Background
Psychosis, a major public health concern, is a chronic recurrent neuropsychiatric disorder that adversely impacts the quality of life of the sufferers [
1]. An estimated 2% of people worldwide experience an episode of psychosis in their lifetime, with 80% of these people experiencing the episodes between the ages of 16 and 40 years [
2,
3]. Although the aetiology of the disease is unknown, hyperdopaminergic activity is closely linked with the pathogenesis of psychosis [
4]. Individuals with psychoses are more prone to suicide, depression, anxiety, aggression, substance abuse, cognitive impairment, victimisation, poverty and increased medical problems [
5]. The onset of psychosis is determined by an underlying vulnerability coupled with the impact of environmental stress (including drug/substance abuse), which may trigger active psychotic symptoms, and this provides a basis for the stress/vulnerability model of psychosis [
6].
Current antipsychotic drugs only provide symptomatic relief, without altering disease progression [
7,
8]. Additionally, the clinical efficacy of these drugs is often limited by adverse reactions such as photo-sensitivity, jaundice, disabling seizures, blindness, agranulocytosis and neuroleptic malignant syndrome [
9,
10]. Moreover, the overall functional and quality of life outcomes of patients still remain poor after treatment [
5]. Thus, there is a critical need to search for more effective and less toxic therapeutic agents to manage psychosis. An increasing number of herbal products have been introduced into psychiatric practice as alternative or complementary medicines, following the identification of their therapeutic potential and mechanisms of action [
11].
Synedrella nodiflora (L.) Gaertn (family Asteraceae) is a common shrub found mainly around small rivers and streams as well as along roadsides and under shady trees [
12]. In Ghana, traditional medicine practitioners use the aqueous extract obtained after boiling the whole plant for the management of epilepsy and pain. The leaves are also used medicinally to prevent spontaneous abortion, hiccup, as a laxative and feed for livestock [
12]. The hydro-ethanolic extract of the whole plant has demonstrated anticonvulsant [
13], sedative [
14], in vitro antioxidant and free radical scavenging properties [
15] as well as anti-nociceptive properties in acute and neuropathic pain [
16,
17]. An acute, sub-acute and sub-chronic toxicity of the extract in rodents showed no significant changes in haematological, biochemical and organ histological changes of animals treated with an LD
50 greater than 6400 mg/kg [
18‐
20]. Our preliminary work conducted on this extract revealed that it was able to reduce stereotypic behaviour characteristic of schizophrenia and other psychotic conditions in experimental animals suggesting that it may have utility in the management of psychotic conditions [
21]. Thus, the present study sought to examine, in greater detail, if SNE possessed anti-psychotic potential and if so, how it compared with current clinically available drugs using in vivo models of psychosis in mice.
Methods
Plant collection and extraction
Samples of the plant were collected from the Botanical Gardens, University of Ghana, Accra (N5
039ʹ32.067 W0
011ʹ55.247) in August 2012 and were identified and authenticated at Ghana Herbarium, Department of Botany, University of Ghana, Legon, Accra where a voucher specimen (PA01/UGSOP/GH12) was kept. The hydro-ethanolic extract was prepared as previously described [
13,
22]. Briefly, samples of the collected plant were air-dried for 7 days and powdered. Two kilograms of the powder were cold-macerated with 70%
v/v of ethanol in water. The hydro-ethanolic extract was then evaporated using a rotary evaporator (Buchi Rotavapor® R-300, Flawil, Switzerland) under reduced pressure to remove ethanol. The aqueous portion was frozen at -20 °C and lyophilised (Bench-top Freeze Dryer, Labfreez Instruments Co., Ltd., Beijing, China). A 14% percentage yield of dried extract was obtained, labelled as SNE and kept in a dessicator.
Qualitative phytochemistry of SNE
The extract (SNE) was screened for the presence of phytochemical constituents such as alkaloids, glycosides, tannins, sterols, flavonoids using determination protocols as previously described [
23] and reported [
13].
HPLC analysis was performed on a Perkin Elmer Flexar HPLC, fitted with a PDA detector and a manual injector. The constituents of SNE were separated on a μBondapak C18 Column (150 × 4.6 mm, 3 μm) with mobile phase 0.1% formic acid (A) and Methanol (A). Gradient elution started with 100% A for 10 min and then moved to 50% in 40 min. It was kept at 50% for another 10 min and returned to 100% in 2 min, making a total run time of 62 min. The flow rate was 1 mL/min and the sample injection was 100 uL (0.108 g in 1:4 methanol-H2O mixture). The wavelength was set at 315 nm.
