Circadian Rhythms and Astrocytes: The Good, the Bad, and the Ugly

This review explores the interface between circadian timekeeping and the regulation of brain function by astrocytes. Although astrocytes regulate neuronal activity across many time domains, their cell-autonomous circadian clocks exert a particular role in controlling longer-term oscillations of brain function: the maintenance of sleep states and the circadian ordering of sleep and wakefulness. This is most evident in the central circadian pacemaker, the suprachiasmatic nucleus, where the molecular clock of astrocytes suffices to drive daily cycles of neuronal activity and behavior. In Alzheimer's disease, sleep impairments accompany cognitive decline. In mouse models of the disease, circadian disturbances accelerate astroglial activation and other brain pathologies, suggesting that daily functions in astrocytes protect neuronal homeostasis. In brain cancer, treatment in the morning has been associated with prolonged survival, and gliomas have daily rhythms in gene expression and drug sensitivity. Thus, circadian time is fast becoming critical to elucidating reciprocal astrocytic-neuronal interactions in health and disease.

Circadian disruption and sleep disorders in neurodegeneration

Disruptions of circadian rhythms and sleep cycles are common among neurodegenerative diseases and can occur at multiple levels. Accumulating evidence reveals a bidirectional relationship between disruptions of circadian rhythms and sleep cycles and neurodegenerative diseases. Circadian disruption and sleep disorders aggravate neurodegeneration and neurodegenerative diseases can in turn disrupt circadian rhythms and sleep. Importantly, circadian disruption and various sleep disorders can increase the risk of neurodegenerative diseases. Thus, harnessing the circadian biology findings from preclinical and translational research in neurodegenerative diseases is of importance for reducing risk of neurodegeneration and improving symptoms and quality of life of individuals with neurodegenerative disorders via approaches that normalize circadian in the context of precision medicine. In this review, we discuss the implications of circadian disruption and sleep disorders in neurodegenerative diseases by summarizing evidence from both human and animal studies, focusing on the bidirectional links of sleep and circadian rhythms with prevalent forms of neurodegeneration. These findings provide valuable insights into the pathogenesis of neurodegenerative diseases and suggest a promising role of circadian-based interventions.

Emerging roles of leptin in Parkinson's disease: Chronic inflammation, neuroprotection and more?

An increasing body of experimental evidence implicates a relationship between immunometabolic deterioration and the progression of Parkinson's disease (PD) with a dysregulation of central and peripheral neuroinflammatory networks mediated by circulating adipokines, in particular leptin. We screened the current literature on the role of adipokines in PD. Hence, we searched known databases (PubMed, MEDLINE/OVID) and reviewed original and review articles using the following terms: "leptin/ObR", "Parkinson's disease", "immune-metabolism", "biomarkers" and "neuroinflammation". Focusing on leptin, we summarize and discuss the existing in vivo and in vitro evidence on how adipokines may be protective against neurodegeneration, but at the same time contribute to the progression of PD. These components of the adipose brain axis represent a hitherto underestimated pathway to study systemic influences on dopaminergic degeneration. In addition, we give a comprehensive update on the potential of adjunctive therapeutics in PD targeting leptin, leptin-receptors, and associated pathways. Further experimental and clinical trials are needed to elucidate the mechanisms of action and the value of central and peripheral adipose-immune-metabolism molecular phenotyping in order to develop and validate the differential roles of different adipokines as potential therapeutic target for PD patients.

Sleep and circadian rhythms in Parkinson's disease and preclinical models

The use of animals as models of human physiology is, and has been for many years, an indispensable tool for understanding the mechanisms of human disease. In Parkinson's disease, various mouse models form the cornerstone of these investigations. Early models were developed to reflect the traditional histological features and motor symptoms of Parkinson's disease. However, it is important that models accurately encompass important facets of the disease to allow for comprehensive mechanistic understanding and translational significance. Circadian rhythm and sleep issues are tightly correlated to Parkinson's disease, and often arise prior to the presentation of typical motor deficits. It is essential that models used to understand Parkinson's disease reflect these dysfunctions in circadian rhythms and sleep, both to facilitate investigations into mechanistic interplay between sleep and disease, and to assist in the development of circadian rhythm-facing therapeutic treatments. This review describes the extent to which various genetically- and neurotoxically-induced murine models of Parkinson's reflect the sleep and circadian abnormalities of Parkinson's disease observed in the clinic.

