The authors studied standard autonomic function tests and measures of heart rate variability in 60 patients with multiple sclerosis (MS) and correlated results with the Fatigue Severity Scale and the Modified Fatigue Impact Scale. The authors found that autonomic responses correlated with fatigue resembling a hypoadrenergic orthostatic response, possibly due to a sympathetic vasomotor lesion with intact vagal heart control. Treatments to control sympathetic dysfunction for MS-associated fatigue deserve further study.

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The neuropeptide corticotropin-releasing factor (CRF) plays a critical role in the proper functioning of the stress response system through its actions on its receptors, CRF receptor 1 (CRF1) and CRF receptor 2 (CRF2), located at multiple anatomical sites. Clinical data indicate that stress response dysfunctions, such as excessive CRF activity and hyperstimulation of CRF1, are present in a range of stress-related disorders, including depression and anxiety disorders. Our previous work along with that of other laboratories has demonstrated that mice deficient in CRF2 (CRF2−/−) display increased anxiety and depression-like behaviors. In this study we found CRF2−/− mice display increased hippocampal levels of activated (phosphorylated) mitogen-activated protein kinase (MAP kinase)/ERK kinase (MEK), extracellular signal-regulated kinases 1 and 2 (ERK1/2), and ribosomal protein S6 kinases 1 (RSK1). These changes can be explained by overactive hippocampal CRF1, in view of the finding that the application of the non-selective CRF receptor antagonist [Glu11,16] astressin ([Glu11,16]Ast) into the dorsal hippocampus of mutant mice returned the levels of the phosphorylated proteins to baseline. Moreover, inhibition of the hippocampal MEK/ERK pathway with the specific MEK inhibitor U0126, decreased depression-like behaviors in the forced swim test and tail suspension test of CRF2−/− mice. Similarly, treatment with [Glu11,16]Ast reversed depression phenotype of CRF2−/− mice without affecting the phenotype of wild-type littermates. Our results support an involvement of CRF receptors in the development of depression, such that elevated hippocampal CRF1 activity, in the absence of CRF2, produces a depression-dominated phenotype via activation of the MEK/ERK pathway.

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