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Vigne MM, Kweon J, Fukuda AM, Brown JC, Carpenter LL. The Role of Brain Derived Neurotrophic Factor Polymorphism in Transcranial Magnetic Stimulation Response for Major Depressive Disorder. J ECT 2025:00124509-990000000-00268. [PMID: 40036478 DOI: 10.1097/yct.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2025]
Abstract
OBJECTIVES Repetitive transcranial magnetic stimulation (rTMS) is a safe and effective therapy for treatment-resistant depression (TRD). A crucial next step in improving rTMS therapy is to identify response predictors to inform patient selection criteria. Brain-derived neurotrophic factor (BDNF) exerts influence over TRD treatment modalities. BDNF polymorphism, Val66Met, has shown altered cortical plasticity after single-session rTMS in healthy subjects and clinical response in noninvasive brain stimulation methods in major depressive disorder, stroke, Alzheimer's, and cerebral palsy. We sought to evaluate the effect of this BDNF polymorphism on clinical response in a standard course of rTMS therapy for TRD. METHODS In this naturalistic study, 75 patients with TRD completed a standard course of rTMS with weekly clinical assessments via the Inventory of Depressive Symptomatology Self-Report (IDS-SR). BDNF polymorphisms were retrospectively compared in respect to treatment response and remission, baseline and final scores, percent change scores, and scores across the 6-week treatment course. RESULTS As expected, rTMS significantly decreased depressive symptoms as measured by IDS-SR scores. No difference was found in baseline, final, or percent change IDS-SR scores between polymorphism types. There was no difference between polymorphisms in IDS-SR scores across the treatment course. Response and remission rates did not differ between genotypes. CONCLUSIONS In contrast to previous research highlighting differential response between BDNF polymorphisms to motor plasticity and clinical rTMS outcomes, our data suggest that BDNF polymorphism status may not influence the response to a standard course of 10-Hz rTMS for major depressive disorder. Differences in TMS protocol, target, or BDNF serum levels may underlie our results.
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Affiliation(s)
- Megan M Vigne
- From the Neuromodulation Research Facility, Butler Hospital, Providence, RI
| | - Jamie Kweon
- Brain Stimulation Mechanisms Laboratory, Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
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Gredicak M, Nikolac Perkovic M, Nedic Erjavec G, Uzun S, Kozumplik O, Svob Strac D, Pivac N. Association between reduced plasma BDNF concentration and MMSE scores in both chronic schizophrenia and mild cognitive impairment. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111086. [PMID: 39002927 DOI: 10.1016/j.pnpbp.2024.111086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/06/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
Reduced brain derived neurotrophic factor (BDNF) concentration is reported to be associated with a cognitive decline in schizophrenia, depending on the stage of the disease. Aim of the study was to examine the possible association between plasma BDNF and cognitive decline in chronic stable schizophrenia and mild cognitive impairment (MCI). The study included 123 inpatients of both sexes with schizophrenia, 123 patients with MCI and 208 healthy control subjects. Cognitive abilities were assessed using mini mental state examination (MMSE), Clock Drawing test (CDT) and cognitive subscale of the Positive and Negative Syndrome Scale (PANSS). Plasma BDNF concentration was determined using ELISA. BDNF concentration was lower in patients with schizophrenia and MCI compared to age-matched healthy controls and was similar in carriers of different BDNF Val/66Met genotypes. The MMSE and CDT scores were lower in patients with schizophrenia compared to healthy controls and subjects with MCI. Reduced plasma BDNF was significantly associated with lower MMSE scores in all subjects. BDNF concentration in patients with schizophrenia was not affected by clinical and demographic factors. BDNF Val66Met polymorphism was not associated with the MMSE scores in all participants. Further studies should include longitudinal follow-up and other cognitive scales to confirm these results and offer cognition-improving strategies to prevent cognitive decline in chronic schizophrenia.
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Affiliation(s)
- Martin Gredicak
- General Hospital Zabok and Hospital for the Croatian Veterans, Zabok, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Zagreb.
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Zagreb.
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatry, Clinics for Psychiatry Vrapce, Zagreb, Croatia; School of Medicine University of Zagreb, Croatia
| | - Oliver Kozumplik
- Department for Biological Psychiatry and Psychogeriatry, Clinics for Psychiatry Vrapce, Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Zagreb.
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Zagreb; University of Applied Sciences Hrvatsko Zagorje Krapina, Krapina, Croatia.
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Chu L, Sun X, Jia X, Li D, Gao P, Zhang Y, Li J. The Relationship Among BDNF Val66Met Polymorphism, Plasma BDNF Level, and Trait Anxiety in Chinese Patients With Panic Disorder. Front Psychiatry 2022; 13:932235. [PMID: 35815047 PMCID: PMC9259790 DOI: 10.3389/fpsyt.2022.932235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is a candidate for susceptibility locus of Panic disorder (PD). However, the findings about the role of the BDNF Val66Met variant in PD were not consistent. Till now, the relationship between BDNF Val66Met polymorphism and anxiety-related traits in PD patients has been rarely explored. This study aimed to explore the relationship among BDNF Val66Met polymorphism, plasma BDNF level and anxiety-related trait in Chinese PD patients. METHOD This multi-center study included 116 PD patients and 99 health controls. We detected single-nucleotide polymorphism (SNP) of BDNF rs6265 (Val66Met) and BDNF plasma level in the two groups. In addition, PD patients were administered the State-Trait Anxiety Inventory (STAI), Panic Disorder Severity Scale-Chinese Version (PDSS-CV) and Hamilton Anxiety Rating Scale (HAMA-14). Quantitative comparison of the differences of BDNF concentration among subjects with different genotypes and association between BDNF Val66Met genotype and trait anxiety were performed. RESULTS There were no significant differences in the genotype frequency (p = 0.79) or allele frequency (p = 0.88) between PD patients and health controls. BDNF plasma levels of PD patients were significantly lower than those in control group (p = 0.003). BDNF plasma levels of the Met/Met genotype were significantly lower than those of Val/Met genotype in PD patients (p = 0.033). PD patients carried Met/Met genotype showed significantly higher scores in STAI trait compared to those carried Val/Val genotype (p = 0.045) and Val/Met genotype (p = 0.018). STAI trait scores of PD patients with agoraphobia were significantly higher than those of patients without agoraphobia (p < 0.05). The ANCOVA showed that the dependent variable STAI trait score was significantly affected by factor "genotype" (Val/Val, Val/Met, Met/Met, p = 0.029), and covariate "agoraphobia" (p = 0.008). In this model, 11.5% of the variance of the STAI trait score was explained by the BDNF genotype. Contrast analysis showed STAI trait scores of Met/Met subjects were significantly higher than those of Val/Met (p = 0.018) and Val/Val individuals (p = 0.045). CONCLUSION We found that anxiety trait was associated with the BDNF polymorphism in PD patients. BDNF Met/Met genotype may decrease plasma BDNF level and increase trait anxiety in panic disorder.
