Single-Prolonged Stress Induces Endoplasmic Reticulum - Dependent Apoptosis in the Hippocampus in a Rat Model of Post-Traumatic Stress Disorder

Background

Our previous research indicated that apoptosis induced atrophy in the hippocampus of post-traumatic stress disorder (PTSD) rats. Endoplasmic reticulum (ER) stress-induced apoptosis has been implicated in the development of several disorder diseases. The aim of this study was to investigate whether endoplasmic reticulum-related pathway is involved in single-prolonged stress (SPS) induces apoptosis in the hippocampus of PTSD rats by examining the expression levels of three important indicators in the ER-related apoptotic pathway: Glucose-regulated protein (GRP) 78, caspase-12 and Ca²⁺/CaM/CaMkinaseIIα (CaMkIIα).

Methods

Wistar rats were sacrificed at 1, 4 and 7 days after SPS. SPS is a reliable animal model of PTSD. The apoptotic cells in the hippocampus were assessed by TUNEL method and transmission electron microscopy (TEM). Free intracellular Ca²⁺ concentration was measured. GRP78 expression was examined by immunohistochemistry, western blotting and RT-PCR. mRNA of caspase-12 and CaM/CaMkIIα were determined by RT-PCR.

Results

Our results showed that apoptotic cells were increased in the SPS rats. TEM analysis revealed characteristic morphological changes of apoptosis in these cells. We observed that GRP78 was significantly up-regulated during early PTSD, and then recovered at 7 days after SPS. By RT-PCR, we observed that the change in caspase-12 expression level was similar to that in GRP78. Moreover, the free intracellular Ca²⁺ concentration was significantly higher at 1 day after SPS and decreased in 7 days. CaM expression increased significantly, while CaMKIIα expression decreased significantly in the hippocampus at 1 day after SPS.

Conclusion

SPS induced change in the expression levels of GRP78, caspase-12 and Ca²⁺/CaM/CaMkIIα in the hippocampus of PTSD rats indicated that the endoplasmic reticulum pathway may be involved in PTSD-induced apoptosis.     

PTSD样情感行为异常大鼠杏仁核Caspase 9的改变

目的观察创伤后应激障碍(PTSD)样行为异常大鼠杏仁核神经元Caspase 9表达变化,有望揭示PTSD的部分发病机制。方法采用国际认定的SPS方法刺激建立大鼠PTSD模型,取成年健康雄性Wistar大鼠60只,随机分为SPS模型的1d、4d、7d组及正常对照组,采用免疫荧光法、免疫印迹和逆转录-聚合酶链式反应检测大鼠杏仁核Caspase 9的表达变化。结果SPS刺激后大鼠杏仁核神经元细胞内Caspase 9于1d开始逐渐升高,7d时表达最多;Caspase 9 mRNA的变化与之相一致。结论海马Caspase 9的表达变化,可能是PTSD大鼠情感行为异常的重要病理生理基础之一。     

What Happened in the Hippocampal Axon in a Rat Model of Posttraumatic Stress Disorder

Studies from postmortem and animal models have revealed altered synapse morphology and function in the brain of posttraumatic stress disorder (PTSD). And the effects of PTSD on dendrites and spines have been reported, however, the effection on axon include microtubule (MT) and synaptic vesicles of presynaptic elements remains unknown. Hippocampus is involved in abnormal memory in PTSD. In the present study, we used the single prolonged stress (SPS) model to mimic PTSD. Quantitative real-time polymerase chain reaction (RT-qPCR) and high-throughput sequencing (GSE153081) were utilized to analyze differentially expressed genes (DEGs) in the hippocampus of control and SPS rats. Immunofluorescence and western blotting were performed to examine change in axon-related proteins. Synaptic function was evaluated by measuring miniature excitatory postsynaptic currents (mEPSCs). RNA-sequencing analysis revealed 230 significantly DEGs between the control and SPS groups. Gene Ontology analysis revealed upregulation in axonemal assembly, MT formation, or movement, but downregulation in axon initial segment and synaptic vesicles fusion in the hippocampus of SPS rats. Increased expression in tau, β-tubulin MAP1B, KIF9, CCDC40, DNAH12 and decreased expression in p-tau, stathmin suggested SPS induced axon extension. Increased protein expression in VAMP, STX1A, Munc18-1 and decreased expression in synaptotagmin-1 suggested SPS induced more SNARE complex formation but decreased ability in synaptic vesicle fusion to presynaptic active zone membrane in the hippocampus of SPS rats. Further, low mEPSC frequency in SPS rats indicated dysfunction in presynaptic membrane. These results suggest that axon extension and synaptic vesicles fusion abnormality are involved in dysfunction of PTSD.

