Recent findings revealed that the repetitions of long DNA sequences comprising the sequence of different genes (CNV – copy-number variations) are very common in the human genome. A well-known example for this type of variations is the “RCCX-module” that implies the tandem duplication of four genes – RP, 21-hydroxylase, complement component C4 and tenascin X – in a haplotype block. Only the C4 gene is active in each module, besides, each module may contain C4A or C4B gene encoding the two isoforms of complement C4. Copy number variation of C4 genes has functional relevance; specific combinations could be risk factors for autoimmune or other immunological diseases. We developed a new, real-time PCR based method for the quantification of C4A and C4B genes. This assay applies specific TaqMan probes, therefore combines the advantages of quantitative measurement (copy number determination) and SNP genotyping (for distinguishing the C4A and C4B isoforms) techniques. The developed real-time PCR methodology was used to determine C4A and C4B gene dosages in a healthy Hungarian population (N=118). The obtained data were compared to the results of an earlier study of the same population analyzed by different techniques. The novel method was demonstrated to be a simple, fast and reliable choice for studies of the complement C4 system, especially in large-scale populations screening.

Keywords: complement component C4, realtime PCR, copy number variations, SNP, immune system

Atypical antipsychotics are now widely used in the acute and long-term treatment in bipolar disorder. The role of atypical antipsychotics as acute agents, add-on medications; or as primary mood stabilizers in different phases of bipolar disorder is an important current research tendency. However, in bipolar disorder the mostly used indication of quetiapine is the management of acute manic phases, clinical data and the actual research results suggest that it may have both antidepressant and long-term antimanic effects. Quetiapine enhances the transmission of the central serotonergic networks, by its high antagonistic affinity for 5-HT(2A) and partial agonistic activity for the 5-HT(1A) receptors. The 5HT(1A) partial agonism causes an increase in the dopaminergic neurotransmission of the prefrontal cortex, and also, the affinity for the alpha 2-adrenoceptor brings a relative increase in extracellular noradrenergic release an tone in the prefrontal cortex. Latest research shows that quetiapine’s main, active, human plasma metabolite, N-desalkyl quetiapine (norquetiapine), has a high inhibition affinity for the noradrenergic transporter. These data suggest that comparing to other atypical antipsychotics, norquetiapine may have a relatively strong antidepressant potential. Modifying the dopaminergic transmission by quetiapine’s D2 receptor blocking activity results indirect mediating the cAMP-PKA and the arrestin-Akt-GSK-3 intracellular signal transduction pathways, which process may explain its long-term antimanic and mood stabilizing capability. Quetiapine’s activity on nerve growth factors, histamine H1 receptor, proinflammatory networks may take an important additional part in its efficacy in bipolar depression. Its very fast dissociation from the D2 receptor is an important pharmakokinetic parameter for managing the optimal quetiapine dose in the daily clinical practice. This review tries to organize the actual information on quetiapine’s multiplex activity in bipolar disorder.

Keywords: quetiapine, bipolar disorder, serotonine, dopamine, noradrenaline, Akt, GSK-3, BDNF, fast dissociation

A pooled analysis of randomized placebo controlled antidepressant trials shows that the rate of antidepressant and placebo responders are 50% and 30% respectively. The traditional calculation of drug-placebo difference (50-30=20%) in these drug-trials is based on the assumption that all placebo responders should be antidepressant responders. However, it seems to be not the case, since about one-third of placebo responders are antidepressant nonresponders. Considering this, the fair calculation of antidepressant-placebo difference in randomized placebo controlled trials results in a 30% rather than 20% difference. The drug-placebo differences in all antidepressant drug trials should be re-calculated.

Keywords: antidepressants, placebo, antidepressant–placebo difference 

The 53-year-old female patient had suffered massive subarachnoid bleeding due to rupture of left-localized aneurysm of the anterior communicant artery. Following the neurosurgical intervention, deterioration of consciousness related to strong vasospasm occurred. Cerebral CT examination was performed, showing a 0.5 cm ischaemic lesion of the left hippocampal fornix. Due to intensive therapy, the patient recovered gradually, however considerable short-time memory deficit and severe anterograde amnesia remained. Admission of the patient in psychiatric care 5 weeks after the operation was necessary since acute deterioration had been added to memory disturbance and anterograde amnesia. Clinical features included severe short-time memory deficit, continuous and severe anterograde amnesia, disorientation, alterations of verbal fluency and abstraction. The amnesic syndrome was probably related to the hippocampal damage, but considering the development of cognitive deficits, cerebral CT was performed again, which verified internal hydrocephalus. A ventriculo-peritoneal shunt has been implanted and the patient was re-admitted in psychiatry care because of her memory deficit, anterograde amnesia and disorientation. Thereafter, low doses of citalopram and donepezil therapy was started together with temporarily used antipsychotic medication (risperidone). Gradual, but continuous improvement of memory and cognitive function could be detected, with total recovery after one year. The deficits in long- and short-term memory, orientation and cognition were totally restored.

Keywords: hippocampal lesion, fornix, anterograde amnesia, memory deficit