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Affiliation(s)
- Lijun Chu
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Xia Sun
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Xiaoju Jia
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Dazhi Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Ping Gao
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Yong Zhang
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
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Rana S, Sultana A, Bhatti AA. Effect of interaction between obesity-promoting genetic variants and behavioral factors on the risk of obese phenotypes. Mol Genet Genomics 2021; 296:919-938. [PMID: 33966103 DOI: 10.1007/s00438-021-01793-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/22/2021] [Indexed: 01/28/2023]
Abstract
The studies investigating gene-gene and gene-environment (or gene-behavior) interactions provide valuable insight into the pathomechanisms underlying obese phenotypes. The Pakistani population due to its unique characteristics offers numerous advantages for conducting such studies. In this view, the current study was undertaken to examine the effects of gene-gene and gene-environment/behavior interactions on the risk of obesity in a sample of Pakistani population. A total of 578 adult participants including 290 overweight/obese cases and 288 normal-weight controls were involved. The five key obesity-associated genetic variants namely MC4R rs17782313, BDNF rs6265, FTO rs1421085, TMEM18 rs7561317, and NEGR1 rs2815752 were genotyped using the TaqMan allelic discrimination assays. The data related to behavioral factors, such as eating pattern, diet consciousness, the tendency toward fat-dense food (TFDF), sleep duration, sleep-wake cycle (SWC), shift work (SW), and physical activity levels were collected via a questionnaire. Gene-gene and gene-behavior interactions were analyzed by multifactor dimensionality reduction and linear regression, respectively. In our study, only TMEM18 rs7561317 was found to be significantly associated with anthropometric traits with no significant effect of gene-gene interactions were observed on obesity-related phenotypes. However, the genetic variants were found to interact with the behavioral factors to significantly influence various obesity-related anthropometric traits including BMI, waist circumference, hip circumference, waist-to-hip ratio, waist-to-height ratio, and percentage of body fat. In conclusion, the interaction between genetic architecture and behavior/environment determines the outcome of obesity-related anthropometric phenotypes. Thus, gene-environment/behavior interaction studies should be promoted to explore the risk of complex and multifactorial disorders, such as obesity.
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Affiliation(s)
- Sobia Rana
- Molecular Biology and Human Genetics Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research (PCMD), International Center for Chemical and Biological Sciences (ICCBS), University of Karachi, Karachi, 75270, Pakistan.
| | - Ayesha Sultana
- Molecular Biology and Human Genetics Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research (PCMD), International Center for Chemical and Biological Sciences (ICCBS), University of Karachi, Karachi, 75270, Pakistan
| | - Adil Anwar Bhatti
- Molecular Biology and Human Genetics Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research (PCMD), International Center for Chemical and Biological Sciences (ICCBS), University of Karachi, Karachi, 75270, Pakistan
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Colle R, Trabado S, David DJ, Brailly-Tabard S, Hardy P, Falissard B, Fève B, Becquemont L, Verstuyft C, Corruble E. Plasma BDNF Level in Major Depression: Biomarker of the Val66Met BDNF Polymorphism and of the Clinical Course in Met Carrier Patients. Neuropsychobiology 2018; 75:39-45. [PMID: 28848102 DOI: 10.1159/000478862] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 06/19/2017] [Indexed: 12/18/2022]
Abstract
AIMS Despite the involvement of the brain-derived neurotrophic factor (BDNF) in the physiopathology of major depressive disorder (MDD), the coherence between the components of the BDNF pathway and their link with the clinical features of MDD are insufficiently studied. We aimed to assess in Caucasian depressed patients the impact of the BDNF Val66Met polymorphism on plasma BDNF levels taking into account the clinical characteristics of MDD. METHODS A total of 328 Caucasian adult MDD patients with a current major depressive episode (MDE) were assessed for the BDNF Val66Met polymorphism, plasma BDNF levels and clinical characteristics of the MDD. RESULTS Plasma BDNF levels were linearly associated with the BDNF Val66Met genotypes (ValVal: 1,525.9 ± 1,183.3 pg/mL vs. ValMet: 1,248.7 ± 1,081.8 vs. MetMet: 1,004.9 ± 952.8; p = 0.04), Met carriers having lower BDNF levels than ValVal ones. Significant interactions between the Val66Met polymorphism and 3 clinical characteristics - age at onset (p = 0.03), MDD duration (p = 0.04), and number of previous MDE (p = 0.04) - were evidenced for plasma BDNF levels. Indeed, in Met carriers, but not in ValVal ones, plasma BDNF levels were negatively correlated with age at onset and positively correlated with MDD duration and number of previous MDE. CONCLUSION Our results show a measurable, coherent, and functional BDNF pathway based on the BDNF Val66Met polymorphism and plasma BDNF levels in patients with a current MDE. This pathway is related to the clinical course of major depression, plasma BDNF levels being associated with the long-term history of MDD in Met carriers. Further studies assessing central BDNF are needed to understand the underlying mechanisms of this association.
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Affiliation(s)
- Romain Colle
- INSERM UMR 1178, Université Paris Sud, Service de Psychiatrie, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris, France
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6
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Laricchiuta D, Andolina D, Angelucci F, Gelfo F, Berretta E, Puglisi-Allegra S, Petrosini L. Cerebellar BDNF Promotes Exploration and Seeking for Novelty. Int J Neuropsychopharmacol 2018; 21:485-498. [PMID: 29471437 PMCID: PMC5932472 DOI: 10.1093/ijnp/pyy015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/29/2018] [Accepted: 02/13/2018] [Indexed: 12/11/2022] Open
Abstract
Background Approach system considered a motivational system that activates reward-seeking behavior is associated with exploration/impulsivity, whereas avoidance system considered an attentional system that promotes inhibition of appetitive responses is associated with active overt withdrawal. Approach and avoidance dispositions are modulated by distinct neurochemical profiles and synaptic patterns. However, the precise working of neurons and trafficking of molecules in the brain activity predisposing to approach and avoidance are yet unclear. Methods In 3 phenotypes of inbred mice, avoiding, balancing, and approaching mice, selected by using the Approach/Avoidance Y-maze, we analyzed endogenous brain levels of brain derived neurotrophic factor, one of the main secretory proteins with pleiotropic action. To verify the effects of the acute increase of brain derived neurotrophic factor, balancing and avoiding mice were bilaterally brain derived neurotrophic factor-infused in the cortical cerebellar regions. Results Approaching animals showed high levels of explorative behavior and response to novelty and exhibited higher brain derived neurotrophic factor levels in the cerebellar structures in comparison to the other 2 phenotypes of mice. Interestingly, brain derived neurotrophic factor-infused balancing and avoiding mice significantly increased their explorative behavior and response to novelty. Conclusions Cerebellar brain derived neurotrophic factor may play a role in explorative and novelty-seeking responses that sustain the approach predisposition.
