1
|
Song C, Zhu ZC, Liu CC, Yun WX, Wang ZY, Lu GY, Song R, Wu N, Li J, Li F. Neuropeptide S Receptor 1 variant (I107N) regulates behavioral characteristics and NPS effect in mice in a sex-dependent manner. Neuropharmacology 2024; 242:109771. [PMID: 37858885 DOI: 10.1016/j.neuropharm.2023.109771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
Accumulated data demonstrate that the A/T single-nucleotide polymorphism (SNP) rs324981 in the human neuropeptide S receptor 1 (NPSR1) gene, resulting in an amino acid change from asparagine (N) to isoleucine (I) at position 107, is associated with susceptibility to psychiatric disorders. Neuropeptide S (NPS) has also been implicated in modulating these disorders in rodent experiments. However, the effect of this SNP on NPSR1 activity remains unclear. To elucidate the pathophysiological and pharmacological implications of this SNP, we generated a mouse model carrying the human-specific AA variant in NPSR1. This model exhibited sex-specific behavioral differences mirroring human observations, including fear response, anxiety, and depression. Notably, intracerebroventricular administration of NPS (1 nmol) significantly promoted locomotor activity and alleviated looming-stimulated fear and anxiety-like behaviors in NPSR TT mice, but not in NPSR AA mice. NPS also reduced depression-like behavior in a sex and genotype-dependent manner in the forced swim test. Our study in NPSR variant mice enhances our understanding of phenotypic and pharmacological differences due to the NPSR1 SNP, providing an animal model for further investigation of physiological processes in humans carrying this SNP.
Collapse
Affiliation(s)
- Chen Song
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China
| | - Zhi-Chen Zhu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China; Department of Pharmacology, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Chuan-Chuan Liu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China; Department of Pharmacology, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Wen-Xin Yun
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China
| | - Zhi-Yuan Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China
| | - Guan-Yi Lu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China
| | - Rui Song
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China
| | - Ning Wu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China
| | - Jin Li
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China.
| | - Fei Li
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China.
| |
Collapse
|
2
|
The association between genetic variability in the NPS/NPSR1 system and chronic stress responses: A gene-environment-(quasi-) experiment. Psychoneuroendocrinology 2022; 144:105883. [PMID: 35914393 DOI: 10.1016/j.psyneuen.2022.105883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022]
Abstract
The neuropeptide S (NPS) and its receptor (NPSR1) have been implicated in stress regulation and stress-related disorders. The present study aimed at investigating the association between overall genetic variability in the NPS/NPSR1 system and psychological and cortisol stress regulation in everyday life. Our study was conceptualized as a gene-environment-(quasi-) experiment, a design that facilitates the detection of true GxE interactions. As environmental variable, we used the preparation for the first state examination for law students. In the prospective and longitudinal LawSTRESS project, students were examined at six sampling points over a 13-months period. While students who prepared for the exam and experienced long-lasting and significant stress, formed the stress group, law students experiencing usual study-related workload were assigned to the control group. As phenotypes we assessed changes over time in the cortisol awakening response (CAR; n = 176), perceived stress levels (n = 401), and anxiety symptoms (n = 397). The CAR was assessed at each sampling point immediately upon awakening and 30 as well as 45 min later. Perceived stress levels in daily life were measured by repeated ambulatory assessments and anxiety symptoms were repeatedly assessed with the anxiety subscale of the Hospital Anxiety and Depression Scale. With gene-set analyses we examined the joint association of 936 NPS/NPSR1 single nucleotide polymorphisms with the phenotypes to overcome well known limitations of candidate gene studies. As previously reported, we found a blunted CAR during the exam as well as significant increases in perceived stress levels and anxiety symptoms until the exam in the stress group, compared to the control group. The gene-set analysis did not confirm associations between genetic variability in the NPS/NPSR1 system and changes in perceived stress levels and anxiety symptoms. Regarding the CAR, we found a significant GxE interaction for the area under the curve with respect to the ground (p = .050) and a trend towards a significant effect for the area under the curve with respect to the increase (p = .054). When the analysis was restricted to the SG, associations for both CAR parameters were significant (ps < .050). This finding suggests that the association between genetic variability in the NPS/NPSR1 system and the CAR becomes visible under the environmental condition 'chronic stress exposure'. We conclude that the present study complements findings from animal models and that it provides novel evidence for a modulatory influence of the NPS/NPSR1 system on cortisol regulation in humans.