     

分子伴侣GRP94在创伤后应激障碍大鼠前额内侧皮质表达变化及其意义

目的检测创伤后应激障碍（Post-traumatic stressdisorder,PTSD）连续单一刺激（single prolonged stress,SPS）模型大鼠前额内侧皮质（medial prefrontal cortex,mPFC）分子伴侣葡萄糖调节蛋白94（Glucose-regulated protein,GRP94）的表达变化,探讨PTSD发病机制过程中存在未折叠蛋白反应（unfolded protein reaction,UPR）的激活及GRP94在UPR中的作用机制及意义。方法健康,雄性,成年Wistar大鼠60只,建立国际认定的PTSD-SPS模型,随机分为正常对照组和模型组,模型组大鼠分别于1d、4d、7d取材。应用免疫组化、蛋白印迹和RT-PCR方法检测PTSD大鼠mPFC神经元GRP94表达变化。结果免疫组化、蛋白印迹和RT-PCR方法均显示,给予SPS刺激后大鼠GRP94的蛋白表达及GRP94mRNA表达均高于正常组（P〈O．05）,7d达到顶峰。结论分子伴侣GRP94表达发生变化,提示SPS刺激后大鼠mPFC神经元出现未折叠蛋白反应的激活,PTSD的发生过程中GRP94参与了未折叠蛋白反应,对揭示PTSD致脑损伤的发病机制具有重要意义。     

PTSD样行为异常大鼠杏仁核Ca^2＋/CaM的改变

目的观察创伤后应激障碍（PTSD）样行为异常大鼠杏仁核细胞内Ca^2＋信号及Ca M（钙调蛋白）表达变化,有望揭示PTSD的部分发病机制。方法成年健康雄性Wistar大鼠60只,随机分为连续单一刺激（single prolonged stress,SPS）模型的12h、1d、4d、7d、14d组及正常对照组,采用荧光探针标记法、免疫组化、Western blott等方法,检测PTSD样行为异常大鼠杏仁核神经元游离Ca^2＋含量和钙调蛋白（Ca M）的表达变化。结果SPS刺激后大鼠杏仁核神经元游离Ca^2＋浓度（nmol/L）于12h内升高,24h增至顶峰,4d开始下降,14d恢复正常。CaM的表达于SPS刺激后4d表达最多,之后渐趋下降。结论杏仁核Ca^2＋信号调控与Ca M表达变化,可能与PTSD样大鼠恐惧增强的发病机制相关。     

Exacerbated Headache-Related Pain in the Single Prolonged Stress Preclinical Model of Post-traumatic Stress Disorder

Chronic headache pain is one of the most commonly reported comorbid pain conditions with post-traumatic stress disorder (PTSD) patients and resistant to effective treatment, yet no combined preclinical model of the two disorders has been reported. Here, we used a modified chronic headache pain model to investigate the contribution of single prolonged stress (SPS) model of PTSD with sodium nitroprusside (SNP)-induced hyperalgesia. Injection of SNP (2 mg/kg, i.p.) occurred every other day from day 7 to day 15 after initiation of SPS in rats. Paw withdrawal threshold (PWT) to von Frey stimuli and tail flick latencies (TFL) dramatically decreased as early as 7 days after SPS and lasted until at least day 21. Basal PWT and TFL also significantly decreased during the SNP treatment period. The lower nociceptive thresholds recovered in 6 days following the final SNP injection in SNP group, but not in SPS?+?SNP group. Elevated nociceptin/OFQ (N/OFQ) levels observed in cerebrospinal fluid of SPS rats were even higher in SPS?+?SNP group. Glial fibrillary acidic protein (GFAP) and N/OFQ peptide (NOP) receptor mRNA expression increased in dorsal root ganglia (DRG) 21 days after SPS exposure; mRNA increases in the SPS/SNP group was more pronounced than SPS or SNP alone. GFAP protein expression was upregulated in trigeminal ganglia by SPS. Our results indicate that traumatic stress exaggerated chronic SNP-induced nociceptive hypersensitivity, and that N/OFQ and activated satellite glia cells may play an important role in the interaction between both conditions.

