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Background. The pharmacological treatment options of Parkinson’s disease (PD) have considerably evolved during the last decades. However, therapeutic regimes are complicated due to individual differences in disease progression as well as the occurrence of complex nonmotor impairments such as mood and anxiety disorders. Antidepressants in particular are commonly prescribed for the treatment of depressive symptoms and anxiety in PD. Case Presentation. In this case report, we describe a case of a 62-year-old female patient with PD and history of depressive symptoms for which she had been treated with moclobemide concurrent with anti-Parkinson medications pramipexole, rasagiline, and L-DOPA+benserazide retard. An increase in the dosage of moclobemide 12 months prior to admission progressively led to serotonergic overstimulation and psychovegetative exacerbations mimicking the clinical picture of an anxiety spectrum disorder. After moclobemide and rasagiline were discontinued based on the hypothesis of serotonergic overstimulation, the patient’s psychovegetative symptoms subsided. Conclusions. The specific pharmacological regime in this case probably caused drug-drug interactions resulting in a plethora of psychovegetative symptoms. Likely due to the delayed onset of adverse effects, physicians had difficulties in determining the pharmacologically induced serotonin toxicity. This case report emphasizes the complexity of pharmacological treatments and the importance of drug-drug interaction awareness in the treatment of PD patients with complicating nonmotor dysfunctions such as depression.

Table S1. Blood sample values since admission. ALT alanine transaminase, AST aspartate transaminase, LDH Lactate dehydrogenase. (DOCX 20 kb)

Major depression and alcohol use disorder are severe psychiatric diseases affecting the world's population with high comorbidity level. However, the pathogenesis of this comorbidity remains unclear, and no selective treatment for this condition is available. A pathogenic pathway and a possible therapeutic target for the treatment of depression-alcoholism comorbidity based on the hyperfunction of acid sphingomyelinase (Asm) were recently suggested. Here we analyzed the effects of alcohol on the depression/anxiety state of homozygous Asm-knockout mice (Asm − /−), which can be considered as a model of an early stage of Niemann-Pick disease, as well as their drinking pattern under normal and stress conditions. It was observed that forced treatment with alcohol (2 g/kg, i.p.) reduces the anxiety level of Asm−/− mice as measured in the elevated plus maze (EPM) test, but enhances the depression level in the forced swim test (FST). The analysis of drinking pattern of these animals in a free-choice alcohol drinking paradigm revealed higher alcohol intake and preference in Asm−/− mice compared to wild type (wt) littermates. However, this difference was overwritten by the stress exposure. Stronger sedating effects of alcohol were observed in Asm−/− mice compared to wt animals in the loss of righting reflex test after single and repeated alcohol injections (3 g/kg, i.p.). Altogether, the present findings might indicate an Asm involvement in the mechanisms of comorbidity between alcoholism and anxiety/depression. CA extern

Methods based on nanotechnologies play a growing role in biomedical research. Quantum dots (QDs) are a group of engineered fluorescent nanoparticles suited for advanced imaging applications. The substitution of the particle’s surface with defined molecular structures could enable the adoption as targeted contrast agents or therapeutic devices for a variety of clinical approaches. However, important aspects such as the basic surfacedependent behavior of non-targeted QDs in the organism and arising health effects upon systemic administration remain incompletely understood. Acute inflammatory effects for instance are often initiated on the microcirculatory level and are probably relevant for cardiovascular pathologies observed in epidemiologic and experimental studies of certain nanoparticles. Most in vitro studies show that the surface structures of QDs and other nanoparticles seem to be predominantly accountable for different cytotoxic effects and a variable potential to liberate proinflammatory cytokines. Currently, no systematic in vivo studies have addressed surface-dependent interactions of QDs on the level of the microcirculation and assessed the resulting impact on biokinetics as well as on proinflammatory parameters. Thus, this thesis aimed to i) analyze the incidence of QDsurface- dependent acute microvascular interactions and their influence on key biokinetic parameters and ii) investigate acute immunomodulatory effects on the multistep process of leukocyte recruitment in vivo. For this, three types of commercially available QDs with different surface modifications: carboxyl-QDs, amine- and polyethylene glycol-QDs (amine-QDs) and polyethylene glycol-QDs (PEG-QDs) were used. The physicochemical characterization was done by dynamic light scattering (DLS) analysis and microscale thermophoresis. In a first set of experiments, circulating half-lives, tissue distribution in different organs, and hepatic as well as renal clearance were measured. Ex vivo analysis of QD tissue distribution was performed on selected tissue samples via transmission electron microscopy (TEM) and two-photon microscopy. By combining reflected-light oblique transillumination (RLOT) and fluorescence in vivo microscopy of the murine M. cremaster, interactions of QDs with components of the microcirculation as well as leukocyte migration parameters were visualized and quantified. The extreme short circulating half-life of anionic carboxyl-QDs was related to pronounced clearance by the mononuclear phagocyte system. Beyond this, further investigations showed, for the first time, that the continuous capillary endothelium of skeletal and heart muscle tissue has the capacity to directly extract carboxyl-QDs from the circulation by means of caveolaemediated endocytosis. Carboxyl-QDs were also taken up by perivascular macrophages in the surgically exposed but not in the native M. cremaster and led to a significant increase of adherent and (subsequently) transmigrated leukocytes in this model. Further experiments provided evidence for a probable involvement of mast cells in the intercellular adhesion molecule-1 (ICAM-1)- and endothelial (E)-selectinmediated modulation of leukocyte recruitment. This process is most likely initiated by the endocytosis of carboxyl-QDs through activated perivascular macrophages. The primary activation of tissue-resident perivascular macrophages seems to be the consequence of tissue damage related to the surgical preparation of the cremaster muscle. This is supposedly a prerequisite for the endocytosis of carboxyl-QDs whereupon endothelial and mast cells seem to be secondarily activated in a paracrine fashion that then leads to an increase in leukocyte recruitment.

Alcohol is a widely consumed drug that can lead to addiction and severe brain damage. However, alcohol is also used as self-medication for psychiatric problems, such as depression, frequently resulting in depression-alcoholism comorbidity. Here, we identify the first molecular mechanism for alcohol use with the goal to self-medicate and ameliorate the behavioral symptoms of a genetically induced innate depression. An induced over-expression of acid sphingomyelinase (ASM), as was observed in depressed patients, enhanced the consumption of alcohol in a mouse model of depression. ASM hyperactivity facilitates the establishment of the conditioned behavioral effects of alcohol, and thus drug memories. Opposite effects on drinking and alcohol reward learning were observed in animals with reduced ASM function. Importantly, free-choice alcohol drinking—but not forced alcohol exposure—reduces depression-like behavior selectively in depressed animals through the normalization of brain ASM activity. No such effects were observed in normal mice. ASM hyperactivity caused sphingolipid and subsequent monoamine transmitter hypo-activity in the brain. Free-choice alcohol drinking restores nucleus accumbens sphingolipid- and monoamine homeostasis selectively in depressed mice. A gene expression analysis suggested strong control of ASM on the expression of genes related to the regulation of pH, ion transmembrane transport, behavioral fear response, neuroprotection and neuropeptide signaling pathways. These findings suggest that the paradoxical antidepressant effects of alcohol in depressed organisms are mediated by ASM and its control of sphingolipid homeostasis. Both emerge as a new treatment target specifically for depression-induced alcoholism. Electronic supplementary material The online version of this article (doi:10.1007/s00401-016-1658-6) contains supplementary material, which is available to authorized users.