Collapse
|
3
|
Henze GI, Rosenbaum D, Bärt C, Laicher H, Konzok J, Kudielka BM, Fallgatter AJ, Wüst S, Ehlis AC, Kreuzpointner L. Comparing two psychosocial stress paradigms for imaging environments - ScanSTRESS and fNIRS-TSST: correlation structures between stress responses. Behav Brain Res 2022; 436:114080. [PMID: 36030907 DOI: 10.1016/j.bbr.2022.114080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022]
Abstract
The present post-hoc analysis of two independent studies conducted in different laboratories aimed at comparing reactions of stress activation systems in response to two different psychosocial stress induction paradigms. Both paradigms are based on the Trier Social Stress Test and suited for neuroimaging environments. In an in-depth analysis, data from 67 participants (36 men, 31 women) from a functional magnetic resonance imaging study implementing ScanSTRESS were compared with data from a functional near-infrared spectroscopy (fNIRS) study implementing the so-called 'fNIRS-TSST' including 45 participants (8 men, 37 women). We tested the equivalence of correlation patterns between the stress response measures cortisol, heart rate, affect, and neural responses in the two samples. Moreover, direct comparisons of affective and neural responses were made. Similar correlation structures were identified for all stress activation systems, except for neural contrasts of paradigm conditions (stress vs. control) showing significant differences in association with cortisol, heart rate, and affective variables between the two samples. Furthermore, both stress paradigms elicited comparable affective and cortical stress responses. Apart from methodological differences (e.g., procedure, timing of the paradigms) the present analysis suggests that both paradigms are capable of inducing moderate acute psychosocial stress to a comparable extent with regard to affective and cortical stress responses. Moreover, similar association structures between different stress response systems were found in both studies. Thus, depending on the study objective and the respective advantages of each imaging approach, both paradigms have demonstrated their usefulness for future studies.
Collapse
Affiliation(s)
| | - David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany; Tübingen Center for Mental Health (TüCMH), Tübingen, Germany.
| | - Christoph Bärt
- Institute of Psychology, University of Regensburg, Regensburg, Germany.
| | - Hendrik Laicher
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany; Tübingen Center for Mental Health (TüCMH), Tübingen, Germany.
| | - Julian Konzok
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany.
| | | | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany; Tübingen Center for Mental Health (TüCMH), Tübingen, Germany.
| | - Stefan Wüst
- Institute of Psychology, University of Regensburg, Regensburg, Germany.
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany; Tübingen Center for Mental Health (TüCMH), Tübingen, Germany.
| | | |
Collapse
|
4
|
Markiewicz-Gospodarek A, Kuszta P, Baj J, Dobrowolska B, Markiewicz R. Can Neuropeptide S Be an Indicator for Assessing Anxiety in Psychiatric Disorders? Front Public Health 2022; 10:872430. [PMID: 35558538 PMCID: PMC9087177 DOI: 10.3389/fpubh.2022.872430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/29/2022] [Indexed: 12/01/2022] Open
Abstract
Neuropeptide S (NPS) is a neuropeptide primarily produced within three brainstem regions including locus coeruleus, trigeminal nerve nucleus, and lateral parabrachial nucleus. NPS is involved in the central regulation of stress, fear, and cognitive integration. NPS is a mediator of behavior, seeking food, and the proliferation of new adipocytes in the setting of obesity. So far, current research of NPS is only limited to animal models; data regarding its functions in humans is still scarce. Animal studies showed that anxiety and appetite might be suppressed by the action of NPS. The discovery of this neuromodulator peptide is effective considering its strong anxiolytic action, which has the potential to be an interesting therapeutic option in treating neuropsychiatric disorders. In this article, we aimed to analyze the pharmaceutical properties of NPS as well as its influence on several neurophysiological aspects-modulation of behavior, association with obesity, as well as its potential application in rehabilitation and treatment of psychiatric disorders.
