We examined ketamine's acute effect in C57BL/6 mice (WTs) and detected significant behavioural responses in antidepressant (AD)-predictive tasks including forced swim (FST), novelty-suppressed feeding (NSF), and learned helplessness (LH) (
Supplementary Fig. 1a-e, 2a-c)
4. Ketamine also produced such responses in sucrose consumption test (SCT), NSF, and FST after chronic mild stress, an animal model of depression (
Supplementary Fig. 1f-i). To elucidate mechanisms underlying ketamine's fast-acting AD action, we focused on FST, a test predictive of non-monoaminergic AD efficacy
4. We examined the time-course of behavioural AD effects in WT mice following single, low dose treatment with ketamine, MK801, or CPP (). After 30 minutes or 3 hours, each NMDAR antagonist significantly reduced immobility in FST compared to vehicle-treated animals, suggesting NMDAR blockade produces fast-acting AD responses. Notably, in our system, acute conventional AD treatment did not produce AD-like FST responses (
Supplementary Fig. 3), which may require multiple doses
5. Effects of ketamine and CPP, but not MK-801, persisted for 24 hours
4. Ketamine's behavioural effect lasted for one week. Acute NMDAR antagonist treatment produced no alterations in hippocampal-dependent learning (
Supplementary Fig. 1d) or locomotor activity (
Supplementary Fig. 4). These drugs have short half-lives (~2-3 hours)
6-8 suggesting sustained NMDAR antagonist-induced AD responses are due to synaptic plasticity, not persistent receptor blockade.
Brain-derived neurotrophic factor (BDNF) is linked to traditional AD action; BDNF expression is increased in hippocampus (HC) by ADs
9 and BDNF deletion in HC attenuates AD behavioural responses
10-12. Moreover, intraventricular or intrahippocampal BDNF infusion causes rapid, sustained AD-like effects lasting 3-6 days in FST
13,14. To examine whether ketamine's AD-like response is mediated through BDNF, we administered ketamine to inducible BDNF knockout (KO) mice
10, then observed FST behaviour. After 30 minutes, ketamine-treated wild-type littermate controls (CTLs) displayed significant reductions in immobility, indicating AD-like responses compared to vehicle-treated CTLs (). However, ketamine did not produce AD-like effects in BDNF KOs, suggesting fast-acting AD responses require BDNF. After 24 hours, ketamine significantly reduced immobility in CTLs, but not in BDNF KOs (), indicating ketamine's sustained effects depend on BDNF. To validate this link between NMDAR antagonists and BDNF-mediated AD responses, MK-801 was administered to BDNF KOs or CTLs. After 30 minutes, MK-801 significantly reduced FST immobility in CTLs, but had no effect in BDNF KOs (
Supplementary Fig. 6). After 24 hours, MK-801 did not affect FST behaviour (
Supplementary Fig. 6), as previously demonstrated (). We next generated postnatal conditional
15 TrkB KOs and found that they are insensitive to ketamine's AD-like effects in FST and NSF (
Supplementary Fig. 5a,b). To confirm TrkB engagement, we examined receptor autophosphorylation and found increased TrkB activation after NMDAR antagonist treatment (
Supplementary Fig. 5c).
To determine if NMDAR antagonists alter BDNF expression in HC, WTs were acutely treated with vehicle, ketamine, or MK-801. Quantitative RT-PCR analysis of exon IX coding region demonstrated BDNF mRNA expression was unaltered by ketamine or MK-801 at 30 minutes or 24 hours (
Supplementary Fig. 7a). Contrastingly, Western blot analysis and ELISA methodology revealed significantly increased BDNF protein at 30 minutes but not 24 hours after NMDAR antagonist treatment (,
Supplementary Fig. 7b). Moreover, ketamine's acute effects on BDNF extended to precursor proBDNF (
Supplementary Fig. 7c). These data suggest rapid increases in BDNF protein translation, not transcription, are necessary for fast-onset AD responses. However, continued BDNF protein up-regulation does not underlie ketamine's long-term behavioural effects.
