Neuropeptides, behavior, and aging

Sarcopenia: An Age-Related Multifactorial Disorder

Sarcopenia is an emerging clinical entity characterized by a gradual decline in skeletal muscle mass and strength that accompanies the normal aging process. It has been noted that sarcopenia is associated with various adverse health outcomes in the geriatric population like prolonged hospital admission, disability, poor quality of life, frailty, and mortality. Factors involved in the development of age-related sarcopenia include anorexia, alteration in the hormone levels, decreased neural innervation, low blood flow to the muscles, cytokine dysregulation, altered mitochondrial activity, genomic instability, intracellular proteolysis, and insulin resistance. Understanding the mechanism may help develop efficient preventive and therapeutic strategies which can improve the quality of life in elderly individuals. Thus, the objective of the present article is to review the literature regarding the mechanism involved in the development of sarcopenia in aged individuals.

Alterations and interactions of subcortical modulatory systems in Alzheimer's disease

The pathogenesis of Alzheimer's disease (AD) is not fully understood. Here we summarize current knowledge on the involvement of the serotonergic, noradrenergic, dopaminergic, cholinergic, and opioid systems in AD, emphasizing the importance of interactions between the serotonergic and the other subcortical modulatory systems during the progression of AD. In physiological conditions, all neurotransmitter systems function in concert and are interdependent at both the neuroanatomical and molecular levels. Through their early involvement in AD, cognitive and behavioral abilities that rely on their interactions also become disrupted. Considering that serotonin (5HT) regulates the release of noradrenaline (NA), dopamine (DA) and acetylcholine (ACh), any alteration in 5HT levels leads to disturbance of NA, DA, and ACh homeostasis in the brain. One of the earliest pathological changes during the prodromal phase of AD is a decrease of serotonergic transmission throughout the brain, with serotonergic receptors being also affected. Additionally, serotonergic and noradrenergic as well as serotonergic and dopaminergic nuclei are reciprocally interconnected. As the serotonergic dorsal raphe nucleus (DRN) is affected by pathological changes early in AD, and the noradrenergic locus coeruleus (LC) and dopaminergic ventral tegmental area (VTA) exhibit AD-related pathological changes, their connectivity also becomes altered in AD. Such disrupted interactions among neurotransmitter systems in AD can be used in the development of multi-target drugs. Some of the potential AD therapeutics (such as ASS234, RS67333, tropisetron) target multiple neurotransmitter systems to achieve the best possible improvement of cognitive and behavioral deficits observed in AD. Here, we review how serotonergic system interacts with other subcortical modulatory systems (noradrenergic, dopaminergic, cholinergic, and opioid systems) during AD.

Age Differences in the Time Course and Magnitude of Changes in Circulating Neuropeptides After Pain Evocation in Humans

This study tested the hypothesis that older adults would have a stronger response for substance P (facilitatory) but weaker response to β-endorphin (inhibitory), in magnitude as well as time course. Eight younger and 9 older adults underwent 3 experimental sessions using well validated laboratory pain models: cold pressor task, contact heat pain, and a nonpainful control. Blood was collected through an indwelling catheter at baseline and 3, 15, 30, 45, and 60 minutes after stimuli administration. Older adults had higher baseline levels of both neuropeptides suggesting increased peripheral activity compared with younger adults. After the cold pressor task, older adults demonstrated a quick and strong release of substance P with dramatic recovery, whereas young adults maintained a constant low-grade response. Unlike substance P, β-endorphin increased between 3 and 15 minutes for both groups with the upsurge substantially higher for older adults. After heat pain, younger adults had an immediate surge in circulating substance P and β-endorphin that was more pronounced than among older adults. However, levels of substance P for younger adults slowly tapered whereas they continued to climb for the older adults through 30 minutes. β-endorphin peaked at 30 minutes for both groups and returned to baseline. No changes were observed during the nonpainful control session.

PERSPECTIVE

Older adults had higher baseline levels of substance P and β-endorphin suggesting increased peripheral activity compared with younger adults. After pain evocation, older adults demonstrated a more intense early response for both neuropeptides suggesting peripheral mechanisms involved in the response to pain may change with age.