Experimental animals and housing
Female Imprint Control Region (ICR) mice 6–8 weeks old(weight: 20–30 g), were obtained from and maintained at the Department of Animal Experimentation, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Legon, Accra, where most of the behavioural experiments were performed. The animals were housed in groups of five in stainless steel cages (dimensions: 34 cm × 47 cm × 18 cm) with soft wood shavings as bedding and maintained under laboratory conditions (temperature 22 ± 2 °C, relative humidity 60–70%, and 12 h light-dark cycle). Additionally, the animals were fed with normal commercial pellet diet (AGRIMAT, Kumasi), and given water ad libitum.
In other experiments conducted at the Health Science Center (HSC), Kuwait University, female Balb/c mice (20–30 g) were obtained from and maintained at the Animal Resource Center, HSC, Kuwait University, Kuwait. Similar laboratory conditions as described above were maintained for this set of animals. All experiments were performed during the day between the hours of 8:00–15:00 GMT and complied with internationally recognized and accepted guidelines for the humane handling of experimental animals as contained in those published by the Canadian Council on Animal Care, 1993.
Chemicals and reagents
The following compounds (source/manufacturer) were used in this study: Chlorpromazine hydrochloride (Renandin, France), haloperidol (STEROP, Belgium) and Apomorphine hydrochloride (Macfarlan Smith Ltd., Scotland, UK).
Primary observation test
The behavioural and neuroactive effects of SNE were initially evaluated according to standardised observation grid similar to that previously described [
24]. Briefly, groups of mice (
n = 5) were treated with SNE (30, 100, 300, 1000 or 3000 mg/kg, p.o) or vehicle (distilled water, 10 ml/kg, p.o). Observations were performed 15, 30, 60, 120 and 180 min after administration of the test substance and also 24 h later and behavioural modifications, physiologic and neurotoxic symptoms were recorded according to a standardised observation grid derived from Irwin (1968). The grid contained the following parameters: death, convulsions, tremor, Straub tail, sedation, excitation, jumping, abnormal gait (rolling, tiptoe), motor incoordination, altered muscle tone, loss of grasping, akinesia, catalepsy, loss of traction, loss of balance, fore-paw treading, writhing, piloerection, stereotypies (sniffing, chewing, head movements), head-twitches, scratching, altered respiration, aggression, altered fear, altered reactivity to touch, ptosis, exophthalmia, loss of righting reflex, loss of corneal reflex, analgesia, defecation/diarrhoea, salivation, lacrimation, and pupil diameter (myosis/mydriasis).
Assessment of novelty-induced rearing and locomotor behaviour
The novelty-induced behaviour was evaluated using an open-field observation box (dimensions: 25 cm × 25 cm × 30 cm) made of transparent Perspex and behavioural events recorded using a camcorder and tracked with Behavior Tracker® software. The base of the maze had 16 squares (6.5 cm × 6.5 cm) demarcated with a non-toxic permanent marker.
To conduct this investigation, groups of mice were treated with SNE (100, 300, 1000 mg/kg, p.o) or chlorpromazine 1 mg/kg (i.p) or vehicle (distilled water, 10 ml/kg, p.o). Thirty minutes after the treatments, the animals were placed individually into the open-field observational box and their behaviour recorded for 5 min using a camcorder (Everio™ model, GZ-MG 130 U, JVC, Tokyo, Japan) suspended above the maze with the aid of a stand. Novelty-induced rearing was counted as the number of times the mouse stood on its hind limbs with its forelimbs against the wall of the observation cage (supported rearing) or in free air (unsupported rearing). The number of rearing (both supported and unsupported) was tracked for 5 min. Also, the number of line crossing was counted as a representation of locomotor activity.
