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European Journal of Pharmacology 853 (2019) 129–135

Contents lists available at ScienceDirect

European Journal of Pharmacology


journal homepage: www.elsevier.com/locate/ejphar

Neuropharmacology and analgesia

Sertraline inhibits nerve growth factor-induced neurite outgrowth in PC12 T


cells via a mechanism involving the sigma-1 receptor

Yukari Matsushimaa,b, Kazuki Teradac, Chiaki Kameia, Yumi Sugimotod,
a
Department of Pharmacology, Faculty of Pharmaceutical Sciences, Yasuda Women's University, 6-13-1 Yasuhigashi, Asaminami-ku, Hiroshima 731-0153, Japan
b
Department of Kampo and Natural Product Chemistry, Yokohama University of Pharmacy, 601 Matanocho, Totsuka-ku, Yokohama 245-0066, Japan
c
Laboratory of Drug Design and Drug Delivery, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
d
Laboratory of Pharmacology, Faculty of Pharmaceutical Sciences, Himeji Dokkyo University, 7-2-1 Kamiohno, Himeji 670-8524, Japan

A R T I C LE I N FO A B S T R A C T

Keywords: The selective serotonin reuptake inhibitors (SSRIs) fluvoxamine and sertraline show a high affinity for sigma-1
Nerve growth factor receptors. Fluvoxamine enhances nerve growth factor (NGF)-induced neurite outgrowth in PC12 cells via a
Neurite outgrowth sigma-1 receptor-mediated mechanism, which suggests that neurogenesis may be involved in the antidepressant
Sertraline action of fluvoxamine. However, the effects of sertraline on neurite outgrowth remain unclear. Here, we report
Selective serotonin reuptake inhibitor
the effects of sertraline on NGF-induced neurite outgrowth in PC12 cells. At concentrations above 0.3 μM, ser-
Sigma-1 receptor
PC12 cells
traline inhibited neurite outgrowth induced by NGF (50 ng/mL) in PC12 cells in a concentration-dependent
manner. At 0.3–3 μM, sertraline inhibited NGF-induced neurite outgrowth; however, had no effect on cell via-
bility. This suggests that at these concentrations, sertraline inhibits NGF-induced neurite outgrowth without
causing cell toxicity. Because sertraline has a high affinity for the sigma-1 receptor, we investigated whether this
receptor is involved in sertraline's inhibitory effect on NGF-induced neurite outgrowth. The effect was reversed
by both the sigma-1 receptor agonist PRE-084 and the sigma-1 receptor antagonist NE-100. These results suggest
that sertraline inhibits NGF-induced neurite outgrowth in PC12 cells by acting as an inverse agonist of the sigma-
1 receptor in this system.

1. Introduction intracellular endoplasmic reticulum membranes. It is involved in the


regulation of mitochondrial calcium concentration and reduction of
Various pathways are implicated in the pathology of depression, endoplasmic reticulum stress (Hayashi et al., 2000; Hayashi and Su,
including the neurotransmission of serotonin (5-hydroxytryptamine, 5- 2007). The sigma-1 receptor has been suggested to play an important
HT), noradrenaline, or glucocorticoid secretion (Libraries, 2001; Liu role in psychiatric disorders, and there is increasing interest in the re-
et al., 2006; Nestler et al., 2002; Ressler and Nemeroff, 2000). Selective lationship between this receptor and depression (Albayrak and
serotonin reuptake inhibitors (SSRIs) are widely used for the treatment Hashimoto, 2017; Furuse and Hashimoto, 2009; Hindmarch and
of depression. SSRIs inhibit the 5-HT transporter, leading to an eleva- Hashimoto, 2010; Ishikawa and Hashimoto, 2010). It has been reported
tion of 5-HT levels in the synaptic cleft (Hyttel, 1994; Sangkuhl et al., that sigma-1 receptor knockout mice exhibit depression-like behavior
2009; Zhou et al., 2009). Although increases in 5-HT levels are elicited (Chevallier et al., 2011). Sigma-1 receptor agonists such as SA4503 and
rapidly, a few weeks of treatment with SSRIs are required before an UMB23 have antidepressant effects in the forced-swim and tail sus-
improvement in symptoms (Berton and Nestler, 2006; Wong and pension tests in mice, which are used to evaluate antidepressants
Licinio, 2001). Therefore, mechanisms other than 5-HT levels may be (Banister and Kassiou, 2012; Fukunaga and Moriguchi, 2017; Skuza and
related to the antidepressant effects of SSRIs. Rogó, 2007; Sugimoto et al., 2012; Wang et al., 2007). In addition,
Sigma receptors were discovered in 1976 and are classified as sigma-1 receptor agonists enhanced neuroplasticity, which may also be
sigma-1 and sigma-2 receptors (Hellewell and Bowen, 1990). The involved in the action of antidepressants (Hayashi and Su, 2004;
sigma-1 receptor is widely distributed in several tissues. In the central Kimura et al., 2013; Takebayashi et al., 2002).
nervous system, it is highly expressed in the hippocampus, frontal The SSRI fluvoxamine has a strong affinity for the sigma-1 receptor
cortex, and hypothalamus (Collina et al., 2013), specifically on (Narita et al., 1996) and enhances nerve growth factor (NGF)-induced