     

大鼠PTSD后蓝斑核 β-catenin的表达下降伴随细胞凋亡

目的 探讨创伤后应激障碍( PTSD) 大鼠蓝斑神经元β-catenin(β-连环蛋白)的表达变化.方法 采用国际认定的SPS方法刺激建立大鼠PTSD模型,取成年健康雄性Wistar 大鼠100 只,随机分为连续单一刺激( single prolonged stress,SPS) 模型1 d、4 d、7 d、14 d 组和对照组,应用免疫组化、免疫印迹方法检测PTSD 大鼠蓝斑神经元β-catenin的表达变化;透射电镜观察PTSD大鼠蓝斑神经元的超微结构变化.结果 经SPS 刺激后大鼠蓝斑神经元细胞内β-catenin于1d开始逐渐减少,14d表达最少;蓝斑神经元出现细胞凋亡改变.结论 蓝斑神经元细胞凋亡可能是导致PTSD 患者蓝斑功能失调的重要原因之一.     

PTSD与杏仁核神经元细胞凋亡的关系

目的观察创伤后应激障碍（PTSD）大鼠杏仁核神经元细胞凋亡相关基因的表达与细胞凋亡的发生,从杏仁核神经元细胞凋亡揭示PTSD的部分发病机制。方法成年健康雄性Wister大鼠50只,随机分为连续单一刺激（single prolonged stress,SPS）模型的1d、4d、7d、14d组及正常对照组。应用免疫组化和Western Blotting技术检测凋亡相关基因Bax、Bcl-2在PTSD杏仁核神经元的表达;采用TUNEL法检测PTSD大鼠杏仁核神经元细胞凋亡。结果PTSD大鼠杏仁核神经元凋亡相关基因Bax于4d达高峰,Bcl-2于1d表达最高,Bax／Bcl-2比值逐渐升高,于4d达到峰值,之后渐趋下降。TUNEL阳性细胞在SPS各组模型均出现,4d达最高峰。结论PTSD大鼠杏仁核神经元细胞凋亡中,凋亡相关基因Bax、Bcl-2各自发挥促进凋亡和抑制凋亡的作用,Bax／Bcl-2比值升高促进细胞发生凋亡,可能与杏仁核调节的PTSD恐惧异常的发病机制相关。     

创伤后应激障碍大鼠蓝斑核神经元细胞凋亡的实验研究

目的探讨创伤后应激障碍(PTSD)大鼠蓝斑核神经元Caspase-3和Caspase-9的表达变化。方法成年健康雄性Wistar大鼠50只,随机分为连续单一刺激(single prolonged stress,SPS)模型1d、4d、7d、14d组和对照组,应用免疫组化、免疫荧光和RT-PCR方法检测PTSD大鼠蓝斑核神经元Caspase-3和Caspase-9的表达变化。结果SPS刺激后1d,4d,Caspase-9的表达逐渐增强,7d和14d逐渐下降,Caspase-3于SPS刺激后7d表达最多,14d出现下降。结论蓝斑神经元细胞凋亡可能是导致PTSD患者蓝斑功能失调的重要原因之一。     

葡萄糖调节蛋白78在PTSD样情感行为异常大鼠大脑皮质中的表达及意义

目的观察创伤后应激障碍(PTSD)大鼠大脑皮质内质网应激标志物葡萄糖调节蛋白78(GRP78)的表达变化,探讨内质网分子伴侣在PTSD发病机制中的作用。方法采用国际认定的SPS方法刺激建立大鼠PTSD模型,取成年健康雄性Wistar大鼠60只,随机分为SPS模型的1d、4d、7d组及正常对照组,采用免疫荧光法、免疫印迹和逆转录--聚合酶链式反应检测大鼠前额皮质GRP 78的表达变化。结果 SPS刺激后大鼠前额皮质神经元细胞内GRP78于1d开始逐渐升高,7d时表达最多;GRP 78mRNA的变化与之相一致。结论大脑皮质GRP 78的表达变化,可能是PTSD大鼠情感行为异常的重要病理生理基础之一。     

