female ; Venlafaxine Hydrochloride/therapeutic use* ; Neurotoxicity Syndromes/metabolism* ; Middle Aged ; Schwann Cells/metabolism* ; Peripheral Nervous System Diseases/drug therapy* ; Antineoplastic Agents

OBJECTIVETo assess the effects of apolipoprotein E (APOE) polymorphism on the susceptibility of depression and the efficacy of antidepressants.

METHODSA total of 275 patients with depression, who met the diagnostic criteria of both CCMD-3 and DSM-4, were randomly assigned into venlafaxine group (n=136)and paroxetine group(n=139). Another 202 healthy subjects were enrolled as the control group. Hamilton Rating Scale for Depression (HAMD)-17 was adopted as the primary rating instrument to evaluate the severity of depression on the baseline and the end of the 1st, 2nd, 4th, 6th week after treatment, respectively. HAMD scores ≤7 was defined as remission, and the reduction of HAMD scores ≥50% was defined as response while <50% was defined as invalid. PCR-restriction fragment length polymorphisms (PCR-RFLP) was applied to detect the genetic polymorphism of the APOE in the case groups and control group.

RESULTSIn the venlafaxine group, the remission rate was 52.9%(n=72), the response rate was 26.5%(n=36), and the invalid rate was 20.6%(n=28), whereas the corresponding data in the paroxetine group wee 42.4%(n=59), 31.7%(n=44), and 25.9% (n=36), respectively. There were no significant differences in the efficacy between the two groups(p>0.05). In the venlafaxine group, there were no significant differences in the genotypes and the allele distribution frequency of APOEΕ2/Ε3/Ε4 between the remitters, nonremitters, and healthy controls at the end of the 6th week(p>0.05), but there was significant differences in the allele distribution frequency between the nonremitters and healthy controls(p=0.02). In paroxetine group, there were no significant differences in the genotypes and the allele distribution frequency of APOEΕ2/Ε3/Ε4 among the remitters, nonremitters and healthy controls at the end of the 6th week(p>0.05), but there were significant differences in the allele distribution frequency between the nonremitters and healthy controls (p=0.04); in addition, there were also significant differences in Ε2/Ε3 and Ε4 allele between the two groups (p=0.014).

CONCLUSIONSThe APOE gene may not play a major role in the pathogenesis of major depression. The efficacy of venlafaxine is same as paroxetine after treatment for six weeks. The APOE (Ε2+Ε3) allele may be an indicator of the bad efficacy of paroxetine treatment.

Adolescent ; Adult ; Aged ; Antidepressive Agents ; therapeutic use ; Apolipoproteins E ; genetics ; Cyclohexanols ; therapeutic use ; Depression ; drug therapy ; genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; Paroxetine ; therapeutic use ; Polymorphism, Genetic ; Treatment Outcome ; Venlafaxine Hydrochloride ; Young Adult

OBJECTIVETo evaluate the effect of venlafaxine on the cognitive impairment of learning and memory in rats with post-stroke depression (PSD) and to investigate its relationship with the expression of brain-derived neurotrophic factor (BDNF) in hippocampus.

METHODSFifty male adult SD rats were randomly divided into control group, model group and three treatment groups (5,10, 20 mg*kg(-1) venlafaxine) with ten in each group. After the procedure of selective cerebral right middle artery embolism, a paradigm of continuous 3-week chronic unpredictable mild stress (CUMS) was used to induce PSD. Along with the course of CUMS the peritoneal injection at different dose levels of venlafaxine were performed once a day in PSD rats in a fixed time interval. Morris water maze test was applied to assess the spatial learning and memory function and immunohistochemical staining was used to detect the change of BDNF expression.

RESULTSThe learning function decreased significantly in PSD rats compared with the control (P<0.05), as well as in spatial exploring time (14.2 s ± 4.8 s Compared with 45.9 s ± 4.5 s) and frequency of spanning platform (1.3 ± 0.3 Compared with 8.3 ± 1.1). Moreover,very fewer BDNF positive cells were found in CA3 area of hippocampus in model group in comparison with the control group (9.8 ± 3.2 Compared with 18.5 ± 4.7). After different dosage of venlafaxine treatment, the BDNF expression and cognition increased markedly.

CONCLUSIONVenlafaxine can improve PSD-induced learning and memory dysfunction, possibly through the enhancement of the BDNF level in the CA3 area of hippocampus.

Animals ; Brain-Derived Neurotrophic Factor ; metabolism ; Cyclohexanols ; administration & dosage ; therapeutic use ; Depression ; drug therapy ; etiology ; metabolism ; Disease Models, Animal ; Hippocampus ; drug effects ; metabolism ; Male ; Maze Learning ; drug effects ; Memory ; drug effects ; Memory Disorders ; drug therapy ; etiology ; Rats ; Rats, Sprague-Dawley ; Stroke ; complications ; metabolism ; Venlafaxine Hydrochloride