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Affiliation(s)
- Daniela Laricchiuta
- Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Faculty of Medicine and Psychology, University “Sapienza” of Rome, Rome, Italy
| | - Diego Andolina
- Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Faculty of Medicine and Psychology, University “Sapienza” of Rome, Rome, Italy
| | - Francesco Angelucci
- Fondazione Santa Lucia, Rome, Italy
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Francesca Gelfo
- Fondazione Santa Lucia, Rome, Italy
- Department of TeCoS, Guglielmo Marconi University, Rome, Italy
| | - Erica Berretta
- Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Faculty of Medicine and Psychology, University “Sapienza” of Rome, Rome, Italy
- Behavioral Neuroscience PhD Programme
| | - Stefano Puglisi-Allegra
- Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Faculty of Medicine and Psychology, University “Sapienza” of Rome, Rome, Italy
| | - Laura Petrosini
- Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Faculty of Medicine and Psychology, University “Sapienza” of Rome, Rome, Italy
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7
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Liu PZ, Nusslock R. Exercise-Mediated Neurogenesis in the Hippocampus via BDNF. Front Neurosci 2018; 12:52. [PMID: 29467613 PMCID: PMC5808288 DOI: 10.3389/fnins.2018.00052] [Citation(s) in RCA: 299] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/23/2018] [Indexed: 12/16/2022] Open
Abstract
Exercise is known to have numerous neuroprotective and cognitive benefits, especially pertaining to memory and learning related processes. One potential link connecting them is exercise-mediated hippocampal neurogenesis, in which new neurons are generated and incorporated into hippocampal circuits. The present review synthesizes the extant literature detailing the relationship between exercise and hippocampal neurogenesis, and identifies a key molecule mediating this process, brain-derived neurotrophic factor (BDNF). As a member of the neurotrophin family, BDNF regulates many of the processes within neurogenesis, such as differentiation and survival. Although much more is known about the direct role that exercise and BDNF have on hippocampal neurogenesis in rodents, their corresponding cognitive benefits in humans will also be discussed. Specifically, what is known about exercise-mediated hippocampal neurogenesis will be presented as it relates to BDNF to highlight the critical role that it plays. Due to the inaccessibility of the human brain, much less is known about the role BDNF plays in human hippocampal neurogenesis. Limitations and future areas of research with regards to human neurogenesis will thus be discussed, including indirect measures of neurogenesis and single nucleotide polymorphisms within the BDNF gene.
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Affiliation(s)
- Patrick Z. Liu
- Department of Psychology, Northwestern University, Evanston, IL, United States
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Ambrus L, Sunnqvist C, Ekman R, Träskman-Bendz L, Westrin Å. Plasma Brain-Derived Neurotrophic Factor and Psychopathology in Attempted Suicide. Neuropsychobiology 2017; 73:241-8. [PMID: 27327436 DOI: 10.1159/000446286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 04/19/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Increasing evidence suggests a link between brain-derived neurotrophic factor (BDNF) and suicidal behaviour (SB). Furthermore, decreased peripheral BDNF levels have been associated with clinical symptoms in various psychiatric disorders as well as with personality dimensions in healthy individuals. However, the relationship between BDNF and psychopathology is poorly investigated regarding SB. METHODS Plasma BDNF concentrations were analysed in 61 recent suicide attempters. Clinical symptoms were evaluated using the Comprehensive Psychopathological Rating Scale. Personality dimensions were assessed using the Marke-Nyman Temperament Scale. RESULTS Plasma BDNF correlated positively and significantly with the personality dimension Solidity but not with the other personality dimensions or with clinical symptoms. CONCLUSION BDNF plays an important role in the regulation of neuroplasticity and neurogenesis in humans. Our results indicate that lower BDNF concentrations are associated with higher levels of impulsiveness and changeability (low scores on the Solidity scale). Furthermore, low plasma BDNF levels may be proposed as a trait marker rather than a state marker for attempted suicide.
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Affiliation(s)
- Livia Ambrus
- Psychiatry Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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Peng JH, Liu CW, Pan SL, Wu HY, Liang QH, Gan RJ, Huang L, Ding Y, Bian ZY, Huang H, Lv ZP, Zhou XL, Yin RX. Potential unfavorable impacts of BDNF Val66Met polymorphisms on metabolic risks in average population in a longevous area. BMC Geriatr 2017; 17:4. [PMID: 28056856 PMCID: PMC5217242 DOI: 10.1186/s12877-016-0393-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/08/2016] [Indexed: 12/14/2022] Open
Abstract
Background Brain-derived neurotrophic factor (BDNF) has been implicated in cognitive performance and the modulation of several metabolic parameters in some disease models, but its potential roles in successful aging remain unclear. We herein sought to define the putative correlation between BDNF Val66Met and several metabolic risk factors including BMI, blood pressure, fasting plasma glucose (FPG) and lipid levels in a long-lived population inhabiting Hongshui River Basin in Guangxi. Methods BDNF Val66Met was typed by ARMS-PCR for 487 Zhuang long-lived individuals (age ≥ 90, long-lived group, LG), 593 of their offspring (age 60–77, offspring group, OG) and 582 ethnic-matched healthy controls (aged 60–75, control group, CG) from Hongshui River Basin. The correlations of genotypes with metabolic risks were then determined. Results As a result, no statistical difference was observed on the distribution of allelic and genotypic frequencies of BDNF Val66Met among the three groups (all P > 0.05) except that AA genotype was dramatically higher in females than in males of CG. The HDL-C level of A allele (GA/AA genotype) carriers was profoundly lower than was non-A (GG genotype) carriers in the total population and the CG (P = 0.009 and 0.006, respectively), which maintained in females, hyperglycemic and normolipidemic subgroup of CG after stratification by gender, BMI, glucose and lipid status. Furthermore, allele A carriers, with a higher systolic blood pressure, exhibited 1.63 folds higher risk than non-A carriers to be overweight in CG (OR = 1.63, 95% CI: 1.05 - 2.55, P = 0.012). Multiple regression analysis displayed that the TC level of LG reversely associated with BDNF Val66Met genotype. Conclusions These data suggested that BDNF 66Met may play unfavorable roles in blood pressure and lipid profiles in the general population in Hongshui River area which might in part underscore their poorer survivorship versus the successful aging individuals and their offspring. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0393-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun-Hua Peng
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China.,Guangxi Colleges and Universities Key Laboratory of Human Development and Disease Research, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Cheng-Wu Liu
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China.,Guangxi Colleges and Universities Key Laboratory of Human Development and Disease Research, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Shang-Ling Pan
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China. .,Guangxi Colleges and Universities Key Laboratory of Human Development and Disease Research, 22 Shuangyong Road, Nanning, 530021, Guangxi, China.
| | - Hua-Yu Wu
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Qing-Hua Liang
- Department of Neurology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, 85 Hedi Road, Nanning, 530021, Guangxi, China
| | - Rui-Jing Gan
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Ling Huang
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Yi Ding
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Zhang-Ya Bian
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Hao Huang
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Ze-Ping Lv
- Department of Neurology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, 85 Hedi Road, Nanning, 530021, Guangxi, China
| | - Xiao-Ling Zhou
- Department of Pathophysiology, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Rui-Xing Yin
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi, China
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Eshragh J, Dhruva A, Paul SM, Cooper BA, Mastick J, Hamolsky D, Levine JD, Miaskowski C, Kober KM. Associations Between Neurotransmitter Genes and Fatigue and Energy Levels in Women After Breast Cancer Surgery. J Pain Symptom Manage 2017; 53:67-84.e7. [PMID: 27720787 PMCID: PMC5191954 DOI: 10.1016/j.jpainsymman.2016.08.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/19/2016] [Accepted: 08/03/2016] [Indexed: 12/16/2022]
Abstract
CONTEXT Fatigue is a common problem in oncology patients. Less is known about decrements in energy levels and the mechanisms that underlie both fatigue and energy. OBJECTIVES In patients with breast cancer, variations in neurotransmitter genes between lower and higher fatigue latent classes and between the higher and lower energy latent classes were evaluated. METHODS Patients completed assessments before and monthly for six months after surgery. Growth mixture modeling was used to identify distinct latent classes for fatigue severity and energy levels. Thirty candidate genes involved in various aspects of neurotransmission were evaluated. RESULTS Eleven single-nucleotide polymorphisms or haplotypes (i.e., ADRB2 rs1042718, BDNF rs6265, COMT rs9332377, CYP3A4 rs4646437, GALR1 rs949060, GCH1 rs3783642, NOS1 rs9658498, NOS1 rs2293052, NPY1R Haplotype A04, SLC6A2 rs17841327, and 5HTTLPR + rs25531 in SLC6A4) were associated with latent class membership for fatigue. Seven single-nucleotide polymorphisms or haplotypes (i.e., NOS1 rs471871, SLC6A1 rs2675163, SLC6A1 Haplotype D01, SLC6A2 rs36027, SLC6A3 rs37022, SLC6A4 rs2020942, and TAC1 rs2072100) were associated with latent class membership for energy. Three of 13 genes (i.e., NOS1, SLC6A2, and SLC6A4) were associated with latent class membership for both fatigue and energy. CONCLUSIONS Molecular findings support the hypothesis that fatigue and energy are distinct, yet related symptoms. Results suggest that a large number of neurotransmitters play a role in the development and maintenance of fatigue and energy levels in breast cancer patients.