PTSD大鼠中缝背核神经元TMP酶表达变化的实验研究

目的研究创伤后应激障碍大鼠中缝背核神经元细胞TMP(三偏磷酸酶)活性分布及其表达变化。方法采用SPS刺激方法,建立PTSD样大鼠SPS模型,随机分为SPS刺激后1d、7d、14d和正常对照组,应用光、电镜酶组化技术方法,分别对各组中缝背核神经元细胞TMP活性分布及其变化进行观察和定量检测。结果光镜下TMP酶反应阳性产物为棕褐色颗粒分布于细胞质中;电镜下TMP酶反应阳性产物为高电子密度的黑色颗粒沉淀,分布于各组中缝背核神经元细胞内溶酶体上。SPS刺激后1d、7d、14d中缝背核神经元TMP活性表达比正常对照组明显增强,并于7d达到高峰。结论创伤后应激障碍大鼠中缝背核神经元细胞TMP活性增强,提示TMP参与了中缝背核神经元细胞凋亡产物的降解和处理过程。     

Inflammation and Oxidative Stress Are Elevated in the Brain,Blood, and Adrenal Glands during the Progression of Post-Traumatic Stress Disorder in a Predator Exposure Animal Model

This study sought to analyze specific pathophysiological mechanisms involved in the progression of post-traumatic stress disorder (PTSD) by utilizing an animal model. To examine PTSD pathophysiology, we measured damaging reactive oxygen species and inflammatory cytokines to determine if oxidative stress and inflammation in the brain, adrenal glands, and systemic circulation were upregulated in response to constant stress. Pre-clinical PTSD was induced in naïve, male Sprague-Dawley rats via a predator exposure/psychosocial stress regimen. PTSD group rats were secured in Plexiglas cylinders and placed in a cage with a cat for one hour on days 1 and 11 of a 31-day stress regimen. In addition, PTSD group rats were subjected to psychosocial stress whereby their cage cohort was changed daily. This model has been shown to cause heightened anxiety, exaggerated startle response, impaired cognition, and increased cardiovascular reactivity, all of which are common symptoms seen in humans with PTSD. At the conclusion of the predator exposure/psychosocial stress regimen, the rats were euthanized and their brains were dissected to remove the hippocampus, amygdala, and pre-frontal cortex (PFC), the three areas commonly associated with PTSD development. The adrenal glands and whole blood were also collected to assess systemic oxidative stress. Analysis of the whole blood, adrenal glands, and brain regions revealed oxidative stress increased during PTSD progression. In addition, examination of pro-inflammatory cytokine (PIC) mRNA and protein demonstrated neurological inflammatory molecules were significantly upregulated in the PTSD group vs. controls. These results indicate oxidative stress and inflammation in the brain, adrenal glands, and systemic circulation may play a critical role in the development and further exacerbation of PTSD. Thus, PTSD may not be solely a neurological pathology but may progress as a systemic condition involving multiple organ systems.     

The polymethoxylated flavone,Tangeretin improves cognitive memory in rats experiencing a single episode of prolonged post-traumatic stress

Post-traumatic stress disorder (PTSD) is a stress-related psychiatric/mental condition. Tangeretin (TAN), a major polymethoxylated flavone of citrus plants, exhibits anti-inflammatory and neuroprotective activities. However, whether TAN leads to cognitive improvement in PTSD patients remains unclear. In the present study, we explored whether TAN improved cognitive impairment induced in rats by single prolonged stress (SPS episode mimicking PTSD induction) and determined whether TAN reversed reductions in dopamine (DA) and serotonin (5-HT) levels. Rats were intraperitoneally injected with TAN for 14 consecutive days after the SPS, which had induced cognitive deficits evident in the object recognition task and the Morris water maze test; the impairments were improved by TAN (100?mg/kg). TAN rescued the neurochemical abnormalities and the SPS-induced decreases in DA and 5-HT levels in the hippocampus and amygdala. These effects may be attributable in part to induction of hippocampal genes encoding tyrosine hydroxylase and tryptophan hydroxylase-1. Our results support the idea that rats with PTSD exhibit changes in DAergic and serotonergic transmission and in memory impairment. Thus, TAN mediated reversal of memory-related behavioral dysfunction associated with traumatic stress may be a useful therapeutic intervention in PTSD patients.     