Opioid system and Alzheimer's disease

The opioid system may be involved in the pathogenesis of AD, including cognitive impairment, hyperphosphorylated tau, Aβ production, and neuroinflammation. Opioid receptors influence the regulation of neurotransmitters such as acetylcholine, norepinephrine, GABA, glutamate, and serotonin which have been implicated in the pathogenesis of AD. Opioid system has a close relation with Aβ generation since dysfunction of opioid receptors retards the endocytosis and degradation of BACE1 and γ-secretase and upregulates BACE1 and γ-secretase, and subsequently, the production of Aβ. Conversely, activation of opioid receptors increases the endocytosis of BACE1 and γ-secretase and downregulates BACE1 and γ-secretase, limiting the production of Aβ. The dysfunction of opioid system (opioid receptors and opioid peptides) may contribute to hyperphosphorylation of tau and neuroinflammation, and accounts for the degeneration of cholinergic neurons and cognitive impairment. Thus, the opioid system is potentially related to AD pathology and may be a very attractive drug target for novel pharmacotherapies of AD.

Clinical manifestations of acute myocardial infarction in older patients

Coronary artery disease is the major cause of morbidity and mortality in the elderly in the United States. In this age group, the clinical presentation of coronary heart disease can be quite atypical. In general, the incidence of typical precordial chest pressure/pain denoting myocardial ischemia is less common, whereas dyspnea as an anginal-equivalent symptom is frequent. The diagnosis of ischemic cardiac pain is frequently confused by the many comorbid conditions present in the elderly. Even when classic ischemic precordial discomfort is present, it tends to be less severe and less well defined. The elderly appear to have reduced pain perception; as a result, silent myocardial ischemia is more common and carries a somewhat worse prognosis in the elderly than in younger age groups. Similarly, the presenting symptoms of acute myocardial infarction in the elderly can be nonspecific. The classic crushing substernal chest pain decreases with age, whereas the symptom of dyspnea gradually increases. Neurologic symptoms, confusional states, weakness, and worsening heart failure are common clinical presentations of an acute infarction in elderly patients. Silent (unrecognized) myocardial infarctions are common in the elderly and carry serious prognostic implications.

Exercise, immunity and aging

In general population, many protective immune responses are impaired in old age, leading to an increased risk of infection. However, recent studies in SENIEUR subjects (healthy centenarians who are examples of successful aging) suggest that complex remodeling and reshaping of the immune system occurs with aging. An appropriate regular regimen of endurance exercise might help elderly to lead a quality of life by preserving immune function. However, very little is known regarding the interaction between exercise, aging and the immune system. Given that a number of age-related changes occur in many physiological systems which are known to alter the immune function both at rest and during exercise, it would be of value to learn the extent to which both acute and chronic exercise influence immune function in the elderly. The immune system response to exercise is multifaceted, depending on the nature of exercise. Significant interaction between the neuroendocrine and immune systems, and the role of lifestyle factors in immune function are known to occur. In theory, moderate exercise should help to reverse the adverse effects of aging upon the immune system by increasing the production of endocrine hormones which may contribute to less accumulation of autoreactive immune cells by enhancing the programmed cell death. Active elderly subjects demonstrated a significantly greater proliferative response to phytohemagglutinins (PHA) and to pokeweed mitogen (PWM), and higher rates of interleukin-2 (IL-2), interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) production. A moderate training program can enhance the resting natural killer (NK) cell function of healthy elderly people, potentially increasing resistance to both viral infections and preventing the formation of malignant cells. Recent studies have suggested that endurance training in later life is associated with a lesser age-related decline in certain aspects of circulating T cell function and related cytokine production. It is important that the dose of physical activity needed to optimize immune function be defined more clearly at various points during the aging process both in females and males in order to optimize the immune function and to prevent any rise in adverse effects of exercise on the elderly population.