Novelty-induced stereotypy
The number and total duration of stereotypic behaviour exhibited by the mice pre-treated with SNE (10, 100 or 1000 mg/kg, p.o) or vehicle (distilled water, 10 ml/kg, p.o) over two-hour periods was assessed in an automated open-field test (VersaMax Animal Activity Monitoring System, AccuScan Instrument Inc., USA) as previously reported [
14]. This test system comprised four animal monitoring chambers (16 in × 16 in × 12 in) covered by transparent lids with perforations, an analyser and a computer. The base of each monitoring chamber was lined with vertical and horizontal laser generators and sensors. The behaviours of interest were pre-configured into the system. During the test, any behaviour exhibited by the test animals through beam interruptions were transmitted to the analyser, recorded on a computer, and the data subsequently exported to Microsoft Excel. Our experimental setup enabled the researcher to test the same animal under three different experimental conditions (primary, secondary and auxillary in succession). In the experiments, primary and secondary sessions were conducted for 60 and 120 min respectively. The test animals were made to acclimatise by undergoing a two-day procedure in the system without drug administration. On the third day, after an initial 60 min primary session, the mice were treated with SNE or distilled water (as a control) and tested for a 120 min secondary session. When the animal broke the same beam (or set of beams) repeatedly then the monitor considered the animal as exhibiting stereotypy. This typically happened during grooming, head bobbing, sniffing, gnawing, etc.
Apomorphine-induced locomotor and rearing activity
Using the experimental set-up as described in the novelty-induced locomotor and rearing activities, mice were pre-treated with SNE (100, 300 or 1000 mg/kg, p.o) or chlorpromazine (0.1, 0.3, or 1.0 mg/kg, i.p) or vehicle (distilled water, 10 ml/kg, p.o) and 30 min later, they received apomorphine (2 mg/kg, i.p) and placed in the open field test chamber. A vehicle group without apomorphine administration was also included. The events were recorded with a camcorder for 30 min and the videos tracked for the frequency of rearing and line-crossings.
Apomorphine–induced stereotypy
This procedure was performed as previously described [
25]. Briefly, mice were pre-treated with various doses of the extracts (10, 100, 1000 mg/kg, p.o), chlorpromazine (0.1, 0.3, and 1 mg/kg, i.p) or vehicle (10 ml/kg, p.o). Thirty minutes later, apomorphine (2 mg/kg, i.p) was administered to each mouse and placed into an observation cage and events recorded for 30 min. The frequency of stereotypic behaviour, mainly sniffing and gnawing, were tracked and scored. The stereotypic episodes were scored as follows: absence of stereotypy (0), sniffing (1), gnawing (2) and staying on the same spot (3). The frequency of these behaviours were measured and weighted as a product of the frequency and the behaviour score. A total of all the scores were made for each mouse and a mean of 5 min period calculated and plotted as described [
26]. An antagonism of the classic stereotypic behaviours of a low dose of apomorphine indicated neuroleptic (antipsychotic) activity.
In a separate experiment, combination of a dose of SNE lower than its anti-psychotic ED
50 dose (i.e SNE 100 mg/kg, p.o) with three doses of chlorpromazine (0.1, 0.3 and 1.0 mg/kg, i.p) were evaluated using the fixed ratio method [
27] for synergism, addition or antagonism. The effect of the combinations of SNE and chlorpromazine was assessed for antipsychotic effects using the apomorphine-induced stereotypy test as described above.
Apomorphine-induced cage climbing
This method as described previously [
28] was employed with minor modifications. Briefly, mice were treated with SNE (100, 300, 1000 mg/kg, p.o), haloperidol (0.1, 0.3, 1 mg/kg, i.p) or vehicle (distilled water, 10 ml/kg, p.o) and injected with apomorphine (2 mg/kg, i.p) 30 min later and immediately placed individually into an all wire-meshed cage (mesh size: 1 cm × 1 cm; dimensions = 27 cm × 20 cm × 20 cm). A camcorder placed above the cage was used to record animal behaviour in the cage for 30 min post-apomorphine injection and the video recording tracked the frequency and duration of climbing. In a preliminary study done in our laboratory, haloperidol was found to be more potent than chlorpromazine in reducing the frequency and duration of cage climbing, thus in this assay haloperidol was used as the reference antipsychotic drug.
In a separate experiment using the above experimental protocol, a combination of low dose SNE (100 mg/kg, p.o) and three doses of haloperidol (0.1, 0.3 and 1.0 mg/kg, i.p) were evaluated for synergism, addition or antagonism using the fixed ratio method [
27].