Corresponding author.
E-mail address: yumisugi@gm.himeji-du.ac.jp (Y. Sugimoto).

https://doi.org/10.1016/j.ejphar.2019.03.032
Received 25 December 2018; Accepted 18 March 2019
Available online 19 March 2019
0014-2999/ © 2019 Elsevier B.V. All rights reserved.
Y. Matsushima, et al. European Journal of Pharmacology 853 (2019) 129–135

Fig. 1. Effects of SSRIs on neurite outgrowth in the presence and absence of NGF (50 ng/mL). (A) NGF + fluvoxamine. (B) NGF + sertraline. (C) NGF + paroxetine.
(D) Fluvoxamine alone. (E) Sertraline alone. (F) Paroxetine alone. Values represent means ± S.E.M (n = 6). * * P < 0.01 vs. NGF.

neurite outgrowth in PC12 cells through stimulation of the sigma-1 2.2. Cell culture
receptor; its effects are blocked by sigma-1 receptor antagonism (Ishima
et al., 2014; Nishimura et al., 2008). This suggests that the sigma-1 PC12 cells (RIKEN Cell Bank, Tsukuba, Japan) were cultured at
receptor has a role in neuroplasticity, and may be connected to the 37 °C and 5% CO2, in Dulbecco's modified Eagle's medium (DMEM)
antidepressant effects of fluvoxamine. Another SSRI, sertraline, also has (Gibco-Life Technologies, Gaithersburg, MD, USA) supplemented with
an affinity for the sigma-1 receptor. It was previously reported that nutrient mixture F-12 (Gibco-Life Technologies), 10% (v/v) fetal bovine
sertraline inhibits NGF-induced neurite outgrowth in PC12 cells, in serum (FBS) (Gibco-Life Technologies) and 1% (v/v) penicillin/strep-
contrast to fluvoxamine (Ishima et al., 2014). However, whether the tomycin (Nacalai Tesque, Kyoto, Japan). To measure neurite sprouting,
sigma-1 receptor is involved in this effect remains unknown. To address PC12 cells were plated at a density of 1.0 × 105 cells/dish on type 1
this, we investigated the inhibitory effect of sertraline on NGF-induced collagen-coated, 60-mm tissue culture dishes in DMEM/F12 containing
neurite outgrowth in PC12 cells compared to fluvoxamine, and the 10% FBS with 1% penicillin/streptomycin and cultured for 24 h.
involvement of the sigma-1 receptor in this effect.

2.3. Drug treatment and measurement of neurite outgrowth


2. Material and methods
Fluvoxamine, sertraline and paroxetine were dissolved in ethanol
and final volume of ethanol was no more than 0.1%. PRE-084 and NGF
2.1. Reagents
were dissolved in distilled water which final volume was no more than
0.1%. Drugs were added to PC12 cells in DMEM/F12 containing 5%
2.5S-NGF from mouse submaxillary glands (mNGF 2.5S) was pur-
FBS for 24 h. Measurement of neurite outgrowth was evaluated with
chased from Alomone Labs (Jerusalem, Israel). Sertraline hydro-
modifying previously described (Terada et al., 2014). After 24 h of
chloride, fluvoxamine hydrochloride and paroxetine hydrochloride
treatment, images of 5 randomly selected fields, each containing 10–15
were purchased from Tokyo Chemical Industry Co., Ltd. (Tokyo,
cells, were captured using an inverted phase-contrast microscope
Japan). PRE-084 hydrochloride and NE-100 hydrochloride were pur-
(Nikon, Tokyo, Japan) equipped with a digital camera (Digital Sight DS-
chased from Santa Cruz Biotechnology, Inc. (CA, USA).
L2 system; Nikon), and 10 cells in each images were measured using
ImageJ version 1.48 v (National Institutes of Health, Bethesda, MD,
USA). Measurement was performed in blinded manner. The neurite

