Major depressive disorder (MDD) affects approximately 17 percent of the population, and is predicted to be the number two cause of illness worldwide by the year 2020
3. The symptoms include cognitive impairment and loss of memory, implicating synaptic dysfunction in the pathophysiology of MDD
4–6. This possibility is supported by studies demonstrating a reduction of dendritic spine number and function of neurons in PFC in animal models of depression
7,8. Postmortem studies also report morphometric changes in PFC of MDD subjects, including a reduction in neuronal body size
1,9. This is also consistent with brain imaging studies reporting a reduction in the volume of PFC subregions in MDD subjects
2,10. Together, these studies suggest a loss of spine number and dendritic arbor although there is no direct evidence demonstrating this type of neuronal atrophy in the brains of MDD subjects.
To gain insight into the mechanisms that underlie neuronal atrophy and reduced volume of PFC, we have re-analyzed the data from a prior microarray gene expression study that we conducted of the dlPFC (Brodmann area 9) of MDD subjects and matched controls
11. We classified the microarray data with a 5% FDR
11and found that about 30% of the down-regulated genes in the MDD group could be related to some aspect of synaptic function. A more extended range (20% cutoff) identified an additional subset of down-regulated synaptic function-related genes in dlPFC of MDD brains (). The synaptic categories include regulation of synaptic vesicles [calmodulin 2, synapsins I and III, Rab3A, amphiphysin, and synaptogyrin 3]
12–16regulation of synaptic strength [neurogranin]
17dendritic spine formation [Rab4B]
18, and axonal outgrowth and regeneration [tubulins]
19. It is notable that other genome-wide expression studies of MDD have reported gene alterations of similar functional categories, including cytoarchitecture, vesicular transport, and synaptic transmission, of some of the same synapse-related genes
20–23or isoforms of the genes identified here (e.g., subtypes of amphiphysin, synaptogyrin, synapsin, and the Ras superfamily
22–24.
PCR analysis demonstrated significant decreases for 5 of the 10 genes, and trends for all but one (amphiphysin) of the remaining genes in the dlPFC of MDD subjects (). In situ hybridization analysis of the five confirmed genes demonstrates enriched expression in gray matter of dlPFC with a laminar distribution in the middle (synapsin I) or middle and deep layers (calmodulin 2, Rab3A, Rab4B and β-tubulin 4) of dlPFC. Quantitative analysis confirms that levels of these five genes are significantly decreased in MDD subjects compared to controls (). Studies in rodents demonstrate that chronic unpredictable stress (CUS), considered one of the most valid rodent models of depression, decreases the expression of synapsin I, calmodulin 2, Rab3A, and Rab4B, but not beta-tubulin 4, in the PFC (
Supplementary Fig. 1), suggesting that the decreased levels of these synapse-related genes in MDD result from chronic stress exposure that could contribute to depressive behaviors.
Decreased expression of synapse-related genes shown here, and a previous report of reduced neuronal cell body size in the dlPFC of MDD subjects
1, suggest a reduction in synaptic density, although there is no direct evidence to support this possibility. Examination of dendritic morphology by microtubule-associated protein 2 (MAP2) immunohistochemistry revealed decreased staining of dendritic processes in dlPFC layers III through V of MDD subjects relative to controls, which was confirmed by MAP2 immunoblotting of dlPFC micro-punches (). Using electron microscopic stereological analysis, a marked decrease in spine synapse number was observed in MDD subjects compared to controls (). Co-factor analysis revealed no significant effects of medication status, age of first episode (<40 vs. ≥40 years old), or suicide on synapse number (
Supplementary Figs. 2, 3, 5).
Examination of the transcription factor binding motifs in the promoter regions of the decreased synapse-related genes identified 3,266 upstream regulatory elements for 218 transcription factors (TRANSFAC scoring matrix,
Supplementary Table 1). Twelve transcription factor-binding sites are localized to the upstream regulatory domain of all of the MDD and CUS-altered synapse-related genes (). The rat homologues of these synapse-related genes include eight of the twelve transcription factor regulatory elements ( and
Supplementary Table 2). Analysis of the microarray data revealed that one of these transcription factors
GATA1 is significantly increased in MDD patients (). Other transcriptions factors were either not significantly changed in MDD (
GKLF and
KID31.0- and 1.1-fold, respectively) or were not included in the microarray gene set. Levels of the related
GATA-2, 3, and
4 isoforms were not significantly altered in MDD compared to controls. Co-factor analysis revealed no effect of medication status on
GATA1 expression, and no significant differences between all MDD subjects and groups categorized by age of first episode, number of episodes, and suicide, although the number of subjects per subgroup was small (
Supplementary Figs. 2–5). Studies in the CUS rodent model of depression demonstrate increased
Gata1 expression in the PFC, which was completely reversed by chronic administration of fluoxetine (). The ability of antidepressant treatment to normalize
Gata1 expression in rodents but not in MDD could be due to the small number of the medicated and un-medicated subgroups, as well as treatment resistance and heterogeneity of the subjects. The binding activity of Gata1 to the promoter of the synapse related genes was confirmed by chromatin immunoprecipitation (ChIP) with a Gata1 antibody followed by PCR for the Gata1 binding region of each gene (). For most of the genes, Gata1 antibody ChIP resulted in an enrichment of the promoter compared to mock, control ChIP.