[Neuroendocrine and metabolic impairments in patients with Parkinson's disease]

ABSRACT

Neuroendocrine and neurometabolic disorders, although occasionally noted in Parkinson's disease (PD), existed in the shadow of motor and non-motor symptoms (hypokinesia, rigidity, tremor, depression, constipation, etc.). In recent years, they are increasingly being diagnosed and are the subject of special research. These include, in particular, disorders of carbohydrate metabolism, changes in body weight, metabolic disorders in bone tissue, secretion, as well as the secretion of neurohormones, such as melatonin. They are associated with other non-motor symptoms, negatively affect patients' general condition and quality of life, but can be treatable. At the same time, treatment of neuroendocrine and neurometabolic disorders can favorably influence the rate of progression of the disease as a whole. This review discusses the pathophysiological mechanisms, clinical consequences, as well as pharmacological and non-pharmacological approaches to the treatment of neuroendocrine and neurometabolic disorders arising in PD, which have been relatively rarely covered in literature.

Saliva Samples as A Tool to Study the Effect of Meal Timing on Metabolic And Inflammatory Biomarkers

Meal timing affects metabolic regulation in humans. Most studies use blood samples for their investigations. Saliva, although easily available and non-invasive, seems to be rarely used for chrononutritional studies. In this pilot study, we tested if saliva samples could be used to study the effect of timing of carbohydrate and fat intake on metabolic rhythms. In this cross-over trial, 29 nonobese men were randomized to two isocaloric 4-week diets: (1) carbohydrate-rich meals until 13:30 and high-fat meals between 16:30 and 22:00 or (2) the inverse order of meals. Stimulated saliva samples were collected every 4 h for 24 h at the end of each intervention, and levels of hormones and inflammatory biomarkers were assessed in saliva and blood. Cortisol, melatonin, resistin, adiponectin, interleukin-6 and MCP-1 demonstrated distinct diurnal variations, mirroring daytime reports in blood and showing significant correlations with blood levels. The rhythm patterns were similar for both diets, indicating that timing of carbohydrate and fat intake has a minimal effect on metabolic and inflammatory biomarkers in saliva. Our study revealed that saliva is a promising tool for the non-invasive assessment of metabolic rhythms in chrononutritional studies, but standardisation of sample collection is needed in out-of-lab studies.

Chronotherapies for Parkinson's disease

Parkinson's disease (PD) is the second-most common progressive neurodegenerative disorder. Although the clinical diagnosis of PD is still based on its cardinal motor dysfunctions, several non-motor symptoms (NMS) have been established as integral part of the disease. Unlike motor disorders, development of therapies against NMS are still challenging and remain a critical unmet clinical need. During the last decade, several studies have characterised the molecular, physiological and behavioural alterations of the circadian system in PD patients. As a consequence, and given the ubiquitous nature of circadian rhythms in the entire organism, the biological clock has emerged as a potential therapeutic target to ease suffering from both motor and NMS in PD patients. Here we discuss the emerging field of using bright light, physical exercise and melatonin as chronotherapeutic tools to alleviate motor disorders, sleep/wake alterations, anxiety and depression in PD patients. We also highlight the potential of these readily available therapies to improve the general quality of life and wellbeing of PD patients. Finally, we provide specific data- and mechanisms-driven recommendations that might help improve the therapeutic benefit of light and physical exercise in PD patients.

The Relation of Circulating Levels of Leptin with Cognition in Patients with Alzheimer's Disease

INTRODUCTION

To investigate the relation of circulating levels of leptin with cognition in Alzheimer's disease (AD) patients.

METHODS

Thirty patients meeting the clinical diagnostic criteria for AD, and twenty-five healthy controls were enrolled into the study. At baseline, all patients underwent standing height, weight measurements, and waist circumference (in centimeters) using a standard scale. Body mass index (BMI) was then calculated as weight (in kilograms). A single 5-ml fasting blood sample was obtained from each patient. All subjects were evaluated by Turkish version of Mini Mental State Examination (MMSE), Clinical Dementia Rating (CDR) and Global Deterioration Scale (GDS).

RESULTS

The mean age of patients and controls were 72.33±10.11 and 67.20±8.95, respectively. There was not any significant difference between age of the patients and the controls (p=0.054). Both patient and control groups consisted of mostly women (60% and 56% respectively). The mean waist circumferences (WC) of patients and controls were 95.46±10.87 and 97.76±10.07, respectively and was not statistically different (p=0.424). The mean serum leptin levels in patients and controls were 5.49±4.06 ng/dL 5.71±4.45 ng/dL, respectively. Leptin levels were not statistically different between patients and controls (p=0.84). The mean MMSE scores of AD patients and controls were 17±6.54 and 27.32±2.15 respectively, and AD patients had significantly lower MMSE scores than the controls (p=0.000). The mean BMI of patients and controls were 25.72±3.98 and 27.92±3.08 respectively. The BMI of controls were higher than patients and there was statistically significant difference between two groups (p=0.029). In the patient group, there were no correlations between leptin levels and age (p=0.067), BMI (p=0.098), WC (p=0.113), MMSE (p=0.203), CDR (p=0.519) and GDS (p=0.587). Similarly in control group leptin levels were not correlated with BMI (p=0.718), WC (p=0.755) and MMSE (p=0.859).

