P-glycoprotein inhibition as a strategy to increase drug delivery across the blood-brain barrier: focus on antidepressants

Depression is among the leading causes of disability worldwide. Currently available antidepressant drugs have unsatisfactory efficacy, with up to 60% of depressed patients failing to respond adequately to treatment. Emerging evidence has highlighted a potential role for the efflux transporter P-glycoprotein (P-gp), expressed at the blood-brain barrier (BBB), in the aetiology of treatment-resistant depression. In this thesis, the potential of P-gp inhibition as a strategy to enhance the brain distribution and pharmacodynamic effects of antidepressant drugs was investigated. Pharmacokinetic studies demonstrated that administration of the P-gp inhibitors verapamil or cyclosporin A (CsA) enhanced the BBB transport of the antidepressants imipramine and escitalopram in vivo. Furthermore, both imipramine and escitalopram were identified as transported substrates of human P-gp in vitro. Contrastingly, human P-gp exerted no effect on the transport of four other antidepressants (amitriptyline, duloxetine, fluoxetine and mirtazapine) in vitro. Pharmacodynamic studies revealed that pre-treatment with verapamil augmented the behavioural effects of escitalopram in the tail suspension test (TST) of antidepressant-like activity in mice. Moreover, pre-treatment with CsA exacerbated the behavioural manifestation of an escitalopram-induced mouse model of serotonin syndrome, a serious adverse reaction associated with serotonergic drugs. This finding highlights the potential for unwanted side-effects which may occur due to increasing brain levels of antidepressants by P-gp inhibition, although further studies are needed to fully elucidate the mechanism(s) at play. Taken together, the research outlined in this thesis indicates that P-gp may restrict brain concentrations of escitalopram and imipramine in patients. Moreover, we show that increasing the brain distribution of an antidepressant by P-gp inhibition can result in an augmentation of antidepressant-like activity in vivo. These findings raise the possibility that P-gp inhibition may represent a potentially beneficial strategy to augment antidepressant treatment in clinical practice. Further studies are now warranted to evaluate the safety and efficacy of this approach.

Pregnancy-specific glycoprotein function, conservation and receptor investigation

Pregnancy-specific glycoproteins (PSGs) are highly glycosylated secreted proteins encoded by multi-gene families in some placental mammals. They are carcinoembryonic antigen (CEA) family and immunoglobulin (Ig) superfamily members. PSGs are immunomodulatory, and have been demonstrated to possess antiplatelet and pro-angiogenic properties. Low serum levels of these proteins have been correlated with adverse pregnancy outcomes. Objectives: Main research goals of this thesis were: 1). To attempt to replicate previously reported cytokine responses to PSG-treatment of immune cells and subsequently to investigate functionally important amino acids within PSG1. 2). To determine whether candidate receptor, integrin αvβ3, was a binding partner for PSG1 and to investigate whether PSG1 possessed functionality in a leukocyte-endothelial interaction assay. 3). To determine whether proteins generated from recently identified putative PSG genes in the horse shared functional properties with PSGs from other species. Outcomes: 1). Sequential domain deletion of PSG1 as well as mutation of conserved residues within the PSG1 Ndomain did not affect PSG1-induced TGF-β1. The investigated response was subsequently found to be the result of latent TGF-β1 contaminating the recombinant protein. Protein further purified by SEC to remove this showed no induction of TGF-β1. The most N-terminal glycosylation site was demonstrated to have an important role in PSG N domain secretion. PSG1 attenuated LPS-induced IL-6 and TNF-α. Investigations into signalling underpinning this proved inconclusive. 2). Integrin αvβ3 was identified as a novel PSG1 receptor mediating an as yet unknown function. Preliminary investigations into a role for PSGs as inhibitors of leukocyte endothelial interactions showed no effect by PSG1. 3). Horse PSG protein, CEACAM49, was shown to be similarly contaminated by latent TGF-β1 particle and once removed did not demonstrate TGF-β1 release. Interestingly horse PSG did show anti-platelet properties through inhibition of the plateletfibrinogen interaction as previously published for mouse and human PSGs.

Na marbhnaí do Shéamas Óg Mac Coitir (1689-1720)

Go príomha, is tráchtas é seo a dhéanann staidéar ar ghné de litríocht iar-chlasaiceach na Gaeilge. Baineann sé go háirithe leis an sraith chaointe nó marbhnaí i bhfoirm véarsaíochta a cumadh do Shéamas Óg Mac Coitir (1689-1720), duine uasal Caitliceach ó Charraig Tuathail, Co. Chorcaí, nuair a ciontaíodh é in éigniú Elizabeth Squibb, bean de Chumann na gCarad; nuair a cuireadh pionós an bháis air; agus nuair a crochadh é i gCathair Chorcaí an 7 Bealtaine, 1720. Ó thaobh na staire de, scrúdaítear Clann Choitir mar shampla de theaghlach nár cheil a ndílseacht do chúis pholaitiúil na Stíobhartach agus a sheas an fód go cróga faoi mar a bhí a ngreim polaitiúil á dhaingniú ag an gCinsealacht Phrotastúnach ó dheireadh an 17ú haois amach. Tagraítear do sheicteachas na sochaí comhaimseartha agus don teannas idir an pobal Caitliceach agus an pobal Protastúnach ag an am. Déantar scagadh ar an véarsaíocht mar fhoinse luachmhar do dhearcadh míshásta an mhóraimh Chaitlicigh ar struchtúr polaitiúil chontae Chorcaí (agus na hÉireann) i dtosach an 18ú haois. Is feiniméan liteartha an dlús véarsaíochta seo a bhaineann go háirithe le traidisiún liteartha Chorcaí. Tá na dánta curtha in eagar agus aistriúchán go Béarla curtha ar fáil: is é seo croí an tráchtais. Tá an t-eagrán bunaithe ar scrúdú cuimsitheach ar thraidisiún na lsí; pléitear modheolaíocht na heagarthóireachta. Déantar iarracht ar na dánta a shuíomh sa traidisiún casta liteartha sa tráchtaireacht tosaigh; sa chuid eile den bhfearas scoláiriúil, scrúdaítear ceisteanna a bhaineann le cúrsaí teanga, foclóra, meadarachta agus stíle. Tá innéacsanna agus liosta foinsí le fáil i ndeireadh an tráchtais.