Clinical manifestations and diagnosis of coronary artery disease

Coronary atherosclerosis is very common in the elderly population with autopsy studies demonstrating the prevalence to be at least 70% in persons over the age of 70. These autopsy findings may be coincidental, with the disease clinically silent throughout the person's life, although 20% to 30% of persons over age 65 years will demonstrate clinical manifestations of coronary heart disease (CHD). In most elderly persons, the disease will have manifested itself much earlier in their lives, however, in others the disease will be entirely silent until the person reaches his or her 70s or 80s. Unfortunately, even though CHD is prevalent in elderly persons, the disease is often not diagnosed or misdiagnosed in this age group. Failure to correctly diagnose the disease in the elderly may be due to the difference in the clinical manifestation in this age group compared with younger patients. Such differences may reflect a difference in the disease process between older and younger patients or it may be related to the superimposition of normal aging changes, plus the presence of concomitant diseases, which may mask the usual clinical manifestations.

Age-related changes in the contents of neuropeptides in the rat brain and pituitary

beta-Endorphin, Leu-enkephalin, Met-enkephalin, substance P, somatostatin, and cholecystokinin were measured in the brain and the pituitary of male Sprague-Dawley rats aged 3 months, 12 months, and 22 months. beta-Endorphin, Met-enkephalin and Leu-enkephalin contents in the neurointermediate lobe, and the enkephalin levels in the anterior lobe of the pituitary increased with age. The increases in contents were both in the day and at night for beta-endorphin and Met-enkephalin. However, the increase for Leu-enkephalin content was in the day only. Hypothalamic beta-endorphin content decreased with age only in the day. beta-Endorphin and Leu-enkephalin contents in the brain stem, and Leu-enkephalin levels contents in the cortex decreased with age at night. Leu-enkephalin in the striatum decreased with age in the day. There was also an age-related decrease for somatostatin and substance P contents in the striatum and the hypothalamus in the day, and in cholecystokinin levels in the hippocampus, and the hypothalamus at night. It is concluded that there are age differences in neuropeptide levels, and that these changes may differ according to diurnal rhythms.

Increased central immunoreactive beta-endorphin content in patients with Wernicke-Korsakoff syndrome and in alcoholics

beta-endorphin, adrenocorticotrophin, and alpha-melanocyte stimulating hormone were measured by radioimmunoassay in three areas of human brain at necropsy in seven subjects with Wernicke-Korsakoff syndrome and in 52 controls. Thiamin concentration in six brain areas was also measured. Mamillary body beta-endorphin concentrations were significantly increased in those with the syndrome compared with controls, and those controls with high alcohol intake showed increased mamillary body beta-endorphin compared with controls with low alcohol intake. Brain thiamin concentration was similar in both groups, with the exception of the brainstem, where it was reduced in subjects with Wernicke-Korsakoff syndrome. Thalamic beta-endorphin in controls was inversely correlated with thiamin in frontal white matter, frontal cortex, parietal white matter and parietal cortex, while beta-endorphin in the hypothalamus of patients was inversely correlated with thiamin in frontal cortex, parietal white matter, thalamus and brainstem. These results suggest that there is a disturbance of the endorphinergic system in Wernicke-Korsakoff syndrome which may be related to alcohol intake.

Elevated CSF somatostatin concentrations in demented patients parallel improved psychomotor functions induced by integrity-promoting care

Elderly demented patients from 2 nursing homes participated in this study. An experimental group (n = 17) was subjected to a 3-month program with integrity-promoting care resulting in emotional, intellectual and physical activation, whereas a control group (n = 18) had no change from the regular ward care. Dementia rating scales and psychological tests were administered before the start of the study and at the end of the 3-month study period. Lumbar punctures were performed at the same time for assessment of neuropeptide concentrations (somatostatin (SRIF), arginine vasopressin (AVP) and corticotropin-releasing factor) in the cerebrospinal fluid (CSF). In the control group no significant changes were found in the ratings before and after the study. In contrast, improvements in intellectual and motor functioning were observed in the experimental group. Concomitantly, the SRIF concentrations in CSF were significantly elevated in the experimental group and not affected in the control group. The CSF AVP concentrations were reduced in both groups at the end of the study, but considerably more in the control group. It is concluded that environmental factors can improve intellectual and motor functioning in demented patients and also alter CSF biochemical measures of dementia.