Collapse
Affiliation(s)
| | - Piotr Kuszta
- Students Scientific Association at the Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | - Jacek Baj
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | - Beata Dobrowolska
- Department of Holistic Care and Management in Nursing, Medical University of Lublin, Lublin, Poland
| | - Renata Markiewicz
- Department of Neurology, Neurological and Psychiatric Nursing, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
5
|
Bülbül M, Sinen O. Centrally Administered Neuropeptide-S Alleviates Gastrointestinal Dysmotility Induced by Neonatal Maternal Separation. Neurogastroenterol Motil 2022; 34:e14269. [PMID: 34561917 DOI: 10.1111/nmo.14269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/18/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Neuropeptide-S (NPS) regulates autonomic outflow, stress response, and gastrointestinal (GI) motor functions. This study aimed to investigate the effects of NPS on GI dysmotility induced by neonatal maternal separation (MS). METHODS MS was conducted by isolating newborn pups from dams from postnatal day 1 to day 14. In adulthood, rats were also exposed to chronic homotypic stress (CHS). Visceral sensitivity was assessed by colorectal distension-induced abdominal contractions. Gastric emptying (GE) was measured following CHS, whereas fecal output was monitored daily. NPS or NPS receptor (NPSR) antagonist was centrally applied simultaneously with electrocardiography and gastric motility recording. Immunoreactivities for NPS, NPSR, corticotropin-releasing factor (CRF), choline acetyltransferase (ChAT), tyrosine hydroxylase (TH), and c-Fos were assessed by immunohistochemistry. KEY RESULTS NPS alleviated the MS-induced visceral hypersensitivity. Under basal conditions, central exogenous or endogenous NPS had no effect on GE and gastric motility. NPS restored CHS-induced gastric and colonic dysmotility in MS rats while increasing sympatho-vagal balance without affecting vagal outflow. NPSR expression was detected in CRF-producing cells of hypothalamic paraventricular nucleus, and central amygdala, but not in Barrington's nucleus. Moreover, NPSR was present in ChAT-expressing neurons in dorsal motor nucleus of the vagus (DMV), and nucleus ambiguus (NAmb) in addition to the TH-positive neurons in C1/A1, and locus coeruleus (LC). Neurons adjacent to the adrenergic cells in LC were found to produce NPS. NPS administration caused c-Fos expression in C1/A1 cells, while no immunoreactivity was detected in DMV or NAmb. CONCLUSIONS NPS/NPSR system might be a novel target for the treatment of stress-related GI dysmotility.
Collapse
Affiliation(s)
- Mehmet Bülbül
- Department of Physiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Osman Sinen
- Department of Physiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| |
Collapse
|
6
|
Tobinski AM, Rappeneau V. Role of the Neuropeptide S System in Emotionality, Stress Responsiveness and Addiction-Like Behaviours in Rodents: Relevance to Stress-Related Disorders. Pharmaceuticals (Basel) 2021; 14:ph14080780. [PMID: 34451877 PMCID: PMC8400992 DOI: 10.3390/ph14080780] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/22/2022] Open
Abstract
The neuropeptide S (NPS) and its receptor (NPSR1) have been extensively studied over the last two decades for their roles in locomotion, arousal/wakefulness and anxiety-related and fear-related behaviours in rodents. However, the possible implications of the NPS/NPSR1 system, especially those of the single nucleotide polymorphism (SNP) rs324981, in stress-related disorders and substance abuse in humans remain unclear. This is possibly due to the fact that preclinical and clinical research studies have remained separated, and a comprehensive description of the role of the NPS/NPSR1 system in stress-relevant and reward-relevant endpoints in humans and rodents is lacking. In this review, we describe the role of the NPS/NPSR1 system in emotionality, stress responsiveness and addiction-like behaviour in rodents. We also summarize the alterations in the NPS/NPSR1 system in individuals with stress-related disorders, as well as the impact of the SNP rs324981 on emotion, stress responses and neural activation in healthy individuals. Moreover, we discuss the therapeutic potential and possible caveats of targeting the NPS/NPSR1 system for the treatment of stress-related disorders. The primary goal of this review is to highlight the importance of studying some rodent behavioural readouts modulated by the NPS/NPSR1 system and relevant to stress-related disorders.
Collapse
|
7
|
Bengoetxea X, Goedecke L, Remmes J, Blaesse P, Grosch T, Lesting J, Pape HC, Jüngling K. Human-Specific Neuropeptide S Receptor Variants Regulate Fear Extinction in the Basal Amygdala of Male and Female Mice Depending on Threat Salience. Biol Psychiatry 2021; 90:145-155. [PMID: 33902914 DOI: 10.1016/j.biopsych.2021.02.967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/31/2021] [Accepted: 02/19/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND A nonsynonymous single nucleotide polymorphism in the neuropeptide S receptor 1 (NPSR1) gene (rs324981) results in isoleucine-to-asparagine substitution at amino acid 107. In humans, the ancestral variant (NPSR1 I107) is associated with increased anxiety sensitivity and risk of panic disorder, while the human-specific variant (NPSR1 N107) is considered protective against excessive anxiety. In rodents, neurobiological constituents of the NPS system have been analyzed in detail and their anxiolytic-like effects have been endorsed. However, their implication for anxiety and related disorders in humans remains unclear, as rodents carry only the ancestral NPSR1 I107 variant. METHODS We hypothesized that phenotypic correlates of NPSR1 variants manifest in fear-related circuits in the amygdala. We used CRISPR/Cas9 (clustered regularly interspaced short palindromic repeats/Cas9)-mediated gene editing to generate a "humanized" mouse strain, in which individuals express either NPSR1 I107 or NPSR1 N107. RESULTS Stimulation of NPSR1 evoked excitatory responses in principal neurons of the anterior basal amygdala with significant differences in magnitude between genotypes, resulting in synaptic disinhibition of putative extinction neurons in the posterior basal amygdala in mice expressing the human-specific hypofunctional N107 but not the ancestral I107 variant. N107 mice displayed improved extinction of conditioned fear, which was phenocopied after pharmacological antagonism of NPSR1 in the anterior basal amygdala of I107 mice. Differences in fear extinction between male and female mice were related to an interaction of Npsr1 genotype and salience of fear training. CONCLUSIONS The NPS system regulates extinction circuits in the amygdala depending on the Npsr1 genotype, contributing to sex-specific differences in fear extinction and high anxiety sensitivity of individuals bearing the ancestral NPSR1 I107 variant.