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Affiliation(s)
- Jasmine Eshragh
- School of Nursing, University of California, San Francisco, California, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | | | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA.
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11
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Dooley LN, Ganz PA, Cole SW, Crespi CM, Bower JE. Val66Met BDNF polymorphism as a vulnerability factor for inflammation-associated depressive symptoms in women with breast cancer. J Affect Disord 2016; 197:43-50. [PMID: 26967918 PMCID: PMC4836957 DOI: 10.1016/j.jad.2016.02.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/15/2015] [Accepted: 02/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inflammation contributes to the development of depression in a subset of individuals, but risk factors that render certain individuals particularly vulnerable to inflammation-associated depression are undetermined. Drawing from animal studies showing that reduced neuroplasticity mediates effects of inflammation on depression, we hypothesized that individuals genetically predisposed to lower levels of neuroplasticity would be more susceptible to inflammation-associated depression. The current study examined whether the Met allele of the BDNF Val66met polymorphism, which predisposes individuals to reduced levels of brain-derived neurotrophic factor (BDNF), a protein vital for neuroplasticity, moderates the association between inflammation and depressive symptoms. METHODS Our sample was 112 women with early-stage breast cancer who had recently completed cancer treatment, which can activate inflammation. Participants provided blood for genotyping and assessment of circulating inflammatory markers, and completed a questionnaire assessing depressive symptoms, including somatic, affective, and cognitive dimensions. RESULTS There was a significant interaction between C-reactive protein (CRP) and the BDNF Val66met polymorphism in predicting cognitive depressive symptoms (p=.004), such that higher CRP was related to more cognitive depressive symptoms among Met allele carriers, but not among Val/Val homozygotes. Post-hoc longitudinal analyses suggested that, for Met carriers, higher CRP at baseline predicted higher cognitive depressive symptoms across a one-year follow-up period (p<.001). CONCLUSION The BDNF Met allele may be a risk factor for inflammation-associated cognitive depressive symptoms among breast cancer survivors. Women with breast cancer who carry this genotype may benefit from early identification and treatment. LIMITATION BDNF genotype is an indirect measure of BDNF protein levels.
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Affiliation(s)
- Larissa N. Dooley
- Department of Psychology, University of California, Los Angeles, United States,Corresponding author. Address: UCLA Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563. Tel.: 323 356 2767.
| | - Patricia A. Ganz
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States,Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA, United States
| | - Steve W. Cole
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States,Cousins Center of Psychoneuroimmunology, Semel Institute for Neuroscience, Los Angeles, CA, United States
| | - Catherine M. Crespi
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Julienne E. Bower
- Department of Psychology, University of California, Los Angeles, United States,Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA, United States,Cousins Center of Psychoneuroimmunology, Semel Institute for Neuroscience, Los Angeles, CA, United States,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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12
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Lack of an association of BDNF Val66Met polymorphism and plasma BDNF with hippocampal volume and memory. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2016; 15:625-43. [PMID: 25784293 DOI: 10.3758/s13415-015-0343-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) has been shown to be important for neuronal survival and synaptic plasticity in the hippocampus in nonhuman animals. The Val66Met polymorphism in the BDNF gene, involving a valine (Val) to methionine (Met) substitution at codon 66, has been associated with lower BDNF secretion in vitro. However, there have been mixed results regarding associations between either circulating BDNF or the BDNF Val66Met polymorphism with hippocampal volume and memory in humans. The current study examined the association of BDNF genotype and plasma BDNF with hippocampal volume and memory in two large independent cohorts of middle-aged and older adults (both cognitively normal and early-stage dementia). Sample sizes ranged from 123 to 649. Measures of the BDNF genotype, plasma BDNF, MRI-based hippocampal volume, and memory performance were obtained from the Knight Alzheimer Disease Research Center (ADRC) and the Alzheimer's Disease Neuroimaging Initiative (ADNI). There were no significant differences between BDNF Met+ and Met- groups on either hippocampal volume or memory in either cohort. In addition, plasma BDNF was not significantly associated with either hippocampal volume or memory in either cohort. Neither age, cognitive status, nor gender moderated any of the relationships. Overall, current findings suggest that BDNF genotype and plasma BDNF may not be robust predictors for variance in hippocampal volume and memory in middle age and older adult cohorts.
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Li RH, Fan M, Hu MS, Ran MS, Fang DZ. Reduced severity of posttraumatic stress disorder associated with Val allele of Val66Met polymorphism at brain-derived neurotrophic factor gene among Chinese adolescents after Wenchuan earthquake. Psychophysiology 2016; 53:705-11. [PMID: 26751724 DOI: 10.1111/psyp.12603] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/01/2015] [Indexed: 01/19/2023]
Abstract
The aim of the present study was to longitudinally investigate the association of BDNF Val66Met with PTSD symptoms in Chinese Han adolescents who experienced the 2008 Wenchuan earthquake. Variants of BDNF Val66Met were identified by polymerase chain reaction-restriction fragment length polymorphism analyses and verified by DNA sequencing. PTSD symptoms were assessed by the PTSD Checklist-Civilian Version (PCL-C) among high school students at 6, 12, and 18 months after the earthquake. No differences of PTSD prevalence and PCL-C scores were found between the Val/Val homozygotes and the Met allele carriers at 6, 12, and 18 months after the earthquake regardless of gender. Decreased PTSD prevalence was observed at 12 and 18 months when compared with that at 6 months after the earthquake regardless of gender and the genotype. Meanwhile, PCL-C scores were decreased consecutively in the female subjects regardless of the genotypes. However, the scores at 18 months were lower when compared with those at 12 months in the male Val/Val homozygotes, but not in the male Met allele carriers. In addition, differences were found for the predictors of PCL-C scores and PTSD prevalence between the Val/Val homozygotes and the Met allele carriers during follow-up. These findings suggest that the association of BDNF Val66Met with PTSD is longitudinally different in Chinese Han adolescents after the 2008 Wenchuan earthquake. The Val allele may be associated with reduced PTSD severity in male adolescents in the later stage of PTSD rehabilitation during follow-up.