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Y. Matsushima, et al. European Journal of Pharmacology 853 (2019) 129–135

length is defined as the distance along a neurite, i.e., the distance from (1 μM) (F(3, 20) = 108.41, P < 0.001) (Fig. 5). The inhibitory effect of
the soma to the end of neurite. The total neirute length of 10 cells for sertraline (1 μM) on NGF-induced neurite outgrowth was significantly
each treatment condition was calculated to evaluate the neurite out- reduced by the sigma-1 receptor agonist PRE-084 (0.1 μM) (F(3, 20)
growth (Terada et al., 2014). = 35.81, P < 0.001) (Fig. 6A). Furthermore, the inhibitory effect of
sertraline on NGF-induced neurite outgrowth was also reversed by co-
2.4. Cell viability treatment with the sigma-1 receptor antagonist NE-100 (1 μM) (F(3,
20) = 55.43, P < 0.001) (Fig. 6B).
Cell viability assay was determined using a the [3-(4,5-di-
methylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay (MTT; 4. Discussion
Nacalai tesque, Kyoto, Japan), following the method modifying de-
scribed(Lombardi et al., 2017; Ogra et al., 2016). Cell viability was also In this study, we found that sertraline inhibited the NGF-induced
determined using a commercially available kit, CellTiter-Glo Lumines- neurite outgrowth without affecting their viability. The effect of ser-
cent Cell Viability Assay (Promega KK, Tokyo, Japan) with small traline was completely blocked by the sigma-1 receptor antagonist.
modification (Setoguchi et al., 2018). Both assays were conducted These findings are the first report that sertraline inhibited the NGF-
under the same conditions. Briefly, PC12 cells were seeded at a density induced neurite outgrowth by via the sigma-1 receptor. Some anti-
of 1.0 × 104 cells /well. After 24 h, cells were treated with different depressants classified as SSRIs show a high affinity for the sigma-1 re-
concentrations of each drug to another 24 h, and the cell viability was ceptor (Ishima et al., 2014; Narita et al., 1996), including fluvoxamine,
measured using each reagent. Results are expressed as a percentage of which has the highest affinity of these (Ki = 36 nM), and sertraline (Ki
the absorbance of vehicle-treated culture wells. = 57 nM) (Narita et al., 1996). In contrast, the potent SSRI paroxetine
has a low affinity with the sigma-1 receptor (Ki = 1893 nM) (Narita
2.5. Statistical analysis et al., 1996). Fluvoxamine is a typical antidepressant and is used for
treating depression, obsessive compulsive disorder, and anxiety
All numerical data are presented as the mean ± S.E.M. Statistical (Carrasco and Sandner, 2005). Fluvoxamine enhances NGF-induced
analysis was performed using an analysis of variance followed by neurite outgrowth in PC12 cells, and this effect is mediated by the
Tukey's post-hoc or Dunnett's tests. sigma-1 receptor (Nishimura et al., 2008). This observation indicates
that the sigma-1 receptor may be involved in fluvoxamine's mechanism
3. Results of action, as it is important in neuronal plasticity and neuropsychiatric
disease (Hashimoto, 2009; Niitsu et al., 2012). Sertraline, another SSRI
3.1. Effects of SSRIs on NGF-induced neurite outgrowth with a high affinity for the sigma-1 receptor, inhibits NGF-induced
neurite outgrowth in PC12 cells (Ishima et al., 2014). However, it was
NGF (50 ng/mL)-induced neurite outgrowth was enhanced by flu- not clear whether these inhibitory effects of sertraline are mediated by
voxamine (F(4, 25) = 48.56, P < 0.001) (Fig. 1A), and inhibited by the sigma-1 receptor. Therefore, we examined the involvement of the
sertraline (F(5, 30) = 572.64, P < 0.001) (Fig. 1B), in a concentration- sigma-1 receptor in the inhibitory effects of sertraline on NGF-induced