Aging decreases beta-endorphin enhancement of T-cell mitogenesis in mice

Numerous studies have demonstrated the role of the central nervous system in immunomodulation. beta-Endorphin, a neuropeptide that is released along with adrenocorticotropin by the pituitary in response to stress, has been shown to have various effects on immune function, although these effects are dependent on dose, animal model, and immune cell tested. Since the increased risk for infection and tumor that is observed in the elderly is thought to be in part secondary to waning cell-mediated immunity, we investigated the effect of age on beta-endorphin immunomodulation of T-cell proliferation in a murine model. Spleen cells obtained from young and old BALB/c mice were cultured in vitro with various mitogens with and without beta-endorphin. beta-Endorphin at 10(-8) M on day 3 of culture significantly enhanced concanavalin A (2.0 micrograms/10(6) cells per ml) mitogenesis but not phytohemagglutinin or lipopolysaccharide mitogenesis. Moreover, this enhancement was shown only in spleen cells from young mice and was not blocked by the opiate receptor antagonist naloxone, which suggests that enhancement of mitogenesis by beta-endorphin was mediated by a non-opiate receptor. Finally, our results support an altered response to neuroimmunomodulation with age.

Enhanced passive avoidance retention following posttrain serotonergic receptor antagonist administration in middle-aged and aged rats

The experiments examined the ability of posttrain administration of serotonergic receptor antagonists to attenuate the age-related deficits in avoidance retention normally exhibited by middle-aged (12 months) and aged (22 months) rats. Ketanserin (0, 1.0, 10.0 mg/kg) produced a significant dose-dependent increase in test step-through latencies in both age groups. The suppression of responding did not appear to be due to generalized learned aversion as nonshocked rats, injected with the highest dose of ketanserin, did not exhibit similar elevations in test latencies. In order to determine whether the ketanserin-induced effect could be generalized to other serotonergic antagonists, middle-aged and aged animals were injected with a single dose of mianserin (10.0 mg/kg). This antagonist also significantly increased step-through latencies in both age groups, while not affecting the performance of nonshocked animals. The results provide additional evidence for a role of the serotonergic nervous system in memory, and may have important implications in the development of effective treatment strategies for geriatric-related cognitive disorders.

Attenuation of scopolamine-induced amnesia in mice

Numerous studies suggest that age-related declines in memory storage are related to impairment of central cholinergic systems. Scopolamine, a muscarinic cholinergic antagonist, has been used with young humans and other animal species as a model of the cognitive impairment that often accompanies normal and pathological aging. The present study examined whether amnesia induced by scopolamine could be counteracted in mice by arecoline, a cholinergic agonist, or by other drugs, epinephrine or glucose, which have been found to enhance memory in aged rodents and humans. Young mice were administered scopolamine (3 mg/kg, IP) or saline prior to training on an inhibitory avoidance apparatus. Immediately after training, animals received injections of epinephrine (0.01, 0.05, 0.1, and 0.2 mg/kg), glucose (10, 100, and 250 mg/kg), arecoline (0.5, 1, 2, 5, 10, and 20 mg/kg), or saline. The results indicate that pre-training scopolamine reliably impaired retention assessed in test trials 48 h after training. This impairment was not attenuated by any post-training dose of arecoline; however, immediate post-training injections of both epinephrine (at 0.05 mg/kg) and glucose (at 100 mg/kg) significantly reduced the amnesia. Neither of these drugs was effective if injections were delayed by 1 h after training. These results support the value of scopolamine as a model of age-related memory impairments, but suggest further that these memory deficits may be particularly susceptible to attenuation with non-cholinergic treatments.

Neuropeptides: conductors of the immune orchestra

There is increasing evidence for a bidirectional communications system between the immune system and the brain. Many of the substances involved in this communication appear to be neuropeptides. These findings have given biochemical validity to the clinical and epidemiological studies that have suggested that psychosocial factors can modulate the response to infections and neoplasms.