Collapse
Affiliation(s)
- Xabier Bengoetxea
- Institute of Physiology I, Westfälische Wilhelms-Universität, Münster, Germany
| | - Lena Goedecke
- Institute of Physiology I, Westfälische Wilhelms-Universität, Münster, Germany
| | - Jasmin Remmes
- Institute of Physiology I, Westfälische Wilhelms-Universität, Münster, Germany
| | - Peter Blaesse
- Institute of Physiology I, Westfälische Wilhelms-Universität, Münster, Germany
| | - Thomas Grosch
- Institute of Physiology I, Westfälische Wilhelms-Universität, Münster, Germany
| | - Jörg Lesting
- Institute of Physiology I, Westfälische Wilhelms-Universität, Münster, Germany
| | - Hans-Christian Pape
- Institute of Physiology I, Westfälische Wilhelms-Universität, Münster, Germany
| | - Kay Jüngling
- Institute of Physiology I, Westfälische Wilhelms-Universität, Münster, Germany.
| |
Collapse
|
8
|
Si W, Liu X, Pape HC, Reinscheid RK. Neuropeptide S-Mediated Modulation of Prepulse Inhibition Depends on Age, Gender, Stimulus-Timing, and Attention. Pharmaceuticals (Basel) 2021; 14:489. [PMID: 34065431 PMCID: PMC8160819 DOI: 10.3390/ph14050489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022] Open
Abstract
Conflicting reports about the role of neuropeptide S (NPS) in animal models of psychotic-like behavior and inconsistent results from human genetic studies seeking potential associations with schizophrenia prompted us to reevaluate the effects of NPS in the prepulse inhibition (PPI) paradigm in mice. Careful examination of NPS receptor (NPSR1) knockout mice at different ages revealed that PPI deficits are only expressed in young male knockout animals (<12 weeks of age), that can be replicated in NPS precursor knockout mice and appear strain-independent, but are absent in female mice. PPI deficits can be aggravated by MK-801 and alleviated by clozapine. Importantly, treatment of wildtype mice with a centrally-active NPSR1 antagonist was able to mimic PPI deficits. PPI impairment in young male NPSR1 and NPS knockout mice may be caused by attentional deficits that are enhanced by increasing interstimulus intervals. Our data reveal a substantial NPS-dependent developmental influence on PPI performance and confirm a significant role of attentional processes for sensory-motor gating. Through its influence on attention and arousal, NPS appears to positively modulate PPI in young animals, whereas compensatory mechanisms may alleviate NPS-dependent deficits in older mice.
Collapse
Affiliation(s)
- Wei Si
- Department of Pharmaceutical Sciences, University of California Irvine, Irvine, CA 92697, USA; (W.S.); (X.L.)
| | - Xiaobin Liu
- Department of Pharmaceutical Sciences, University of California Irvine, Irvine, CA 92697, USA; (W.S.); (X.L.)