dependent manner. Paroxetine did not affect NGF-neurite outgrowth (F neurite outgrowth in PC12 cells compared with fluvoxamine and par-
(4, 25) = 0.17, P > 0.05) (Fig. 1C). In addition, none of the drugs oxetine, using a sigma-1 receptor agonist and antagonist.
changed neurite outgrowth in the absence of NGF (Fluvoxamine; F(4, Fluvoxamine significantly enhanced NGF-induced neurite out-
25) = 1.38, P > 0.05, Sertraline; F(5, 30) = 0.87, P > 0.05, Parox- growth in PC12 cells at concentrations above 0.1 μM, consistent with
etine; F(4, 25) = 2.57, P > 0.05) (Fig. 1D–F). results reported by Nishimura et al. (2008). Fluvoxamine had no affect
Typical Representative image of phase-contrast photomicrographs neurite outgrowth in PC12 cells in the absence of NGF. These results
are shown in Fig. 2A-D. suggest that fluvoxamine does not act as an NGF-like agonist but en-
hances the stimulation induced by NGF. Sertraline, which has a high
3.2. Effects of SSRIs on PC12 cell viability affinity for the sigma-1 receptor, significantly inhibited NGF-induced
neurite outgrowth at concentrations over 0.3 μM, but did not affect
The viability of PC12 cells was significantly decreased by treatment neurite outgrowth in the absence of NGF. Ishima et al. (2014) reported
with fluvoxamine at concentrations of 100–300 μM (MTT assay; F(8, that sertraline did not inhibit NGF (2.5 ng/mL)-induced neurite out-
36) = 24.80, P < 0.001, CellTiter assay; F(8, 45) = 286.40, growth at 1 μM and had a significant inhibitory effect at 10 μM (Ishima
P < 0.001), sertraline at 10–300 μM (MTT assay; F(8, 36) = 132.78, et al., 2014). This discrepancy in sertraline concentrations that inhibit
P < 0.001, CellTiter assay; F(8, 45) = 275.76, P < 0.001), and par- neurite outgrowth may be due to differences in experimental condi-
oxetine at 30–500 μM (MTT assay; F(8, 36) = 60.28, P < 0.001, tions, such as NGF concentration (2.5 vs. 50 ng/mL) or duration in
CellTiter assay; F(8, 45) = 916.27, P < 0.001) (Fig. 3). culture (5 days vs. 24 h). We examined neurite outgrowth after 2.5 ng/
mL NGF for 5 days which is the same condition as Ishima et al. (2014).
3.3. Effect of sigma-1 receptor stimulation on NGF-induced neurite We confirmed that its neurite outgrowth was similar to 50 ng/mL NGF
outgrowth in PC12 cells for 24 h culture in our present experiments (data is not shown).
Therefore, our experimental condition of 50 ng/mL NGF for 24 h is
The sigma-1 receptor agonist PRE-084 (0.01–10 μM) enhanced sufficient time and NGF concentration. Paroxetine, which has a low
neurite outgrowth caused by NGF in a concentration-dependent manner affinity for the sigma-1 receptor, had no effects on PC12 cell neurite
(F(4, 25) = 73.56, P < 0.001) (Fig. 4A). The potentiating effect of outgrowth in the presence or absence of NGF.
PRE-084 (1 μM) on NGF-induced neurite outgrowth was blocked by the SSRIs show cytotoxicity in several cell lines (Levkovitz et al., 2005;
sigma-1 receptor antagonist NE-100 (1 μM) (F(3, 20) = 224.04, Nordenberg et al., 1999). In addition, sertraline has been suggested to
P < 0.001) (Fig. 4B). show cytotoxicity at lower concentrations than other SSRIs (Kuwahara
et al., 2015). For example, the IC50 value of sertraline for reducing cell
3.4. Involvement of the sigma-1 receptor in the effects of fluvoxamine and viability in HT29 cells is 14.7 μM, and potency is sertraline >
sertraline in NGF-induced neurite outgrowth paroxetine > clomipramine > fluoxetine (Irit et al., 2008). The IC50
value of anticancer effects on HepG2 cells induced by sertraline is
The enhancing effect of fluvoxamine (1 μM) on NGF-induced neurite 1.24 ± 0.0551 μM, which is 25 times lower than that of fluvoxamine
outgrowth was blocked by the sigma-1 receptor antagonist NE-100 (Kuwahara et al., 2015). The concentrations of sertraline that