To study translation or transcription in ketamine's AD-like effects, we examined FST behaviour with the protein synthesis inhibitor anisomycin
16 or RNA polymerase inhibitor actinomycin D (ActD)
17 which block respective processes by ~80% within two hours. We pre-treated mice with anisomycin or ActD before ketamine (). Anisomycin prevented ketamine-induced rapid behavioural responses (30 minutes) in FST and NSF paradigms, suggesting dependence on new protein synthesis (;
Supplementary Fig. 8a,b). Anisomycin also prevented ketamine's long-term FST effect (24 hours), suggesting rapid protein translation was involved in sustained AD-like responses (). We found both mature and proBDNF synthesis in HC were sensitive to anisomycin treatment (
Supplementary Fig. 8c,d). However, ActD did not impact ketamine's AD-like FST behaviour at either time-point, suggesting independence of new gene expression (
Supplementary Fig. 9b,c). To confirm that ActD crossed the blood-brain barrier, we examined BDNF mRNA expression in drug-treated animals and found decreased BDNF transcription in HC (
Supplementary Fig. 9a). Taken together, these findings suggest rapid, transient BDNF translation is required for ketamine's fast-acting and long-lasting AD-like behavioural effects and that long-term AD responses may be due to synaptic plasticity alterations initiated by transient increases in BDNF translation.
We observed increased BDNF protein in cortex but not nucleus accumbens 30 minutes following actute ketamine or MK801 administration (
Supplementary Fig. 10a,b). We further investigated whether NMDAR antagonism affected proteins other than BDNF. We found activity-regulated cytoskeletal (Arc) protein is increased in HC (sensitive to anisomycin treatment;
Supplementary Fig. 8e) but not Homer, GluR1, or s6 kinase phosphorylation (
Supplementary Fig. 10c-f). Additionally, these proteins remain unaltered in cortex following acute NMDAR antagonist treatment (
Supplementary Fig. 11a-e).
Synaptic plasticity and ensuing learning processes are often mediated by NMDAR activation-driven protein translation, but AD-like effects require NMDAR blockade-induced protein translation. To resolve this paradox, we turned to recent evidence that NMDAR blockade by MK-801 or AP5, without neuronal activity, augments protein synthesis through eukaryotic elongation factor 2 (eEF2) dephosphorylation (activation), a critical catalytic factor for ribosomal translocation during protein synthesis
18. In this model, resting NMDAR activity causes sustained eEF2 kinase (eEF2K, or CamKIII) activation, which phosphorylates eEF2, effectively halting translation whereas acute NMDAR blockade at rest attenuates eEF2 phosphorylation allowing target transcript translation.
To evaluate this model, we tested whether excess synaptic glutamate possibly elicited by NMDAR blockade was responsible for ketamine's behavioural effects. Acute NMDA administration did not alter FST behaviour () as previously demonstrated
19 but increased Arc expression (
Supplementary Fig. 10i), suggesting excess glutamate does not elicit rapid behavioural AD effects. To define the role of neuronal activity in AD behavioural effects, we tested whether NBQX, an AMPA channel blocker that reduces neuronal activity, or picrotoxin (PTX), a GABA channel blocker that increases activity, impacted FST behaviour
4,20. Acute systemic treatment with these drugs did not affect FST behaviour (), or BDNF synthesis, though PTX enhanced Arc expression in HC (
Supplementary Fig. 10 g,h). However, when co-applied with ketamine, NBQX abolished behavioural FST AD-like responses () as previously described
4. These data suggest behavioural AD effects are not elicited by alterations in evoked neurotransmission, but require ketamine-mediated augmentation of AMPA-receptor activation.
Recent evidence suggests cortical mTOR signalling underlies ketamine-mediated AD responses
21. We investigated whether ketamine's rapid behavioural AD effects required mTOR activation, and if this signalling was downstream of BDNF. Regulation of phosphorylated mTOR was not detected after acute ketamine administration in CTL or BDNF KO hippocampal tissue () or WT cortex tissue (
Supplementary Fig. 11d). In earlier work, rapamycin prevented ketamine-mediated antidepressant responses; however, the link between rapamycin and AD-like effects is equivocal
22. We tested whether rapamycin pre-treatment could block acute ketamine-mediated FST behaviour. Thirty minutes after ketamine administration, WTs show AD responses unaffected by rapamycin treatment (
Supplementary Fig. 11h). Rapamycin reduced s6 kinase phosphorylation in cortex and HC (
Supplementary Fig. 11 f,g) suggesting brain tissue penetration. The earlier study examined molecular effects 2 hours or behavioural effects 24 hours after drug treatment
21, therefore mTOR's role in ketamine's AD effect may be maintenance rather than rapid induction.