CONCLUSION

In the present study, we could not find any relation between blood leptin levels and cognition in AD patients.

An overview of sleep and circadian dysfunction in Parkinson's disease

Sleep and circadian alterations are amongst the very first symptoms experienced in Parkinson's disease, and sleep alterations are present in the majority of patients with overt clinical manifestation of Parkinson's disease. However, the magnitude of sleep and circadian dysfunction in Parkinson's disease, and its influence on the pathophysiology of Parkinson's disease remains often unclear and a matter of debate. In particular, the confounding influences of dopaminergic therapy on sleep and circadian dysfunction are a major challenge, and need to be more carefully addressed in clinical studies. The scope of this narrative review is to summarise the current knowledge around both sleep and circadian alterations in Parkinson's disease. We provide an overview on the frequency of excessive daytime sleepiness, insomnia, restless legs, obstructive apnea and nocturia in Parkinson's disease, as well as addressing sleep structure, rapid eye movement sleep behaviour disorder and circadian features in Parkinson's disease. Sleep and circadian disorders have been linked to pathological conditions that are often co-morbid in Parkinson's disease, including cognitive decline, memory impairment and neurodegeneration. Therefore, targeting sleep and circadian alterations could be one of the earliest and most promising opportunities to slow disease progression. We hope that this review will contribute to advance the discussion and inform new research efforts to progress our knowledge in this field.

Emerging preclinical interest concerning the role of circadian function in Parkinson's disease

The importance of circadian function in the aetiology, progression and treatment of Parkinson's disease is a topic of increasing interest to the scientific and clinical community. While clinical studies on this theme are relatively new and limited in number there are many preclinical studies which explore possible circadian involvement in Parkinson's disease and speculate as to the mechanism by which clinical benefit can be derived by manipulating the circadian system. The present review explores the sequelae of circadian related studies from a historical perspective and reveals mechanisms that may be involved in the aetiology and progression of the disease. A systematic review of these studies also sets the stage for understanding the basic neuroscientific approaches which have been applied and provides new direction from which circadian function can be explored.

Retinal Ganglion Cells and Circadian Rhythms in Alzheimer's Disease, Parkinson's Disease, and Beyond

There is increasing awareness on the role played by circadian rhythm abnormalities in neurodegenerative disorders such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). The characterization of the circadian dysfunction parallels the mounting evidence that the hallmarks of neurodegeneration also affect the retina and frequently lead to loss of retinal ganglion cells (RGCs) and to different degrees of optic neuropathy. In the RGC population, there is the subgroup of cells intrinsically photosensitive and expressing the photopigment melanopsin [melanopsin-containing retinal ganglion cells (mRGCs)], which are now well known to drive the entrainment of circadian rhythms to the light–dark cycles. Thus, the correlation between the pathological changes affecting the retina and mRGCs with the circadian imbalance in these neurodegenerative diseases is now clearly emerging, pointing to the possibility that these patients might be amenable to and benefit from light therapy. Currently, this connection is better established for AD and PD, but the same scenario may apply to other neurodegenerative disorders, such as Huntington’s disease. This review highlights similarities and differences in the retinal/circadian rhythm axis in these neurodegenerative diseases posing a working frame for future studies.

Neuroendocrine abnormalities in Parkinson's disease

Neuroendocrine abnormalities are common in Parkinson's disease (PD) and include disruption of melatonin secretion, disturbances of glucose, insulin resistance and bone metabolism, and body weight changes. They have been associated with multiple non-motor symptoms in PD and have important clinical consequences, including therapeutics. Some of the underlying mechanisms have been implicated in the pathogenesis of PD and represent promising targets for the development of disease biomarkers and neuroprotective therapies. In this systems-based review, we describe clinically relevant neuroendocrine abnormalities in Parkinson's disease to highlight their role in overall phenotype. We discuss pathophysiological mechanisms, clinical implications, and pharmacological and non-pharmacological interventions based on the current evidence. We also review recent advances in the field, focusing on the potential targets for development of neuroprotective drugs in Parkinson's disease and suggest future areas for research.

The Influence of Adipose Tissue on Brain Development, Cognition, and Risk of Neurodegenerative Disorders

The brain is a highly metabolic organ and thus especially vulnerable to changes in peripheral metabolism, including those induced by obesity-associated adipose tissue dysfunction. In this context, it is likely that the development and maturation of neurocognitive circuits may also be affected and modulated by metabolic environmental factors, beginning in utero. It is currently recognized that maternal obesity, either pre-gestational or gestational, negatively influences fetal brain development and elevates the risk of cognitive impairment and neuropsychiatric disorders in the offspring. During infancy and adolescence, obesity remains a limiting factor for healthy neurodevelopment, especially affecting executive functions but also attention, visuospatial ability, and motor skills. In middle age, obesity seems to induce an accelerated brain aging and thus may increase the risk of age-related neurodegenerative diseases such as Alzheimer's disease. In this chapter we review and discuss experimental and clinical evidence focusing on the influence of adipose tissue dysfunction on neurodevelopment and cognition across lifespan, as well as some possible mechanistic links, namely the role of the most well studied adipokines.