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Y. Matsushima, et al. European Journal of Pharmacology 853 (2019) 129–135

Fig. 2. Representative image of phase-contrast photomicrographs. (A) NGF (50 ng/mL) only. (B) NGF + fluvoxamine (1 μM). (C) NGF + sertraline (1 μM). (D)
NGF + paroxetine (1 μM). Scale bars: 50 µm.

significantly inhibit NGF-induced neurite outgrowth are in the same above 30 μM significantly decreased the viability of PC12 cells.
range as those eliciting cytotoxic effects in other cell lines. Therefore, Sertraline had significant inhibitory effects on NGF-induced neurite
there is a possibility that the inhibitory effects of sertraline on NGF- outgrowth above concentrations of 0.3 μM, which are lower than those
induced neurite outgrowth may be caused by cytotoxic effects on PC12 decreasing cell viability in PC12 cells. These results indicate that at
cells. However, the cytotoxic effects of SSRI on PC12 cells are not yet lower concentrations, sertraline inhibits NGF-induced neurite out-
clear. Therefore, we examined their effects on PC12 cell viability. growth in PC12 cells without affecting their viability. The inhibitory
Fluvoxamine above 100 μM, sertraline above 10 μM and paroxetine effects on NGF-induced neurite outgrowth over sertraline 10 μM may be

Fig. 3. Effects of SSRIs on PC12 cell viability. Cell viability is expressed as a percentage of control. (A) Fluvoxamine. (B) Sertraline. (C) Paroxetine. Data represent
means ± S.E.M (n = 9). *P < 0.05, **P < 0.01 vs. control (without SSRI), MTT assay. # P < 0.05, ##P < 0.01 vs. control (without SSRI), CellTiter assay.

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Fig. 4. Involvement of the sigma-1 receptor in


NGF-induced neurite outgrowth in PC12 cells.
(A) Concentration-dependent effects of the
sigma-1 receptor agonist PRE-084 on neurite
outgrowth induced by NGF (50 ng/mL).
**P < 0.01 vs. NGF. (B) Effect of the sigma-1
receptor antagonist NE-100 (1 μM) on PRE-084
(1 μM)-induced potentiation of neurite out-
growth elicited by NGF (50 ng/mL). Values
represent means ± S.E.M (n = 6).
**P < 0.01 vs. (A) NGF, (B) NGF + PRE-084.

caused, in part, by cytotoxicity.


The sigma-1 receptor may be involved in fluvoxamine's enhance-
ment of NGF-induced neurite outgrowth (Nishimura et al., 2008). We
demonstrated that the selective sigma-1 receptor agonist PRE-084 po-
tentiated NGF-induced neurite outgrowth in a concentration-dependent
manner. Although Rossi et al. (2011) also reported that PRE-084 en-
hances NGF-induced neurite outgrowth in PC12 cells (Rossi et al.,
2011), no reported studies have examined the effects of sigma-1 re-
ceptor antagonism on the action of PRE-084. In the present study, we
have demonstrated that the potentiating effects of PRE-084 were
blocked by co-administration of the sigma-1 receptor antagonist NE-
100. These results indicate that PRE-084 elicits the effect via stimula-
tion of the sigma-1 receptor. The potentiating effects of fluvoxamine on
NGF-induced neurite outgrowth were also significantly blocked by NE-
100, confirming that the augmentation of NGF-induced neurite out-
growth by fluvoxamine is caused by sigma-1 receptor stimulation; in
Fig. 5. NE-100 blocks fluvoxamine potentiation of NGF-induced neurite out- other words, fluvoxamine acts as a sigma-1 receptor agonist. In con-
growth. PC12 cells were treated with NGF (50 ng/mL), fluvoxamine (1 μM) and trast, sertraline inhibits NGF-induced neurite outgrowth. The involve-
NE-100 (1 μM). Values represent means ± S.E.M (n = 6). **P < 0.01 vs. ment of the sigma-1 receptor in the effects of sertraline was not in-
NGF + fluvoxamine. vestigated, but as sertraline has an affinity with the sigma-1 receptor,

Fig. 6. Effects of PRE-084 and NE-100 on NGF-


induced neurite outgrowth inhibition by ser-
traline. PC12 cells were treated with NGF
(50 ng/mL) with or without sertraline (1 μM),
PRE-084 (0.1 μM) or NE-100 (1 μM). (A)
Sertraline + PRE-084. (B) Sertraline + NE-
100. Values represent means ± S.E.M (n = 6).
**P < 0.01 vs. NGF + sertraline.

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Declaration of interest Nishimura, T., Ishima, T., Iyo, M., Hashimoto, K., 2008. Potentiation of nerve growth
factor-induced neurite outgrowth by fluvoxamine: role of sigma-1 receptors, IP3 re-
ceptors and cellular signaling pathways. PLoS One 3, e2558.
None. Nordenberg, J., Fenig, E., Landau, M., Weizman, R., Weizman, A., 1999. Effects of psy-
chotropic drugs on cell proliferation and differentiation. Biochem. Pharmacol. 58,
1229–1236.
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