The ability of SNE to induce catalepsy in mice was evaluated as previously described [
29,
30]. Briefly, mice treated with the SNE (100, 300, 1000 mg/kg, p.o), haloperidol (0.1, 0.3 1.0 mg/kg, i.p) or vehicle were tested individually on the catalepsy set-up made of a Perspex rod elevated over a height of 3.5 cm. 30 min posttreatment, the mice were placed individually on the rod with their fore-paws and time spent by each mouse in that position recorded until the animal removed its fore-paws from the rod unto the floor or climbed the rod, indicating the end of catalepsy. This procedure was repeated at 30, 60 and 120 min post-treatment.
Haloperidol-induced catalepsy
The effect of SNE on haloperidol-induced catalepsy was performed as previously described with a slight modification [
30,
31]. In brief, mice were pre-treated with SNE (100, 300 or 1000 mg/kg, p.o) or vehicle (distilled water, 0.01 ml/kg, p.o) and 30 min later each mouse was treated with haloperidol 1 mg/kg (i.p) and tested for catalepsy as described above.
Statistical analysis
The ED
50 (concentration responsible for 50% of the maximal effect) of extract/reference drug was determined using an iterative computer least squares method in Prism for Windows version 5.0 (GraphPad Software, San Diego, CA, USA) with the following nonlinear regression (four-parameter logistic equation).
$$ Y=\frac{a+\left(a-b\right)}{1+{10}^{\left(\left( Log\;{ED}_{50}-X\right)\times Hill\kern0.5em Slope\right)\Big)}} $$
Where, X is the logarithm of concentration. Y is the response, starting at a and ending at point b with a sigmoid shape.
The fitted midpoints (ED50s) of the curves were compared statistically using the F test.
Statistical analyses (one- or two-way ANOVA followed by an appropriate post hoc test) were conducted using Prism 5.0, with P ≤ 0.05 considered statistically significant. Graphs were plotted using Sigma Plot for Windows version 11.0 (Systat Software Inc., Germany).
Discussion
The findings reported in this study provide initial evidence demonstrating that SNE has antipsychotic potential when tested in murine models of schizophrenia. SNE also potentiated the antipsychotic activities of reference antipsychotic drugs; haloperidol and chlorpromazine, suggesting it may enhance the actions of current antipsychotic agents when used in combination. On the other hand, such combinations may also exacerbate the side/adverse effects associated with the use of these agents.
The Irwin test primarily evaluates the qualitative effects of a test substance on the behaviour and physiological functions of experimental animals, ranging from the first doses that have observable effects up to doses that induce clear behavioural toxicity or even death [
24]. The test also permits a reasonable estimate of the test substance’s duration of action on the different outcome parameters [
32]. In this study, the extract induced defaecation and fore-paw treading at doses 30–3000 mg/kg suggesting cholinergic and serotonergic mechanisms, respectively [
33,
34]. The sedation observed at a high dose of 3000 mg/kg also suggests GABAergic or serotonergic mechanisms [
35]. Earlier reports of the neuropharmacological properties of the extract confirmed the sedative effect observed here [
14].
Rearing behaviour in mice is regulated by multiple neurotransmitter systems including GABAergic (GABA
A), opioidergic and dopaminergic (D
2) systems and receptors [
36]. Locomotor activity in experimental animals are generally reduced by central nervous system (CNS) depressants and increased by CNS stimulants [
37,
38]. Drug-induced decrease in locomotion of experimental animals may be due to decreased motor effects and/or increased sedation [
8]. We are not certain which of these two possibilities account for SNE’s effect.
Stereotypy behaviour is one of the key features of psychosis and in humans, it manifests as repetitive performance of strange gestures such as asking the same questions or making the same kind of comments [
8]. The ability of SNE to reduce stereotypy count and duration is the first indication of its possible antipsychotic potential.