| | - Hans-Christian Pape
- Institute of Physiology I, Westfälische-Wilhelms University, 48149 Münster, Germany;
| | - Rainer K. Reinscheid
- Institute of Physiology I, Westfälische-Wilhelms University, 48149 Münster, Germany;
- Institute of Pharmacology and Toxicology, Friedrich-Schiller University, 07747 Jena, Germany
| |
Collapse
|
9
|
Ahmad A, Almsned F, Ghazal P, Ahmed MW, Jafri MS, Bokhari H. Neuropeptide S receptor gene Asn107 polymorphism in obese male individuals in Pakistan. PLoS One 2020; 15:e0243205. [PMID: 33332443 PMCID: PMC7745988 DOI: 10.1371/journal.pone.0243205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 11/17/2020] [Indexed: 12/12/2022] Open
Abstract
Neuropeptide S (NPS) is a naturally occurring appetite stimulant, associated with anxiety, stress, and excitement regulation. Neuropeptide S serves as a hypothalamic energy regulator that enhances food intake with a reduced level of satiety. NPS activates fat angiogenesis and the proliferation of new adipocytes in obesity. NPS has an established role in energy regulation by many pre-clinical investigations; however we have limited data available to support this notion in humans. We found significant association of Neuropeptide S receptor (NPSR1) Asn107Ile (rs324981, A>T) polymorphism with obese male participants. The current investigation carried out genotype screening of NPSR1 allele to assess the spectrum of the Asn107Ile polymorphism in obese and healthy Pakistani individuals. We revealed a significant (p = 0.04) difference between AA vs TT + AT genotype distribution of NPSR1 (SNP rs324981,) between obese and healthy individuals (p = 0.04). In this genotype analysis of (SNP rs324981) of the NPSR1 gene, T allele was marked as risk allele with higher frequency in the obese (38%) compared to its frequency in the controls (25%). Single Nucleotide Polymorphism (SNP, rs324981) Asn107Ile of NPSR1gene, that switches an amino acid from Asn to Ile, has been found associated with increased susceptibility to obesity in Pakistani individuals. Furthermore, molecular simulation studies predicted a lower binding affinity of NPSR1 Asn107Ile variant to NPS than the wild-type consistent with the genotype studies. These molecular simulation studies predict a possible molecular mechanism of this interaction by defining the key amino acid residues. However, a significantly (p<0.0001) lower concentration of NPS was recorded independent of genotype frequencies in obese subjects compared to healthy controls. We believe that large scale polymorphism data of population for important gene players including NPSR1 will be more useful to understand obesity and its associated risk factors.
Collapse
Affiliation(s)
- Aftab Ahmad
- Department of Biosciences, COMSATS University Islamabad, Chak Shahzad, Islamabad, Pakistan
| | - Fahad Almsned
- School of Systems Biology and Krasnow Institute for Advanced Study, George Mason University, Fairfax, Virginia, United States of America
- King Fahad Specialist Hospital– Dammam, Dammam, Saudi Arabia
| | - Pasha Ghazal
- Department of Biosciences, COMSATS University Islamabad, Chak Shahzad, Islamabad, Pakistan
| | - Malik Waqar Ahmed
- Department of Biosciences, COMSATS University Islamabad, Chak Shahzad, Islamabad, Pakistan
| | - M. Saleet Jafri
- School of Systems Biology and Krasnow Institute for Advanced Study, George Mason University, Fairfax, Virginia, United States of America
- Center for Biomedical Engineering and Technology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Habib Bokhari
- Department of Biosciences, COMSATS University Islamabad, Chak Shahzad, Islamabad, Pakistan
- Center for Biomedical Engineering and Technology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| |
Collapse
|
10
|
Chand T, Li M, Jamalabadi H, Wagner G, Lord A, Alizadeh S, Danyeli LV, Herrmann L, Walter M, Sen ZD. Heart Rate Variability as an Index of Differential Brain Dynamics at Rest and After Acute Stress Induction. Front Neurosci 2020; 14:645. [PMID: 32714132 PMCID: PMC7344021 DOI: 10.3389/fnins.2020.00645] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022] Open
Abstract
The brain continuously receives input from the internal and external environment. Using this information, the brain exerts its influence on both itself and the body to facilitate an appropriate response. The dynamic interplay between the brain and the heart and how external conditions modulate this relationship deserves attention. In high-stress situations, synchrony between various brain regions such as the prefrontal cortex and the heart may alter. This flexibility is believed to facilitate transitions between functional states related to cognitive, emotional, and especially autonomic activity. This study examined the dynamic temporal functional association of heart rate variability (HRV) with the interaction between three main canonical brain networks in 38 healthy male subjects at rest and directly after a psychosocial stress task. A sliding window approach was used to estimate the functional connectivity (FC) among the salience network (SN), central executive network (CEN), and default mode network (DMN) in 60-s windows on time series of blood-oxygen-level dependent (BOLD) signal. FC between brain networks was calculated by Pearson correlation. A multilevel linear mixed model was conducted to examine the window-by-window association between the root mean square of successive differences between normal heartbeats (RMSSD) and FC of network-pairs across sessions. Our findings showed that the minute-by-minute correlation between the FC and RMSSD was significantly stronger between DMN and CEN than for SN and CEN in the baseline session [b = 4.36, t(5025) = 3.20, p = 0.006]. Additionally, this differential relationship between network pairs and RMSSD disappeared after the stress task; FC between DMN and CEN showed a weaker correlation with RMSSD in comparison to baseline [b = −3.35, t(5025) = −3.47, p = 0.006]. These results suggest a dynamic functional interplay between HRV and the functional association between brain networks that varies depending on the needs created by changing conditions.