Midazolam Ameliorates the Behavior Deficits of a Rat Posttraumatic Stress Disorder Model through Dual 18 kDa Translocator Protein and Central Benzodiazepine Receptor and Neurosteroidogenesis

Post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that may develop after an individual has experienced or witnessed a severe traumatic event. It has been shown that the 18 kDa translocator protein (TSPO) may be correlated with PTSD and that the TSPO ligand improved the behavioral deficits in a mouse model of PTSD. Midazolam, a ligand for TSPO and central benzodiazepine receptor (CBR), induces anxiolytic- and anti-depressant-like effects in animal models. The present study aimed to determine whether midazolam ameliorates PTSD behavior in rats as assessed by the single prolonged stress (SPS) model. The SPS rats received daily Sertraline (Ser) (15 mg/kg, p.o.) and midazolam (0.125, 0.25, 0.5, and 1 mg/kg, p.o.) during the exposure to SPS and behavioral assessments, which included the open field (OF) test, the contextual fear paradigm (CFP), and the elevated plus-maze (EPM). The results showed that, like Ser (15 mg/kg, p.o.), midazolam (0.25 and 0.5 mg/kg, p.o.) significantly reversed the behavioral deficiencies of the SPS rats, including PTSD-associated freezing and anxiety-like behavior but not the effects on spontaneous locomotor activity. In addition, the anti-PTSD effects of midazolam (0.5 mg/kg, p.o.) were antagonized by the TSPO antagonist PK11195 (3 mg/kg, i.p.), the CBR antagonist flumazenil (15 mg/kg, p.o.) and the inhibitor of steroidogenic enzymes finasteride (30 mg/kg, p.o.), which by themselves had no effect on PTSD-associated freezing and anxiety-like behavior. In summary, this study demonstrated that midazolam improves the behavioral deficits in the SPS model through dual TSPO and CBR and neurosteroidogenesis.     

Experimental Post-traumatic Stress Disorder Decreases Astrocyte Density and Changes Astrocytic Polarity in the CA1 Hippocampus of Male Rats

Post-traumatic stress disorder (PTSD) is a psychiatric condition resulting from exposure to a traumatic event. It is characterized by several debilitating symptoms including re-experiencing the past trauma, avoidance behavior, increased fear, and hyperarousal. Key roles in the neuropathology of PTSD and its symptomatology have been attributed to the hippocampus and amygdala. These regions are involved in explicit memory processes and context encoding during fear conditioning. The aim of our study was to investigate whether PTSD is capable of altering the morphology, density and expression of glial fibrillary acidic protein (GFAP) in astrocytes from the CA1 region of the hippocampus and the medial amygdala and correlate the data obtained with the orientation index of the polarity of astrocytes. Thirty male rats were divided in two groups: control (n = 15) and PTSD (n = 15). The inescapable shock protocol, in which the animals are exposed to a single episode of footshock, was used to induce PTSD. Our results show that, in the hippocampus, PTSD is capable of decreasing the density of GFAP+ astrocytes as well as altering astrocytic morphology, as shown by the reductions observed in the total number of primary processes, in the number of primary processes in the lateral quadrants, and the degree of branching in the lateral quadrants. The analysis of the orientation index indicates that PTSD alters the polarity of hippocampal astrocytes. No alterations were observed in the amygdala astrocytes. Therefore, this study demonstrates notable changes in hippocampal astrocytes, supporting the concept that these cells play an important role in PTSD symptomatology.

     

PTSD样大鼠海马神经元凋亡及其ACP变化的研究

目的研究PTSD（posttraumatic stress disorder创伤后应激障碍）样大鼠海马神经元凋亡及ACP（Acid phosphatase酸性磷酸酶）的变化。方法建立大鼠PTSD模型-SPS（single-prolonged stress）,于模型建立后的6h、12h、1d、7d、14d取材;同时取材正常组作为对照,应用Annexin V-F1TC／PI双标记流式细胞术、透射电镜、酶组化方法分别进行各组海马神经元凋亡及ACP表达变化的观察及定量检测。结果模型建立后的6h、12h海马神经元的凋亡细胞增加、ACP活性增强,1d时凋亡细胞增加更为明显、ACP活性更为显著,7d、14d时凋亡细胞逐渐减少、ACP活性减弱。结论PTSD样大鼠海马神经元出现凋亡,凋亡增加的同时ACP酶活性增强,说明ACP酶参与PTSD大鼠海马神经元的凋亡。     