The possibility that elevated GATA1 underlies decreased expression of the synapse-related genes and the atrophy of dendritic processes was examined in primary neuronal cultures. Initial studies focused on Rab4B because this class of small GTP-binding protein is required for endosomal recycling that is critical for maintenance of spine size
18 and because
RAB4B showed the greatest reduction (). Expression of a GFP-tagged rAAV-GATA1 vector in cultured cortical neurons () significantly decreased the expression of
Rab4b (). Expression of a cofactor target gene, FOG1, that is positively regulated by GATA1
25,26, was significantly increased by viral expression of GATA1 (not shown). To analyze dendrite morphology, neurons were fixed and labeled with anti-GFP (), as well as anti-MAP2 antibodies (). Viral expression of GATA1 decreased the complexity of the dendritic arbor (), the number of spines (), and the intensity of MAP2 staining (), which was confirmed by western blot analysis (). Sholl analysis demonstrated that viral expression of GATA1 significantly decreased the number of dendrite intersections, indicating decreased complexity ().
Next the effects of GATA1 expression on behavior in rodent models of depression were examined. Control or GATA1 viral vectors were infused into the PFC (), and the expression and location were confirmed by GFP expression (). Infusion of rAAV-GATA1 produced depressive-like behaviors in two established rodent models. In the forced swim test, rAAV-GATA1 increased the time spent immobile, a measure of behavioral despair that is reversed by antidepressant treatment (). In the learned helplessness model, exposing animals to inescapable stress causes escape deficits that are reversed by antidepressant treatment. Infusions of rAAV-GATA1 increased the number of escape failures during the initial block of active avoidance testing, similar to the effects of inescapable stress exposure (). During the second block of active avoidance testing, there was no significant effect (), indicating that GATA1 delays responding, but does not produce a sustained effect in this model. Infusion of rAAV-GATA1 did not influence locomotor activity (not shown), indicating that there was no generalized effect on ambulation. Further studies showed that the effects of rAAV-GATA1 in the forced swim test were not reversed by the antidepressant imipramine as expected, since drug treatment would not influence viral expression of GATA1 (
Supplementary Fig. 6).
The influence of GATA1 on depressive behavior caused by chronic stress was examined with a viral knock down strategy, using a small hairpin RNA (shRNA) targeted to GATA1 (rAAV-GATA1
shRNA) (). The ability of rAAV-GATA1
shRNA to effectively decrease
Gata1 mRNA was confirmed in cultured cells and rat PFC (
Supplementary Fig. 7). The rAAV-GATA1
shRNA or scrambled control (rAAV-Scr
shRNA) was infused into the PFC () of rats that were then subjected to the CUS paradigm shown to increase
Gata1 mRNA (). This paradigm results in anhedonia, a core symptom of depression that can be measured by preference for a sweetened solution
27. CUS exposure significantly decreased sucrose preference in control rats infused with rAAV-Scr
shRNA and this effect was completely blocked by infusion of rAAV-GATA1
shRNA. There was no effect of rAAV-GATA1
shRNA in non-stressed rats indicating that basal levels of GATA1 are low and not sufficient to suppress basal rates of sucrose preference.
Using three complimentary approaches we have identified and confirmed a subset of synapse-related genes that are repressed in dlPFC of MDD subjects. At the presynaptic level, synapsin I, Rab3A and calmodulin 2 regulate the size, number, and targeting of synaptic vesicles, and β-tubulins are involved in axonal outgrowth and regeneration
19, 28–31. Postsynaptically, Rab4B regulates endosomal recycling that is required for spine maintenance and neurotransmitter receptor recycling
18,32. Consistent with the role of these genes in synaptic function and structure, our results also demonstrate a reduction in synapse numbers in dlPFC. Together these findings demonstrate molecular and cellular alterations that could underlie the reduction in neuronal cell body size and volume of PFC in MDD patients
1,10. Decreased expression of these genes in response to chronic stress exposure also suggests an etiological relationship to MDD, which is often associated with severe life stress and trauma
33,34.
GATA1 was also identified as a transcriptional repressor that is increased in MDD and has binding elements in the promoter regions of the synapse related genes. GATA1 is a member of a zinc finger family of transcription factors that are evolutionarily conserved and play important roles in embryonic development
35. Although originally characterized in hematopoietic and cardiac tissues, GATA transcription factors are also expressed in endocrine tissue and brain, and are reported to regulate neuronal differentiation during development
35–38. Although GATA1 levels are low in controls, expression is increased in MDD and in response to chronic stress. Over expression of
Gata1 was sufficient to cause dendrite atrophy and decreased synaptic protein expression in cultured cortical neurons. Moreover, expression of
Gata1 in PFC was sufficient to produce depressive behaviors, while knock down of
Gata1 completely blocked depressive, anhedonic behavior caused by CUS exposure. Together, these studies demonstrate that expression of
Gata1 in the PFC is sufficient and necessary for the development of depressive behaviors in multiple animal paradigms. Further evidence for a role of GATA1 is provided by a recent report of a polymorphism in the GATA1 binding site of the promoter for interleukin 6, an inflammatory cytokine dysregulated in depression
39.
Together the results describe molecular and cellular mechanisms that are sufficient to cause a reduction in synapse numbers and dendritic complexity and could contribute to neuronal atrophy and decreased cortical volume reported in MDD patients. The results suggest that approaches that block or reverse neuronal atrophy in the PFC could be effective antidepressant treatments. This possibility is supported by recent studies demonstrating that the rapid antidepressant actions of NMDA receptor blockade are associated with increased spine number and function, and increased synaptogenesis in the PFC
40.