Collapse
Affiliation(s)
- Tara Chand
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Hamidreza Jamalabadi
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Anton Lord
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Sarah Alizadeh
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Lena V Danyeli
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Luisa Herrmann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Zumrut D Sen
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| |
Collapse
|
11
|
Henze GI, Konzok J, Kreuzpointner L, Bärtl C, Peter H, Giglberger M, Streit F, Kudielka BM, Kirsch P, Wüst S. Increasing Deactivation of Limbic Structures Over Psychosocial Stress Exposure Time. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:697-704. [PMID: 32507729 DOI: 10.1016/j.bpsc.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Understanding the interplay between central nervous system and hypothalamic-pituitary-adrenal axis responses to stress in humans is assumed to be essential to contribute to the central question of stress research, namely how stress can increase disease risk. Therefore, the present study used a neuroimaging stress paradigm to investigate the interplay of 3 stress response domains. Furthermore, we asked if the brain's stress response changes over exposure time. METHODS In a functional magnetic resonance imaging study, changes in brain activation, cortisol levels, affect, and heart rate in response to an improved ScanSTRESS protocol were assessed in 67 young, healthy participants (31 females). RESULTS Stress exposure led to significant increases in cortisol levels, heart rate, and negative affect ratings as well as to activations and deactivations in (pre)limbic regions. When cortisol increase was used as a covariate, stronger responses in the hippocampus, amygdala, medial prefrontal cortex, and cingulate gyrus were observed. Responses within the same regions predicted negative affect ratings. Remarkably, an increasing deactivation over the two ScanSTRESS runs was found, again, in the same structures. A reanalysis of an independent sample confirmed this finding. CONCLUSIONS For the first time, reactions in a cluster of (pre)limbic structures was consistently found to be associated with changes in cortisol and negative affect. The same neural structures showed increasing deactivations over stress exposure time. We speculate that investigating possible associations between exposure-time effects in neural stress responses and stress-related interindividual differences (e.g., chronic stress) might be a promising new avenue in stress research.
Collapse
Affiliation(s)
| | - Julian Konzok
- Institute of Psychology, University of Regensburg, Regensburg, Germany
| | | | - Christoph Bärtl
- Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - Hannah Peter
- Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - Marina Giglberger
- Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Stefan Wüst
- Institute of Psychology, University of Regensburg, Regensburg, Germany.
| |
Collapse
|
12
|
Kolodziejczyk MH, Fendt M. Corticosterone Treatment and Incubation Time After Contextual Fear Conditioning Synergistically Induce Fear Memory Generalization in Neuropeptide S Receptor-Deficient Mice. Front Neurosci 2020; 14:128. [PMID: 32231512 PMCID: PMC7081924 DOI: 10.3389/fnins.2020.00128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/31/2020] [Indexed: 12/18/2022] Open
Abstract
Fear memory generalization is a learning mechanism that promotes flexible fear responses to novel situations. While fear generalization has adaptive value, overgeneralization of fear memory is a characteristic feature of the pathology of anxiety disorders. The neuropeptide S (NPS) receptor (NPSR) has been shown to be associated with anxiety disorders and has recently been identified as a promising target for treating anxiety disorders. Moreover, stress hormones play a role in regulating both physiological and pathological fear memories and might therefore also be involved in anxiety disorders. However, little is known about the interplay between stress hormone and the NPS system in the development of overgeneralized fear. Here, we hypothesize that NPSR-deficient mice with high corticosterone (CORT) levels during the fear memories consolidation are more prone to develop generalized fear. To address this hypothesis, NPSR-deficient mice were submitted to a contextual fear conditioning procedure. Immediately after conditioning, mice received CORT injections (2.5 or 5 mg/kg). One day and 1 month later, the mice were tested for the specificity and strength of their fear memory, their anxiety level, and their startle response. Moreover, CORT blood levels were monitored throughout the experiment. Using this protocol, a specific contextual fear memory was observed in all experimental groups, despite the 5-mg/kg CORT-treated NPSR-deficient mice. This group of mice showed a generalization of contextual fear memory and a decreased startle response, and the females of this group had significantly less body weight gain. These findings indicate that interplay between CORT and the NPS system during the consolidation of fear memories is critical for the generalization of contextual fear.