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Affiliation(s)
- Rong Hui Li
- Department of Biochemistry and Molecular Biology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, P. R. China
| | - Mei Fan
- Department of Biochemistry and Molecular Biology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, P. R. China
| | - Min Shan Hu
- Department of Biochemistry and Molecular Biology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, P. R. China
| | - Mao Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, P. R. China
| | - Ding Zhi Fang
- Department of Biochemistry and Molecular Biology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, P. R. China
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Nomoto H, Baba H, Satomura E, Maeshima H, Takebayashi N, Namekawa Y, Suzuki T, Arai H. Serum brain-derived neurotrophic factor levels and personality traits in patients with major depression. BMC Psychiatry 2015; 15:33. [PMID: 25885038 PMCID: PMC4354762 DOI: 10.1186/s12888-015-0413-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/19/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family of growth factors. Previous studies have demonstrated lower serum BDNF levels in patients with major depressive disorder (MDD) and reported an association between BDNF levels and depression-related personality traits in healthy subjects. The aim of the present study was to explore for a possible association between peripheral BDNF levels and personality traits in patients with MDD. METHODS In this cross-sectional study, a total of 123 inpatients with MDD (Diagnostic and Statistical Manual for Mental Disorders, 4th edition) at the Juntendo University Koshigaya Hospital were recruited. Serum levels of BDNF were measured. Personality traits were assessed using the 125-item short version of the Temperament and Character Inventory (TCI). RESULTS Multiple regression analysis adjusted for age, sex, body mass index, dose of antidepressant, and depression severity showed that TCI Self-Directedness (SD) scores were negatively associated with serum BDNF levels (β = -0.23, p = 0.026). CONCLUSIONS MDD patients who have low SD did not show the reduction in serum BDNF levels that is normally associated with depressive state. Our findings suggest that depression-related biological changes may not occur in these individuals.
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Affiliation(s)
- Hiroshi Nomoto
- Department of Psychiatry, Juntendo University, School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-ku, Japan.
| | - Hajime Baba
- Department of Psychiatry, Juntendo University, School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-ku, Japan. .,Juntendo University Mood Disorder Project (JUMP), Department of Psychiatry, Juntendo University Koshigaya Hospital, 560 Fukuroyama, 343-0032, Koshigaya, Saitama, Japan.
| | - Emi Satomura
- Department of Psychiatry, Juntendo University, School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-ku, Japan.
| | - Hitoshi Maeshima
- Department of Psychiatry, Juntendo University, School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-ku, Japan. .,Juntendo University Mood Disorder Project (JUMP), Department of Psychiatry, Juntendo University Koshigaya Hospital, 560 Fukuroyama, 343-0032, Koshigaya, Saitama, Japan.
| | - Naoko Takebayashi
- Department of Psychiatry, Juntendo University, School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-ku, Japan. .,Juntendo University Mood Disorder Project (JUMP), Department of Psychiatry, Juntendo University Koshigaya Hospital, 560 Fukuroyama, 343-0032, Koshigaya, Saitama, Japan.
| | - Yuki Namekawa
- Department of Psychiatry, Juntendo University, School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-ku, Japan. .,Juntendo University Mood Disorder Project (JUMP), Department of Psychiatry, Juntendo University Koshigaya Hospital, 560 Fukuroyama, 343-0032, Koshigaya, Saitama, Japan.
| | - Toshihito Suzuki
- Department of Psychiatry, Juntendo University, School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-ku, Japan. .,Juntendo University Mood Disorder Project (JUMP), Department of Psychiatry, Juntendo University Koshigaya Hospital, 560 Fukuroyama, 343-0032, Koshigaya, Saitama, Japan.
| | - Heii Arai
- Department of Psychiatry, Juntendo University, School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-ku, Japan.
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Phillips C, Baktir MA, Srivatsan M, Salehi A. Neuroprotective effects of physical activity on the brain: a closer look at trophic factor signaling. Front Cell Neurosci 2014; 8:170. [PMID: 24999318 PMCID: PMC4064707 DOI: 10.3389/fncel.2014.00170] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/02/2014] [Indexed: 12/18/2022] Open
Abstract
While the relationship between increased physical activity and cognitive ability has been conjectured for centuries, only recently have the mechanisms underlying this relationship began to emerge. Convergent evidence suggests that physical activity offers an affordable and effective method to improve cognitive function in all ages, particularly the elderly who are most vulnerable to neurodegenerative disorders. In addition to improving cardiac and immune function, physical activity alters trophic factor signaling and, in turn, neuronal function and structure in areas critical for cognition. Sustained exercise plays a role in modulating anti-inflammatory effects and may play a role in preserving cognitive function in aging and neuropathological conditions. Moreover, recent evidence suggests that myokines released by exercising muscles affect the expression of brain-derived neurotrophic factor synthesis in the dentate gyrus of the hippocampus, a finding that could lead to the identification of new and therapeutically important mediating factors. Given the growing number of individuals with cognitive impairments worldwide, a better understanding of how these factors contribute to cognition is imperative, and constitutes an important first step toward developing non-pharmacological therapeutic strategies to improve cognition in vulnerable populations.
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Affiliation(s)
- Cristy Phillips
- Department of Physical Therapy, Arkansas State University Jonesboro, AR, USA
| | - Mehmet Akif Baktir
- Department of Physiology, Erciyes University Kayseri, Turkey; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Malathi Srivatsan
- Department of Biological Sciences, Arkansas State University Jonesboro, AR, USA
| | - Ahmad Salehi
- VA Palo Alto Health Care System Palo Alto, CA, USA
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Abstract
The study of the biological basis of personality is a timely research endeavor, with the aim of deepening our understanding of human nature. In recent years, a growing body of research has investigated the role of the brain derived neurotrophic factor (BDNF) in the context of individual differences across human beings, with a focus on personality traits. A large number of different approaches have been chosen to illuminate the role of BDNF for personality, ranging from the measurement of BDNF in the serum/plasma to molecular genetics to (genetic) brain imaging. The present review provides the reader with an overview of the current state of affairs in the context of BDNF and personality.
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Tsuru J, Tanaka Y, Ishitobi Y, Maruyama Y, Inoue A, Kawano A, Ikeda R, Ando T, Oshita H, Aizawa S, Masuda K, Higuma H, Kanehisa M, Ninomiya T, Akiyoshi J. Association of BDNF Val66Met polymorphism with HPA and SAM axis reactivity to psychological and physical stress. Neuropsychiatr Dis Treat 2014; 10:2123-33. [PMID: 25419135 PMCID: PMC4234157 DOI: 10.2147/ndt.s68629] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Decreased expression of brain-derived neurotrophic factor (BDNF) is implicated in enhanced stress responses. The BDNF Val66Met polymorphism is associated with psychological changes; for example, carriers of the Met allele exhibit increased harm avoidance as well as a higher prevalence of depression and anxiety disorder. METHODS To analyze the effects of BDNF Val66Met on stress responses, we tested 226 university students (88 women and 138 men) using a social stress procedure (Trier Social Stress Test [TSST]) and an electrical stimulation stress test. Stress indices were derived from repeated measurements of salivary α-amylase, salivary cortisol, heart rate, and psychological testing during the stress tests. All subjects were genotyped for the Val66Met polymorphism (G196A). RESULTS A significant three-way interaction (time [3 levels] × BDNF [Val/Val, Val/Met, Met/Met]; P<0.05) was demonstrated that revealed different salivary cortisol responses in the TSST but not in electrical stimulation. Met/Met women had stronger cortisol responses than Val/Met and Val/Val individuals in the TSST. Met/Met men exhibited stronger salivary cortisol responses than Val/Met and Val/Val individuals in the TSST. CONCLUSION These results indicate that a common, functionally significant polymorphism in BDNF had different effects on hypothalamic-pituitary-adrenocortical axis reactivity but not on sympathetic adrenomedullary reactivity in TSST and electrical stimulation tests.