To determine whether ketamine inhibits spontaneous miniature NMDA-receptor mediated currents (NMDA-mEPSC)
23,24 at rest and regulates eEF2 phosphorylation, we tested its impact on hippocampal neurons
in vitro. After ketamine perfusion (1, 5, or 50 μM), we recorded NMDA-mEPSCs () and within minutes detected a significant decrease in NMDA-mEPSCs similar to AP5
23. Moreover, protein extracts from ketamine-treated neurons revealed decreased eEF2 phosphorylation (peEF2) compared to vehicle-treated cultures, suggesting ketamine, in the absence of neuronal activity, dose-dependently leads to eEF2 de-phosphorylation, permitting protein synthesis (). Additionally, we evaluated ketamine's effects on hippocampal field potentials. Acute ketamine application (20 uM at rest) potentiated subsequent evoked synaptic responses in hippocampal slices (), further suggesting increased AMPA-mediated neurotransmission underlies ketamine's AD-like behavioural effects consistent with findings on BDNF- and protein synthesis-dependent synaptic plasticity
25.
To examine whether fast-acting AD response is mediated via eEF2, we administered ketamine or MK801 to WTs and analyzed eEF2 phosphorylation. Within 30 minutes, ketamine and MK801 lead to rapid decreases in peEF2 in HC (;
Supplementary Fig. 12,13), detected by immunostaining and Western blot analysis (). However, cortical peEF2 levels were unaltered with acute NMDAR antagonist treatment (
Supplementary Fig. 11f).
To examine whether eEF2K inhibition alters BDNF protein expression
in vivo, WTs were administered eEF2K inhibitors, rottlerin or NH125, then sacrificed 30 minutes later. Rottlerin and NH125 produced significantly increased BDNF protein expression (), with corresponding significant peEF2 decreases in HC (). To directly assess whether eEF2K inhibition is sufficient to mediate fast-acting AD-like responses, WTs were administered rottlerin or NH125 and examined in FST. Both rottlerin and NH125 produced significant decreases in FST immobility at 30-minutes (), a time-scale similar to NMDAR antagonists' effects, suggesting fast-acting behavioural effects are mediated through eEF2K inhibition. To test whether extracellular-related kinase (ERK), a regulator of protein translation during neural activity, impacts FST behaviour, we treated WTs with inhibitor SL327. This treatment reduced ERK phosphorylation in HC tissue (
Supplementary Fig. 10j), but did not affect FST behaviour (), suggesting AD-like effects are specific to eEF2K inhibition during resting spontaneous glutamatergic signalling. We found that an acute dose of rottlerin or NH125 did not affect locomotor activity, but AD-related behavioural effects were long-lasting (
Supplementary Fig. 14a-f). To validate that AD effects following eEF2K inhibition were mediated through BDNF, we administered rottlerin to BDNF KOs and tested FST behaviour. Like NMDAR antagonists, rottlerin is ineffective in BDNF KOs, demonstrating a requirement for increased BDNF expression upon eEF2K inhibition to produce AD-like behavioural responses ().
In summary, our data support the hypothesis that ketamine produces rapidly acting AD-like behavioural effects through inhibition of spontaneous NMDA-mEPSCs, leading to decreased eEF2 kinase activity, thus permitting rapid increases in BDNF translation (
Supplementary Fig. 15) which may in turn exert strong influences on pre- or postsynaptic efficacy
26,27. We found that fast-acting AD-like effects cannot be elicited by disinhibition of behavioural circuitry, or by evoked neurotransmission, but must rely on enhanced neurotransmission following NMDAR antagonist-induced plasticity occurring at rest
18. The observation of behavioural effects mediated through spontaneous neurotransmission provides the first evidence that tonic resting neurotransmission is involved in behaviour, and supports the notion that spontaneous and evoked forms of glutamatergic signalling are segregated
18,23,28,29. These data demonstrate that eEF2K inhibition, resulting in de-suppression of protein translation, is sufficient to produce AD-like effects, implicating eEF2K inhibitors as potential novel MDD treatments with rapid onset. Moreover, our results show that synaptic translational machinery may serve as a viable therapeutic target for development of faster acting antidepressants.