Collapse
Affiliation(s)
- Malgorzata H Kolodziejczyk
- Neuropharmaclogy of Emotional Systems, Institute for Pharmacology and Toxicology, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Markus Fendt
- Neuropharmaclogy of Emotional Systems, Institute for Pharmacology and Toxicology, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Otto von Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
13
|
Zänkert S, Bellingrath S, Wüst S, Kudielka BM. HPA axis responses to psychological challenge linking stress and disease: What do we know on sources of intra- and interindividual variability? Psychoneuroendocrinology 2019; 105:86-97. [PMID: 30390966 DOI: 10.1016/j.psyneuen.2018.10.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/24/2018] [Accepted: 10/26/2018] [Indexed: 01/05/2023]
Abstract
Stress is an ubiquitous phenomenon with significant impact on human physiology when it lasts too long, when it is too intense, or when it hits vulnerable individuals. Examining the mechanisms linking stress exposure with health and disease is an important endeavor in psychoneuroendocrine research. Empirical evidence so far revealed large intra- as well as inter-individual variability in hypothalamic-pituitary-adrenal (HPA) axis responses to acute psychosocial stress, showing that the HPA axis is a highly adaptive system. Thus, the characterization of intra- und inter-individual patterns of HPA axis reactivity is of high scientific interest and forms the basis on which mechanistic links between stress response (dys)regulation and health impairments can be examined. To date, basic knowledge has been, and still is, accumulated on demographic, biological (including genetic and epigenetic) factors, lifestyle behavioral variables, consumption of substances and medication, psychological and personality factors, as well as on methodological aspects. Besides this, there is also very recent progress in respect to the development of laboratory stress paradigms that can be applied in virtual reality or inside an MRI-scanner. In sum, the present review updates our current knowledge on moderating and intervening factors as sources of intra- und inter-individual variability in human cortisol stress responses and offers recommendations for future research designs.
Collapse
Affiliation(s)
- Sandra Zänkert
- Department of Medical Psychology, Psychological Diagnostics and Research Methodology, University of Regensburg, Germany
| | - Silja Bellingrath
- Department of Work- and Organizational Psychology, University of Duisburg-Essen, Germany
| | - Stefan Wüst
- Institute of Experimental Psychology, University of Regensburg, Germany
| | - Brigitte M Kudielka
- Department of Medical Psychology, Psychological Diagnostics and Research Methodology, University of Regensburg, Germany.
| |
Collapse
|
14
|
Lin X, Liu J, Zeng X, Zhang S, Pan Y, Wu J. Effects of the neuropeptide S receptor gene on the mediating effect of somatization on the association between life-event scores and psychological distress. J Affect Disord 2019; 246:738-744. [PMID: 30616163 DOI: 10.1016/j.jad.2018.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 11/04/2018] [Accepted: 12/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mechanisms underlying the relationship between life events and psychological distress are unclear. However, evidence of genetic involvement, including the neuropeptide S receptor gene (NPSR1), exists. METHODS A total of 600 Chinese adults were enrolled in this cross-sectional study using random cluster sampling. Demographic information, measures of life events and psychiatric symptoms, and fasting blood samples were collected. RESULTS Significant correlations were observed among life-event scores, somatization, and psychological distress (i.e., anxiety and depressive symptoms). Regression revealed life-event scores and somatization predicted anxiety, depressive symptoms, and psychological distress, while controlling for sex, age, income, education, and marital status. Structural equation modeling indicated that somatization mediated the association between life-event scores and psychological distress. Moreover, the mediating effect was influenced by the NPSR1 gene, suggesting that the NPSR1 polymorphisms rs324981, rs6947841, and rs6972158 influenced the association between life-event scores and somatization (ps < 0.05). The NPSR1 polymorphisms rs12673132 significantly affected the relationship of somatization with psychological distress (p < 0.05). CONCLUSIONS In conclusion, somatization mediated the association between life-event scores and psychological distress. The current study is the first to demonstrate this relationship with a Chinese sample, whereby the NPSR1 gene affects the mediating effect of somatization on the association between life-event scores and psychological distress.
Collapse
Affiliation(s)
- Xiujin Lin
- Department of Psychology, School of Public Health, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, China
| | - Jianbo Liu
- Department of Child Psychiatry of Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen University, Mental Health School, Shenzhen 518020, China
| | - Xuan Zeng
- Department of Psychology, School of Public Health, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, China
| | - Shengjie Zhang
- Department of Psychology, School of Public Health, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, China
| | - Yuli Pan
- Department of Psychology, School of Public Health, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, China
| | - Junduan Wu
- Department of Psychology, School of Public Health, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, China.