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Affiliation(s)
- Jusen Tsuru
- Department of Neuropsychiatry, Oita University, Oita, Japan
| | | | | | | | - Ayako Inoue
- Department of Neuropsychiatry, Oita University, Oita, Japan
| | - Aimi Kawano
- Department of Neuropsychiatry, Oita University, Oita, Japan
| | - Rie Ikeda
- Department of Neuropsychiatry, Oita University, Oita, Japan
| | - Tomoko Ando
- Department of Neuropsychiatry, Oita University, Oita, Japan
| | - Harumi Oshita
- Department of Applied Linguistics, Faculty of Medicine, Oita University, Oita, Japan
| | - Saeko Aizawa
- Department of Neuropsychiatry, Oita University, Oita, Japan
| | - Koji Masuda
- Department of Neuropsychiatry, Oita University, Oita, Japan
| | - Haruka Higuma
- Department of Neuropsychiatry, Oita University, Oita, Japan
| | | | - Taiga Ninomiya
- Department of Neuropsychiatry, Oita University, Oita, Japan
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Terracciano A, Piras MG, Lobina M, Mulas A, Meirelles O, Sutin AR, Chan W, Sanna S, Uda M, Crisponi L, Schlessinger D. Genetics of serum BDNF: meta-analysis of the Val66Met and genome-wide association study. World J Biol Psychiatry 2013; 14:583-9. [PMID: 22047184 PMCID: PMC3288597 DOI: 10.3109/15622975.2011.616533] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Lower levels of serum brain derived neurotrophic factor (BDNF) is one of the best known biomarkers of depression. To identify genetic variants associated with serum BDNF, we tested the Val66Met (rs6265) functional variant and conducted a genome-wide association scan (GWAS). METHODS In a community-based sample (N = 2054; aged 19-101, M = 51, SD = 15) from Sardinia, Italy, we measured serum BDNF concentration and conducted a GWAS. RESULTS We estimated the heritability of serum BDNF to be 0.48 from sib-pairs. There was no association between serum BDNF and Val66Met in the SardiNIA sample and in a meta-analysis of published studies (k = 13 studies, total n = 4727, P = 0.92). Although no genome-wide significant associations were identified, some evidence of association was found in the BDNF gene (rs11030102, P = 0.001) and at two loci (rs7170215, P = 4.8 × 10⁻⁵ and rs11073742 P = 1.2 × 10⁻⁵) near and within NTRK3 gene, a neurotrophic tyrosine kinase receptor. CONCLUSIONS Our study and meta-analysis of the literature indicate that the BDNF Val66Met variant is not associated with serum BDNF, but other variants in the BDNF and NTRK3 genes might regulate the level of serum BDNF.
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Affiliation(s)
| | - Maria Grazia Piras
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
| | - Monia Lobina
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
| | - Antonella Mulas
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
| | | | | | - Wayne Chan
- National Institute on Aging, NIH, DHHS, Baltimore, MD, USA
| | - Serena Sanna
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
| | - Manuela Uda
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
| | - Laura Crisponi
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
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Milaneschi Y, Cesari M, Simonsick EM, Vogelzangs N, Kanaya AM, Yaffe K, Patrignani P, Metti A, Kritchevsky SB, Pahor M, Ferrucci L, Penninx BWJH. Lipid peroxidation and depressed mood in community-dwelling older men and women. PLoS One 2013; 8:e65406. [PMID: 23776478 PMCID: PMC3679197 DOI: 10.1371/journal.pone.0065406] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/24/2013] [Indexed: 12/31/2022] Open
Abstract
It has been hypothesized that cellular damage caused by oxidative stress is associated with late-life depression but epidemiological evidence is limited. In the present study we evaluated the association between urinary 8-iso-prostaglandin F2α (8-iso-PGF2α), a biomarker of lipid peroxidation, and depressed mood in a large sample of community-dwelling older adults. Participants were selected from the Health, Aging and Body Composition study, a community-based longitudinal study of older persons (aged 70–79 years). The present analyses was based on a subsample of 1027 men and 948 women free of mobility disability. Urinary concentration of 8-iso-PGF2α was measured by radioimmunoassay methods and adjusted for urinary creatinine. Depressed mood was defined as a score greater than 5 on the 15-item Geriatric Depression Scale and/or use of antidepressant medications. Depressed mood was present in 3.0% of men and 5.5% of women. Depressed men presented higher urinary concentrations of 8-iso-PGF2α than non-depressed men even after adjustment for multiple sociodemographic, lifestyle and health factors (p = 0.03, Cohen’s d = 0.30). This association was not present in women (depressed status-by-sex interaction p = 0.04). Our study showed that oxidative damage may be linked to depression in older men from a large sample of the general population. Further studies are needed to explore whether the modulation of oxidative stress may break down the link between late-life depression and its deleterious health consequences.
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Affiliation(s)
- Yuri Milaneschi
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands.
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Brain-derived neurotrophic factor serum levels and genotype: association with depression during interferon-α treatment. Neuropsychopharmacology 2013; 38:985-95. [PMID: 23303061 PMCID: PMC3629388 DOI: 10.1038/npp.2012.263] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Depression has been associated with inflammation, and inflammation may both influence and interact with growth factors such as brain-derived neurotrophic factor (BDNF). Both the functional Val66Met BDNF polymorphism (rs6265) and BDNF levels have been associated with depression. It is thus plausible that decreased BDNF could mediate and/or moderate cytokine-induced depression. We therefore prospectively employed the Beck Depression Inventory-II (BDI-II), the Hospital Anxiety and Depression Scale (HADS), and the Montgomery-Asberg Depression Rating Scale (MADRS) in 124 initially euthymic patients during treatment with interferon-alpha (IFN-α), assessing serum BDNF and rs6265. Using mixed-effect repeated measures, lower pretreatment BDNF was associated with higher depression symptoms during IFN-α treatment (F144,17.2=6.8; P<0.0001). However, although the Met allele was associated with lower BDNF levels (F1,83.0=5.0; P=0.03), it was only associated with increased MADRS scores (F4,8.9=20.3; P<0.001), and not the BDI-II or HADS. An exploratory comparison of individual BDI-II items indicated that the Met allele was associated with suicidal ideation, sadness, and worthlessness, but not neurovegetative symptoms. Conversely, the serotonin transporter promoter polymorphism (5-HTTLPR) short allele was associated with neurovegetative symptoms such as insomnia, poor appetite and fatigue, but not sadness, worthlessness, or suicidal ideation. IFN-α therapy further lowered BDNF serum levels (F4,37.7=5.0; P=0.003), but this decrease occurred regardless of depression development. The findings thus do not support the hypothesis that decreasing BDNF is the primary pathway by which IFN-α worsens depression. Nonetheless, the results support the hypothesis that BDNF levels influence resiliency against developing inflammatory cytokine-associated depression, and specifically to a subset of symptoms distinct from those influenced by 5-HTTLPR.
