Depression is an affective disorder characterized by low mood and loss of interest. With the continuous development and progress of society, social stress is gradually increasing, and the prevalence of depression is increasing year by year, which has become a serious social public health problem[1]. According to a recent study published in Lancet Psychiatry, the lifetime prevalence of depression in China is 6.8%, of which major depressive disorder (MDD) is 3.4%[2]. For a long time, the monoamine transmitter hypothesis has played a dominant role in the study of the pathogenesis of depression. At present, the mechanism of commonly used antidepressants in the clinic is mainly based on the monoamine transmitter hypothesis. However, this approach has shown multiple problems, such as large individual differences in curative effect, low effective rate, high incidence of side effects, delayed drug effect, and low patient compliance rate, serious withdrawal symptoms[3, 4]. In view of the many problems of clinically available antidepressants, it is assumed that in addition to changes in the monoamine transmitter system, there are other dysfunctions in depression. Indeed, the pathogenesis of depression is complex and diverse, and has not been precisely clarified, thus it is urgent to unravel the pathogenesis of depression anew and find potential therapeutic targets.
Neuronal synapses are mainly composed of presynaptic structures, synaptic gaps, and postsynaptic structures. It is the structural basis of information transmission between neurons and is a key part of neuroplasticity regulation. Functional brain imaging studies[5] reported that synaptic connections in the hippocampus, prefrontal cortex, and amygdala in patients with depression were significantly reduced, suggesting that neuronal synapses may have been lost in depressed patients. In addition, an autopsy report[6] indicated that synaptic structures and function-related genes in the hippocampus of depressed patients were significantly reduced, including synaptosomal-associated protein 25 (SNAP25) and glutamate receptors. Another autopsy report[7] stated that post-synaptic density-95 (PSD-95) and γ-aminobutyric acid receptors in the prefrontal cortex of patients with depression were also significantly reduced. Both autopsy reports suggest that there is indeed a loss of synapses in the brains of patients with depression. Researchers have also observed similar experimental results in animal models of depression, where the expressions of PSD-95, Synaptophysin, and growth-associated protein 43 in the hippocampus and prefrontal cortex of depressed rats induced by mother-infant separation were significantly reduced[8]. Our group[9] also found that the dendritic spine density in the hippocampus of depressed mice, induced by chronic unpredictable mild stress, (CUMS) was significantly reduced. In addition, some drugs, such as Liraglutide[10], Calpeptin[11], and Panaxynol[12] are able to upregulate the expression of synaptophysin, PSD-95, and synapsin I in the hippocampus, or enhance the hippocampal nerve metasynaptic plasticity and long-term potentiation (LTP) to alleviate depressive behaviors of model animals. These results suggest that reversing the loss of synapses can improve depressive behaviors of model animals. In view of this, it is necessary to explore the mechanism of synapse loss, which may provide a new strategy for the treatment of depression.
Shiosaka et al. proposed the concept of "synaptic microenvironment"[13]. Synaptic microenvironment refers to the synapses of neurons and their internal and external environments, including microglia, astrocytes, oligodendrocytes, vascular endothelial cells, extracellular matrix, and cytokines. The synaptic microenvironment has an important influence on the structure and function of synapses. Therefore, paying attention to the changes of various cells or factors in the synaptic microenvironment can provide new ideas for exploring the mechanism of synaptic loss in depression. Microglia are innate immune cells in the central nervous system, accounting for about 10–12% of adult brain cells, and are one of the important components of the synaptic microenvironment. Under normal circumstances, the main role of microglia is to remove pathogens and phagocyte debris. In addition, microglia also monitor and trim the synapses through phagocytosis to promote the maturation and maintain the function of the synapses[14]. In 2011, Paolicelli RC et al.[15] described in their Science article the finding, that normal mouse microglia contained synaptic fragments. These fragments were synapse-related molecules, including the presynaptic protein SNAP25 and the postsynaptic protein PSD-95, which confirmed the phagocytosis of synapses by glial cells. It is thus rendered obvious, that the loss of neuronal synapses is closely related to the phagocytosis of microglia.
One positron emission tomography (PET) study[16] reported that translocator protein (TSPO), a marker of microglia was significantly upregulated in the hippocampus, frontal cortex, and temporal cortex of patients with depression, suggesting that microglial activation may be involved in the pathogenesis of depression. In addition, Du Preez A et al. [17] found that microglia in the hippocampal dentate gyrus of CUMS depression mice were significantly activated. Our group performed PET imaging and immunohistochemical studies[18], and found that TSPO in the hippocampus of depressed rats was significantly upregulated, and the density of microglia increased significantly. Thus, we asked if under pathological conditions, in addition to participating in neuroinflammation, activated microglia can abnormally engulf neuronal synapses.
We speculated that the loss of synapses in the hippocampus of patients with depression may also be caused by the abnormal phagocytosis of activated microglia. In order to verify this conjecture, we conducted two experiments: (1) As shown in Figure 1A, we investigated the effect of chronic social defeat stress (CSDS) on behaviors, synapses, microglia, and phagocytosis of synapses by microglia in mice; (2) As shown in Figure 4A, to confirm the role of microglia in depression, we investigated the effect of minocycline (a microglial activation inhibitor) on behaviors and phagocytosis of synapses in stressed mice. Our work thus aims to explicate the role of microglia phagocytosis of synapses in the pathogenesis of depression for the first time, in order to provide new insights into the pathogenesis of depression and its treatment.