PTSD样大鼠蓝斑核盐皮质激素受体表达变化的研究

目的探讨PTSD样大鼠蓝斑（locus ceruleus,LC）神经元盐皮质激素受体（mineralocorticoid receptors,MR）表达的变化。方法使用连续单一应激（SPS）方法建立PTSD大鼠模型,随机分为SPS处理后24h、4d、7d、14d和28d组,非SPS刺激大鼠作为对照,应用免疫组化、免疫印迹方法分别进行各组蓝斑神经元MR表达变化的观察及检测,进行图像分析和统计学处理。结果蓝斑神经元MR的表达呈现24h急剧下调,4d、7d,14d和28d恢复性上调。结论PTSD样大鼠蓝斑神经元MR的表达变化可能直接参与了PTSD持续性精神行为障碍的发生发展过程。     

Glutamine Treatment Attenuates Endoplasmic Reticulum Stress and Apoptosis in TNBS-Induced Colitis

Endoplasmic reticulum (ER) stress and apoptotic cell death play an important role in the pathogenesis and perpetuation of inflammatory bowel disease (IBD). We aimed to explore the potential of glutamine to reduce ER stress and apoptosis in a rat model of experimental IBD. Colitis was induced in male Wistar rats by intracolonic administration of 30 mg of 2,4,6-trinitrobenzene sulfonic acid (TNBS). Glutamine (25 mg/dL) was given by rectal route daily for 2 d or 7 d. Both oxidative stress (TBARS concentration and oxidised/reduced glutathione ratio) and ER stress markers (CHOP, BiP, calpain-1 and caspase-12 expression) increased significantly within 48 h of TNBS instillation, and glutamine attenuated the extent of the changes. Glutamine also inhibited the significant increases of ATF6, ATF4 and spliced XBP-1 mRNA levels induced by TNBS instillation. TNBS-colitis resulted in a significant increase in p53 and cytochrome c expression, and a reduced Bcl-xL expression and Bax/Bcl-2 ratio. These effects were significantly inhibited by glutamine. Treatment with the amino acid also resulted in significant decreases of caspase-9, caspase-8 and caspase-3 activities. Double immunofluorescence staining showed co-localization of CHOP and cleaved caspase-3 in colon sections. Phospho-JNK and PARP-1 expression was also significantly higher in TNBS-treated rats, and treatment with glutamine significantly decreased JNK phosphorylation and PARP-1 proteolysis. To directly address the effect of glutamine on ER stress and apoptosis in epithelial cells, the ER stress inducers brefeldin A and tunicamycin were added to Caco-2 cells that were treated with glutamine (5 mM and 10 mM). The significant enhancement in PERK, ATF6 phosphorylated IRE1, BiP and cleaved caspase-3 expression induced by brefeldin A and tunicamycin was partly prevented by glutamine. Data obtained indicated that modulation of ER stress signalling and anti-apoptotic effects contribute to protection by glutamine against damage in TNBS-induced colitis.     

Stress Affects a Gastrin-Releasing Peptide System in the Spinal Cord That Mediates Sexual Function: Implications for Psychogenic Erectile Dysfunction

Background

Many men suffering from stress, including post-traumatic stress disorder (PTSD), report sexual dysfunction, which is traditionally treated via psychological counseling. Recently, we identified a gastrin-releasing peptide (GRP) system in the lumbar spinal cord that is a primary mediator for male reproductive functions.

Methodology/Principal Findings

To ask whether an acute severe stress could alter the male specific GRP system, we used a single-prolonged stress (SPS), a putative rat model for PTSD in the present study. Exposure of SPS to male rats decreases both the local content and axonal distribution of GRP in the lower lumbar spinal cord and results in an attenuation of penile reflexes in vivo. Remarkably, pharmacological stimulation of GRP receptors restores penile reflexes in SPS-exposed males, and induces spontaneous ejaculation in a dose-dependent manner. Furthermore, although the level of plasma testosterone is normal 7 days after SPS exposure, we found a significant decrease in the expression of androgen receptor protein in this spinal center.

Conclusions/Significance

We conclude that the spinal GRP system appears to be a stress-vulnerable center for male reproductive functions, which may provide new insight into a clinical target for the treatment of erectile dysfunction triggered by stress and psychiatric disorders.