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Buchman AS, Boyle PA, Wilson RS, Leurgans SE, Arnold SE, Bennett DA. Neuroticism, extraversion, and motor function in community-dwelling older persons. Am J Geriatr Psychiatry 2013; 21:145-54. [PMID: 23343488 PMCID: PMC3406259 DOI: 10.1016/j.jagp.2012.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 06/17/2011] [Accepted: 07/26/2011] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Personality traits are associated with adverse health outcomes in old age, but their association with motor function is unclear. We tested the hypothesis that neuroticism and extraversion are associated with motor decline in older persons. DESIGN Prospective, observational cohort study. SETTING Retirement communities across metropolitan Chicago. PARTICIPANTS Nine hundred eighty-three older persons without dementia. MEASUREMENTS At baseline, neuroticism and extraversion were assessed and annual assessment of 18 motor measures were summarized in a composite measure. RESULTS Average follow-up was 5 years. Separate linear mixed-effects models controlling for age, sex, and education showed that baseline levels of neuroticism and extraversion were associated with the rate of motor decline. For each 7-point (∼1 SD) higher neuroticism score at baseline, the average annual rate of motor decline was more than 20% faster. This amount of motor decline was associated with a 10% increased risk of death compared to a participant with an average neuroticism score. Each 6-point (∼1 SD) lower extraversion score at baseline was associated with an 8% faster rate of motor decline. This amount of motor decline was associated with about a 9% increased risk of death compared to a participant with an average extraversion score. Neuroticism and extraversion were relatively independently associated with motor decline. These associations were unchanged when controlling for depressive symptoms and current health status but were partially attenuated when controlling for late-life cognitive and social activities. CONCLUSIONS Higher levels of neuroticism and lower levels of extraversion are associated with more rapid motor decline in old age.
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Affiliation(s)
- Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA.
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Abstract
Neurotrophins and other growth factors have been advanced as critical modulators of depressive behavior. Support for this model is based on analyses of knockout and transgenic mouse models, human genetic studies, and screens for gene products that are regulated by depressive behavior and/or antidepressants. Even subtle alteration in the regulated secretion of brain-derived neurotrophic factor (BDNF), for example, due to a single nucleotide polymorphism (SNP)-encoded Val-Met substitution in proBDNF that affects processing and sorting, impacts behavior and cognition. Alterations in growth factor expression result in changes in neurogenesis as well as structural changes in neuronal cytoarchitecture, including effects on dendritic length and spine density, in the hippocampus, nucleus accumbens, and prefrontal cortex. These changes have the potential to impact the plasticity and stability of synapses in the CNS, and the complex brain circuitry that regulates behavior. Here we review the role that neurotrophins play in the modulation of depressive behavior, and the downstream signaling targets they regulate that potentially mediate these behavioral pro-depressant and antidepressant effects.
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Wu WW, Shen RF, Park SS, Martin B, Maudsley S. Precursor ion exclusion for enhanced identification of plasma biomarkers. Proteomics Clin Appl 2012; 6:304-8. [PMID: 22641611 DOI: 10.1002/prca.201100107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Our study aims to establish a plasma biomarker analysis workflow, with fewer fractionation steps, for enhanced identification of plasma biomarkers by precursor ion exclusion (PIE). EXPERIMENTAL DESIGN Plasma samples were depleted for highly abundant proteins, then further fractionated by molecular weight (MW), before trypsinization for LTQ-Orbitrap mass analysis. Data-dependent acquisition (DDA) was used for baseline analysis. PIE involves the re-injection of samples with exclusion of the previously identified peptides. We compared analyses using multiple PIE iterations, compared to DDA, for plasma interrogation RESULTS A higher percentage of unique plasma peptides was identified with PIE, compared to DDA. The first PIE iteration reveals an increase of 75-112% more peptides than the DDA method alone. PIE can interrogate complex plasma samples with the percentage of peptides identified successively increasing with even ≥4 iterations. The total number of peptides identified increases rapidly across the first three PIE iterations and then continues more slowly up to nine iterations. CONCLUSIONS AND CLINICAL RELEVANCE Iterative injections with PIE resulted in many more peptide identifications in plasma samples of varying degrees of complexity, compared to re-injections using similar DDA parameters. PIE methods may therefore expand our ability to recover plasma peptides for plasma biomarker discovery.
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Affiliation(s)
- Wells W Wu
- Metabolism Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
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Driscoll I, Martin B, An Y, Maudsley S, Ferrucci L, Mattson MP, Resnick SM. Plasma BDNF is associated with age-related white matter atrophy but not with cognitive function in older, non-demented adults. PLoS One 2012; 7:e35217. [PMID: 22523577 PMCID: PMC3327651 DOI: 10.1371/journal.pone.0035217] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/13/2012] [Indexed: 12/16/2022] Open
Abstract
Brain derived neurotrophic factor (BDNF) seems to be involved in regulation of synaptic plasticity and neurogenesis. BDNF plasma and serum levels have been associated with depression, Alzheimer's disease, and other psychiatric and neurodegenerative disorders. In a community sample, drawn from the Baltimore Longitudinal Study of Aging (BLSA), we examined whether BDNF plasma concentration was associated with rates of age-related change in cognitive performance (n = 429) and regional brain volume (n = 59). Plasma BDNF levels, which were significantly higher in females (p<0.05), were not associated with either concurrent cognitive performance or rates of age-related change in performance across cognitive domains (p's>0.05). Sex differences in the relationship between BDNF and the trajectories of regional brain volume changes were observed for the whole brain and frontal white matter volumes (p<0.05), whereby lower plasma BDNF was associated with steeper volume decline in females but not males. Together, our findings contribute to furthering the understanding of the relationships between plasma BDNF, structural brain integrity and cognition. Potential mechanisms mediating these relationships merit further investigation.
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Affiliation(s)
- Ira Driscoll
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland, United States of America.
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Bachmann V, Klein C, Bodenmann S, Schäfer N, Berger W, Brugger P, Landolt HP. The BDNF Val66Met polymorphism modulates sleep intensity: EEG frequency- and state-specificity. Sleep 2012; 35:335-44. [PMID: 22379239 PMCID: PMC3274334 DOI: 10.5665/sleep.1690] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES EEG slow waves are the hallmark of deep NREM sleep and may reflect the restorative functions of sleep. Evidence suggests that increased sleep slow waves after sleep deprivation reflect plastic synaptic processes, and that brain-derived neurotrophic factor (BDNF) is causally involved in their homeostatic regulation. The functional Val66Met polymorphism of the gene encoding pro-BDNF causes impaired activity-dependent secretion of mature BDNF protein. We investigated whether this polymorphism contributes to the pronounced inter-individual variation in sleep slow wave activity (SWA) in humans. SETTING Sleep laboratory in temporal isolation unit. PARTICIPANTS Eleven heterozygous Met allele carriers and 11 individually sex- and age-matched Val/Val homozygotes. INTERVENTIONS Forty hours prolonged wakefulness. MEASUREMENTS AND RESULTS Cognitive performance, subjective state, and waking and sleep EEG in baseline and after sleep deprivation were studied. Val/Val homozygotes showed better response accuracy than Met allele carriers on a verbal 2-back working memory task. This difference did not reflect genotype-dependent differences in sleepiness, well-being, or sustained attention. In baseline and recovery nights, deep stage 4 sleep and NREM sleep intensity as quantified by EEG SWA (0.75-4.5 Hz) were higher in Val/Val compared to Val/Met genotype. Similar to sleep deprivation, the difference was most pronounced in the first NREM sleep episode. By contrast, increased activity in higher EEG frequencies (> 6 Hz) in wakefulness and REM sleep was distinct from the effects of prolonged wakefulness. CONCLUSION BDNF contributes to the regulation of sleep slow wave oscillations, suggesting that genetically determined variation in neuronal plasticity modulates NREM sleep intensity in humans.