Circadian Dysregulation in Parkinson's Disease

Parkinson's disease (PD) is the second most common neurodegenerative disorder that affects over one million individuals in the US alone. PD is characterized by a plethora of motor and non-motor manifestations, resulting from a progressive degeneration of dopaminergic neurons and disbalance of several other neurotransmitters. A growing body of evidence points to significant alterations of the circadian system in PD. This is not surprising given the pivotal role that dopamine plays in circadian regulation as well as the role of circadian influences in dopamine metabolism. In this review we present basic and clinical investigations that examined the function of the circadian system in PD.

Alterations of the circadian system in Parkinson's disease patients

Alterations of circadian rhythms are among the most debilitating non-motor symptoms in Parkinson's Disease (PD). Although a growing awareness towards these symptoms has occurred during the last decade, their underlying neuropathophysiology remains poorly understood and consequently no effective therapeutic strategies are available to alleviate these problems. Recent studies have investigated multiple circadian rhythms at different stages of PD. The advances made have allowed an accurate evaluation of the affected underlying pathways and mechanisms. Here I dissect, over disease progression, the relative causal contribution to health impairments in PD patients of dysfunctions in the different components of the neural network governing circadian rhythms. A deeper understanding of these mechanisms will provide not only a greater understanding of disease neuropathology, but also hold the promise for effective therapies. © 2016 International Parkinson and Movement Disorder Society.

Serum Leptin Levels and Cognition in Parkinson's Disease Patients

INTRODUCTION

To investigate the relationship between serum leptin levels and cognition in Parkinson's disease (PD) patients.

METHODS

Thirty patients with idiopathic PD and 30 healthy controls were enrolled. At baseline, all patients had their standing height, weight, and waist circumference measurements taken using a standard scale. Their body mass index was then calculated. A fasting blood of 5 ml was obtained from each patient in the morning. ELISA was used to analyze leptin concentrations. The severity of PD was evaluated using the Hoehn and Yahr scale, and the clinical status of patients was evaluated using the Unified Parkinson's Disease Rating Scale. The cognitive status of whole patients was evaluated using a validated form of the Montreal Cognitive Assessment Scale in Turkey (MoCA-TR).

RESULTS

The mean ages of the patients and controls were 59.37±9.22 and 58.50±9.85 years, while the mean leptin levels were 4.13±3.61 and 3.12±2.43 ng/mL, respectively. Leptin levels did not differ between PD patients and the controls. PD patients had significantly lower MoCA-TR scores than the controls (p=0.028). MoCA-TR scores were not correlated to leptin levels in PD patients.

CONCLUSION

In this study, we could not find a relationship between blood leptin levels of PD patients and cognition as assessed by MoCA-TR. Larger longitudinal studies are needed.

Circadian system - A novel diagnostic and therapeutic target in Parkinson's disease?

The circadian system regulates biological rhythmicity in the human body. The role of the circadian system in neurological disorders is a theme that is attracting an increasing amount of interest from the scientific community. This has arisen, in part, from emerging evidence that disorders such as Parkinson's disease (PD) are multifactorial with many features exhibiting diurnal fluctuations, thereby suggestive of circadian involvement. Although the importance of fluctuating motor and nonmotor manifestations in PD have been well acknowledged, the role of the circadian system has received little attention until recently. It is proposed that intervening with circadian function provides a novel research avenue down which new strategies for improving symptomatic treatment and slowing of the progressive degenerative process can be approached to lessen the burden of PD. In this article we review the literature describing existing circadian research in PD and its experimental models.

Neuroprotective and anti-ageing role of leptin

Leptin (Lep), an adipose-derived hormone, exerts very important functions in the body mainly on energy storage and availability. The physiological effects of Lep controlling the body weight and suppressing appetite are mediated by the long form of Lep receptor in the hypothalamus. Lep receptor activates several downstream molecules involved in key pathways related to cell survival such as STAT3, PI3K, MAPK, AMPK, CDK5 and GSK3β. Collectively, these pathways act in a coordinated manner and form a network that is fully involved in Lep physiological response. Although the major interest in Lep is related to its role in the regulation of energy balance, and since resistance to Lep affects is the primary risk factor for obesity, the interest on their effects on brain cognition and neuroprotection is increasing. Thus, Lep and Lep mimetic compounds now await and deserve systematic exploration as the orchestrator of protective responses in the nervous system. Moreover, Lep might promote the activation of a cognitive process that may retard or even partially reverse selected aspects of Alzheimer's disease or ageing memory loss.