| |
Collapse
|
15
|
Imaging stress: an overview of stress induction methods in the MR scanner. J Neural Transm (Vienna) 2019; 126:1187-1202. [DOI: 10.1007/s00702-018-01965-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/13/2018] [Indexed: 12/30/2022]
|
16
|
Lin X, Liu J, Fu P, Zeng X, Qin J, Tang Z, Wu J. Associations Between Gene Polymorphisms and Psychological Stress in the Guangxi Minority Region of China. Med Sci Monit 2018; 24:6680-6687. [PMID: 30242809 PMCID: PMC6166522 DOI: 10.12659/msm.910432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/28/2018] [Indexed: 12/25/2022] Open
Abstract
To investigate whether there is an association between gene polymorphisms, genetic and environmental interactions, and psychological stress reactivity in Chinese subjects living in the Guangxi minority region. This cross-sectional study enrolled subjects older than 18 years, living in Nandan county, Guangxi minority region, China for at least 1 year. All participants were healthy, without any mental diseases, and were able to communicate. Eligible participants were randomly selected. The Life Event Scale Questionnaire, Simplified Coping Style Questionnaire, and Social Support Rating Scale were used to measure the physiological stress, coping style, and social support, respectively, in individuals. A total of 600 participants were recruited. A decreased risk of psychological stress was only found in TT of NPSR1 (rs324981): A allele carriers vs. TT genotype (OR 1.64, 95% CI 1.11, 2.42), and AT genotype vs. TT genotype (OR 1.76, 95% CI 1.17, 2.65). The overall coping style was positively associated with psychological stress, and no significant interactions between genetics and environment were found. We found that the NPSR1 (rs324981) T/T genotype decreased the risk of psychological stress, while the overall coping style was a risk factor for psychological stress. However, there was no interactive effects of genes and environment on psychological stress. Our findings will improve understanding of the biological basis underlying psychological stress if the results can be replicated in further research.
Collapse
Affiliation(s)
- Xiujin Lin
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jianbo Liu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
- Mental Health Institute of The Second Xiangya Hospital and Key Laboratory of Psychiatry and Mental Health of Hunan Province, The Central South University, Changsha, Hunan, P.R. China
| | - Peipei Fu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Xuan Zeng
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jian Qin
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Zhenghua Tang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Junduan Wu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, P.R. China
| |
Collapse
|
17
|
Spodenkiewicz M, Aigrain J, Bourvis N, Dubuisson S, Chetouani M, Cohen D. Distinguish self- and hetero-perceived stress through behavioral imaging and physiological features. Prog Neuropsychopharmacol Biol Psychiatry 2018; 82:107-114. [PMID: 29191571 DOI: 10.1016/j.pnpbp.2017.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 11/25/2022]
Abstract
Stress reactivity is a complex phenomenon associated to multiple and multimodal expressions. Response to stressors has an obvious survival function and may be seen as an internal regulation to adapt to threat or danger. The intensity of this internal response can be assessed as the self-perception of the stress response. In species with social organization, this response also serves a communicative function, so-called hetero-perception. Our study presents multimodal stress detection assessment - a new methodology combining behavioral imaging and physiological monitoring for analyzing stress from these two perspectives. The system is based on automatic extraction of 39 behavioral (2D+3D video recording) and 62 physiological (Nexus-10 recording) features during a socially evaluated mental arithmetic test. The analysis with machine learning techniques for automatic classification using Support Vector Machine (SVM) show that self-perception and hetero-perception of social stress are both close but different phenomena: self-perception was significantly correlated with hetero-perception but significantly differed from it. Also, assessing stress with SVM through multimodality gave excellent classification results (F1 score values: 0.9±0.012 for hetero-perception and 0.87±0.021 for self-perception). In the best selected feature subsets, we found some common behavioral and physiological features that allow classification of both self- and hetero-perceived stress. However, we also found the contributing features for automatic classifications had opposite distributions: self-perception classification was mainly based on physiological features and hetero-perception was mainly based on behavioral features.
Collapse
Affiliation(s)
- Michel Spodenkiewicz
- Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, Institut des Systèmes Intelligents et de Robotique, Paris, France; CEPOI EA 7388, Unité de Pédopsychiatrie de Liaison, Pôle de Santé Mentale, CHU Sud Réunion, Université de la Réunion, Saint-Pierre, France; CESP Inserm U1178, Groupe IPSOM, Paris, France.
| | - Jonathan Aigrain
- Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, Institut des Systèmes Intelligents et de Robotique, Paris, France
| | - Nadège Bourvis
- Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, Institut des Systèmes Intelligents et de Robotique, Paris, France; Département de Psychiatrie de l'Enfant et de l'Adolescent, AP-HP, GHU Pitié-Salpêtrière, Paris, France
| | - Séverine Dubuisson
- Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, Institut des Systèmes Intelligents et de Robotique, Paris, France
| | - Mohamed Chetouani
- Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, Institut des Systèmes Intelligents et de Robotique, Paris, France
| | - David Cohen
- Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, Institut des Systèmes Intelligents et de Robotique, Paris, France; Département de Psychiatrie de l'Enfant et de l'Adolescent, AP-HP, GHU Pitié-Salpêtrière, Paris, France.
| |
Collapse
|