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Affiliation(s)
- Valérie Bachmann
- Institute of Pharmacology and Toxicology, University of Zürich, Switzerland
- Zürich Center for Integrative Human Physiology, University of Zürich, Switzerland
| | - Carina Klein
- Institute of Pharmacology and Toxicology, University of Zürich, Switzerland
| | - Sereina Bodenmann
- Institute of Pharmacology and Toxicology, University of Zürich, Switzerland
| | - Nikolaus Schäfer
- Institute of Medical Molecular Genetics, University of Zürich, Schwerzenbach, Switzerland
| | - Wolfgang Berger
- Institute of Medical Molecular Genetics, University of Zürich, Schwerzenbach, Switzerland
- Zürich Center for Integrative Human Physiology, University of Zürich, Switzerland
| | - Peter Brugger
- Department of Neurology, University Hospital Zürich, Switzerland
- Zürich Center for Integrative Human Physiology, University of Zürich, Switzerland
| | - Hans-Peter Landolt
- Institute of Pharmacology and Toxicology, University of Zürich, Switzerland
- Zürich Center for Integrative Human Physiology, University of Zürich, Switzerland
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Terracciano A, Lobina M, Piras MG, Mulas A, Cannas A, Meirelles O, Sutin AR, Zonderman AB, Uda M, Crisponi L, Schlessinger D. Neuroticism, depressive symptoms, and serum BDNF. Psychosom Med 2011; 73:638-42. [PMID: 21949427 PMCID: PMC3188695 DOI: 10.1097/psy.0b013e3182306a4f] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Animal models and clinical studies suggest that brain-derived neurotrophic factor (BDNF) is involved in the pathophysiology of depression. We test whether serum and plasma levels of BDNF are associated with trait neuroticism and its facets and with state measures of depressive symptoms. METHODS In a community-based cohort (N = 2099), we measured serum and plasma BDNF concentrations and administered the Revised NEO Personality Inventory and the Center for Epidemiological Studies Depression Scale. Covariates included age, sex, cigarette smoking, obesity, and antidepressant use. RESULTS Serum BDNF concentrations were inversely related to neuroticism (r = -0.074, p < .001), in particular the depression facet (r = -0.08, p < .001). Lower BDNF concentrations were also associated with severe depressive symptoms (Center for Epidemiological Studies Depression Scale ≥ 28; odds ratio = 0.906; 95% confidence interval = 0.851-0.965). The association of serum BDNF with neuroticism was independent of depressive symptoms, indicating that serum BDNF might represent a biological correlate of neuroticism and not just of transient depressive states. Plasma BDNF was not associated with measures of depression. CONCLUSIONS Our study suggests that lower serum BDNF is associated with both a dispositional vulnerability to depression and acute depressive states in the general population.
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Affiliation(s)
- Antonio Terracciano
- National Institute on Aging, National Institutes of Health, Department of Health and Human Services, 251 Bayview Blvd, Baltimore, MD 21224, USA.
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BDNF polymorphism predicts the rate of decline in skilled task performance and hippocampal volume in healthy individuals. Transl Psychiatry 2011; 1:e51. [PMID: 22833197 PMCID: PMC3309489 DOI: 10.1038/tp.2011.47] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Numerous studies have indicated a link between the presence of polymorphism in brain-derived neurotrophic factor (BDNF) and cognitive and affective disorders. However, only a few have studied these effects longitudinally along with structural changes in the brain. This study was carried out to investigate whether valine-to-methionine substitution at position 66 (val66met) of pro-BDNF could be linked to alterations in the rate of decline in skilled task performance and structural changes in hippocampal volume. Participants consisted of 144 healthy Caucasian pilots (aged 40-69 years) who completed a minimum of 3 consecutive annual visits. Standardized flight simulator score (SFSS) was measured as a reliable and quantifiable indicator for skilled task performance. In addition, a subset of these individuals was assessed for hippocampal volume alterations using magnetic resonance imaging. We found that val66met substitution in BDNF correlated longitudinally with the rate of decline in SFSS. Structurally, age-dependent hippocampal volume changes were also significantly altered by this substitution. Our study suggests that val66met polymorphism in BDNF can be linked to the rate of decline in skilled task performance. Furthermore, this polymorphism could be used as a predictor of the effects of age on the structure of the hippocampus in healthy individuals. Such results have implications for understanding possible disabilities in older adults performing skilled tasks who are at a higher risk for cognitive and affective disorders.Translational Psychiatry (2011) 1, e51; doi:10.1038/tp.2011.47; published online 25 October 2011.
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Chen SP, Fuh JL, Wang SJ, Tsai SJ, Hong CJ, Yang AC. Brain-derived neurotrophic factor gene Val66Met polymorphism modulates reversible cerebral vasoconstriction syndromes. PLoS One 2011; 6:e18024. [PMID: 21437208 PMCID: PMC3060928 DOI: 10.1371/journal.pone.0018024] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 02/18/2011] [Indexed: 11/28/2022] Open
Abstract
Background Reversible cerebral vasoconstriction syndrome (RCVS) could be complicated by cerebral ischemic events. Hypothetical mechanisms of RCVS involve endothelial dysfunction and sympathetic overactivity, both of which were reported to be related to brain-derived neurotrophic factor (BDNF). The study investigated the association between functional BDNF Val66Met polymorphism and RCVS. Methods Patients with RCVS and controls were prospectively recruited and genotyped for the BDNF Val66Met polymorphism. Magnetic resonance angiography (MRA) and transcranial color-coded Doppler sonography were employed to evaluate cerebral vasoconstriction. Genotyping results, clinical parameters, vasoconstriction scores, mean flow velocities of the middle cerebral artery (VMCA), and Lindegaard indices were analyzed. Split-sample approach was employed to internally validate the data. Principal Findings Ninety Taiwanese patients with RCVS and 180 age- and gender-matched normal controls of the same ethnicity completed the study. The genotype frequencies did not differ between patients and controls. Compared to patients with Met/Met homozygosity, patients with Val allele had higher mean vasoconstriction scores of all arterial segments (1.60±0.72 vs. 0.87±0.39, p<0.001), VMCA values (116.7±36.2 vs. 82.7±17.9 cm/s, p<0.001), and LI (2.41±0.91 vs. 1.89±0.41, p = 0.001). None of the Met/Met homozygotes, but 38.9% of the Val carriers, had VMCA values of >120 cm/s (p<0.001). Split-sample validation by randomization, age, entry time or residence of patients demonstrated concordant findings. Conclusions Our findings link BDNF Val66Met polymorphism with the severity of RCVS for the first time and implicate possible pathogenic mechanisms for vasoconstriction in RCVS.
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Affiliation(s)
- Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail:
| | - Shih-Jen Tsai
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Jee Hong
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Albert C. Yang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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