Apomorphine, a non-selective dopamine receptor agonist, induces changes in animal behaviour and is a test model that provides predictive validity for antipsychotic drug screening [
39‐
42]. Administration of apomorphine in mice can produce increased locomotor activity [
43], stereotyped behaviours [
44], rearing/grooming [
45] and cage-climbing behaviours [
46,
47]. In the present study, apomorphine was used as the agent for inducing psychotic/schizophrenic-like behaviours in mice. Psychosis has been linked with increased dopaminergic and serotonergic neurotransmissions, and both preclinical and clinical investigations have confirmed their role in the development of the disease [
7,
48]. Apomorphine directly activates post-synaptic dopamine D
2 receptors in the brain, and by this mechanism low dose of apomorphine (2 mg/kg, s.c) increases locomotor activity and produce stereotypy behaviour, resulting in restricted and persevering behavioural pattern [
49]. SNE blunted or reduced the apomorphine-induced rearing, locomotion, stereotypy and cage climbing suggesting that it may have antipsychotic/antischizophrenic activity. Since apomorphine acts by activating dopamine receptors, it is plausible that SNE works as a dopamine receptor antagonist. However, this hypothesis would need to be tested using appropriate models e.g. receptor-binding assays.
The catalepsy test has been used to predict major tranquillizer activity as well as to evaluate motor effects of drugs, particularly related to the extra-pyramidal system [
29]. Catalepsy is one of the major adverse effects associated with the use of conventional antipsychotic drugs [
50]. Thus, testing for cataleptic behaviour forms an integral part of the discovery and development of antipsychotic drugs. The apparent lack of cataleptic effect of SNE at 100 mg/kg in both naïve and haloperidol-treated mice suggests that the extract at lower doses may not produce any significant motor side-effects. This dose was also able to reduce haloperidol-induced catalepsy. The significant appearance of cataleptic event in naïve mice at 60 min post-SNE 300 mg/kg administration and its significant increase in haloperidol-induced catalepsy also at the 60th min may suggest that motor side effects are likely to develop with higher doses of the extract [
31]. Serotonergic, cholinergic and dopaminergic (D
2 receptor antagonism in the nigrostriatal dopaminergic pathway) systems have been implicated as mechanisms in drug-induced catalepsy or drug-enhanced haloperidol-induced catalepsy [
51‐
54]. SNE’s ability to cause catalepsy does not place it in the “typical” antipsychotic category since this major side effect is shared by both “typical” and most “atypical” antipsychotic agents such as risperidone, aripiprazole, olanzapine, amisulpride, ziprasidone and sertindole [
55‐
59]. Several clinical studies have actually indicated a less significant difference between first generation/typical and second generation/atypical antipsychotic drugs in the incidences of extrapyramidal side effects (EPS). Thus, the use of whether an antipsychotic agent induces EPS or not as the basis of classification needs re-examination [
60‐
64]. Since the effects demonstrated here are from an extract, future isolation of active constituents of this extract responsible for the cataleptic activity would provide a much clearer understanding of SNE’s mechanism of action to produce catalepsy, and hence its classification as either “typical” or “atypical”. The fact that the cataleptic effect of SNE is dose-dependent and hence absent at a low dose of 100 mg/kg of the extract is also worth mentioning.
The combination of CPZ and SNE showed potentiation of CPZ’s antipsychotic-like activities in the tested models as the ED50 value of CPZ alone was significantly higher than the CPZ–SNE combination. Thus, SNE can potentially be used by patients on CPZ enabling a reduction in CPZ dose. Furthermore, SNE had a similar effect on the ED50 of HAL when combined with it. This also suggests SNE’s effects are not specific to the agent but possibly on the underlying pathophysiology, again suggesting that the extract may be used to reduce the requirement of these clinically established antipsychotic drugs in clinical settings. However, since SNE causes catalepsy (at high doses) just as much as HAL and CPZ, the doses of these orthodox drugs must be reduced if combined with SNE to prevent exaggerated extrapyramidal motor side effects while possibly enhancing the therapeutic outcome. Further clinical studies are required to determine if such combination produce a superior clinical outcomes (e.g. better control of symptoms or less side effects) than conventional therapies alone.
Acknowledgements
The authors acknowledge the support provided by Michael K. Clottey in the apomorphine-induced cage climbing experiments. We are also grateful to Juliet Hammond, Emmanuel Agyei-Yeboah, Mark Tetteh-Tsifoanya, Bernard Abeiku Sam, Constance Agbemelo-Tsomafo, Shirley Nyarko Adu-Poku and other technical staff at the Animal Experimentation unit of the NMIMR, Accra, Ghana and the technical staff of the Animal Resource Center, Health Sciences Center, Kuwait University Kuwait, for their immense contributions during the experiments conducted there.