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bioRxiv · 10.1101/2021.04.23.441143

Cannabidiol as an add-on therapy to overcome the slow-onset and, possibly, resistance to antidepressant treatment: involvement of NAPE-PLD in the medial prefrontal cortex

Scarante, F. F.·Lopes, V. D.·Fusse, E. J.·Vicente, M. A.·Araujo, M. R.·Scomparin, D. S.·Aguiar, R. P.·Guimaraes, F. S.·Nardini, V.·Sorgi, C. A.·Faccioli, L. H.·Hallak, J. E. C.·Joca, S. R. L.·Mackie, K.·Zuardi, A. W.·Crippa, J. A. S.·Campos, A. C.
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Abstract

Antidepressant drugs are the first-line treatment for chronic stress-related psychiatric disorders such as major depressive disorder, anxiety disorders, and post-traumatic stress disorder. However, their delayed-onset of therapeutic action, frequently occurring side effects, and incomplete clinical efficacy impose significant challenges for clinicians and patients adherence to treatment. Cannabidiol (CBD) is a major non-psychotomimetic phytocannabinoid with a wide range of potential clinical applications such as either a standalone drug or as an add-on treatment. In our study, we found that in chronically stressed male mice, CBD (30 mg/kg) rapidly induced behavioral improvement within 7 days, which was quicker than the high dose of escitalopram (ESC, 14 days). Additionally, repeated administration of a low and initially ineffective dose of CBD (7.5 mg/kg) potentiated the anti-stress effects of ESC (10 mg/kg) in mice subjected to 10 or 21 days of chronic unpredictable stress (CUS). Furthermore, our results suggested the involvement of N-acyl phosphatidylethanolamine phospholipase (NAPE-PLD) located in the prefrontal cortex (PFC) in the anti-stress effects of the 7-day treatment with ESC + CBD. This combination restored CUS-induced decreased expression of NAPE-PLD in the PFC. The behavioral effects of ESC + CBD were not observed in either constitutive NAPE-PLD knockout (KO) mice or mice with a CRISPR/Cas9-induced deletion of NAPE-PLD in the PFC. ESC + CBD treatment facilitated NAPE-PLD expression in parvalbumin (PV) interneurons in the PFC. As a conclusion, we suggest that CBD might be useful as an add-on therapy to optimize the action of (SSRI-)antidepressants, possibly by restoring the inhibitory/excitatory balance of the PFC via NAPE-PLD-mediated signaling. HighlightsO_LICBD (7.5 mg/kg) reduces the latency for anti-stress effects of escitalopram (ESC) C_LIO_LIESC + CBD increases neuroplasticity in the prefrontal cortex (PFC) C_LIO_LIESC + CBD reverses stress-induced loss of NAPE-PLD in PFC-Parvalbumin (PV)+ interneurons. C_LIO_LINAPE-PLD in the PFC participates in the anti-stress effects of ESC + CBD. C_LI Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=151 HEIGHT=200 SRC="FIGDIR/small/441143v2_ufig1.gif" ALT="Figure 1"> View larger version (59K): org.highwire.dtl.DTLVardef@d61ef2org.highwire.dtl.DTLVardef@189e2ecorg.highwire.dtl.DTLVardef@1910213org.highwire.dtl.DTLVardef@11f6bbf_HPS_FORMAT_FIGEXP M_FIG Cannabidiol (CBD) enhances the antidepressant-like effects of escitalopram (ESC) in chronically stressed mice. While an effective dose of CBD (30mg/kg) alone rapidly improved stress-related behaviors when compared to a high dose of ESC (20mg/kg), ESC+CBD combination in sub-effective doses potentiated anti-stress responses and restored prefrontal cortex (PFC) function. These effects depended on N-acyl phosphatidylethanolamine phospholipase D (NAPE-PLD) activity within PFC parvalbumin interneurons, highlighting NAPE-PLD-mediated signaling as a key mechanism by which CBD may optimize antidepressant efficacy and reestablish inhibitory/excitatory balance in the PFC. C_FIG Chemical compounds used in this articleCannabidiol (PubChem CID: 644019); Escitalopram oxalate (PubChem CID: 146571); URB597 (PubChem CID: 1383884); Ketamine hydrochloride (PubChem CID: 15851); xylazine hydrochloride (PubChem CID: 68554); 2,2,2-Tribromoethanol (PubChem CID: 6400); Flunixin meglumine (PubChem CID: 39212); Lidocaine hydrochloride (PubChem CID: 6314); Amoxicillin (PubChem CID: 33613).

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Scarante, F. F., Lopes, V. D., Fusse, E. J., Vicente, M. A., Araujo, M. R., Scomparin, D. S., Aguiar, R. P., Guimaraes, F. S., Nardini, V., Sorgi, C. A., Faccioli, L. H., Hallak, J. E. C., Joca, S. R. L., Mackie, K., Zuardi, A. W., Crippa, J. A. S., Campos, A. C.. 2021-04-26. Cannabidiol as an add-on therapy to overcome the slow-onset and, possibly, resistance to antidepressant treatment: involvement of NAPE-PLD in the medial prefrontal cortex. https://doi.org/10.1101/2021.04.23.441143

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