1
|
Wen C, Liu X, Lian Y, Guo W, Zhang L, Chen Y, Lan X, Li M, Zhang S, Huang W, Zou J, Chen H. Analysis of the association between long-term exposure to low-dose ionizing radiation and dyslipidemia and its components in medical radiologists: The mediating role of inflammatory markers. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2025; 25:200406. [PMID: 40290399 PMCID: PMC12023881 DOI: 10.1016/j.ijcrp.2025.200406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Revised: 03/20/2025] [Accepted: 04/10/2025] [Indexed: 04/30/2025]
Abstract
Introduction Our study aimed to explore the association between long-term exposure to low-dose ionizing radiation (LDIR) and dyslipidemia and its components among medical radiologists, and to identify the mediating role of inflammatory markers. Methods This cross-sectional study was conducted on 3918 medical radiologists, with data collected through questionnaires and occupational external exposure dosimeters. The multifactorial logistic regression and restricted cubic spline model were used to analyze the association between long-term exposure to LDIR and dyslipidemia and its components among medical radiologists, and mediation analysis was used to identify potential mediation effects. Results Of 3918 medical radiologists, 995 (25.4 %) had dyslipidemia. The gender, age, body mass index (BMI), and smoking status were influential factors for dyslipidemia of medical radiologists. After adjusting for confounders, the OR and 95 % CI for the occurrence of dyslipidemia and high TG in the highest tertile group (Q3) were 1.32 (95 % CI: 1.04, 1.67) and 1.51 (95 % CI: 1.11, 2.07), respectively. Restricted cubic spline model showed that the cumulative effective dose was linearly associated with both dyslipidemia and high TG, and the risk of dyslipidemia and high TG increased with the cumulative effective dose. Mediation analysis suggested that the inflammatory marker SII significantly mediated the association between cumulative effective dose and TG levels. Conclusion Our study shows that medical radiologists have a high detection rate of dyslipidemia, and the risk of dyslipidemia and high TG increases with increasing cumulative effective dose. Inflammatory marker SII may play a mediating role in the association between cumulative effective dose and TG levels.
Collapse
Affiliation(s)
- Changyong Wen
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, Guangdong, China
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Xiaolian Liu
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Yiqing Lian
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Weizhen Guo
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Lingyu Zhang
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Yanting Chen
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Xin Lan
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Mingfang Li
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Sufen Zhang
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Weixu Huang
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Jianming Zou
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| | - Huifeng Chen
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, Guangdong, China
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, 510300, Guangdong, China
| |
Collapse
|
2
|
Qu W, Yan G, Du Y, Zhou X, Huang C, Li B, Zhou J, Li Q. Crosstalk Between Mitochondrial DNA and Immune Response: Focus on Autism Spectrum Disorder. Mol Neurobiol 2025; 62:5629-5639. [PMID: 39589631 DOI: 10.1007/s12035-024-04637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 11/16/2024] [Indexed: 11/27/2024]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by multiple dysfunctions in behavior, the nervous system, and the immune system. Increasing evidence suggests that mitochondrial DNA (mtDNA) plays a crucial role in the pathology of ASD. In clinical practice, altered mtDNA levels have been observed in various tissues of individuals with ASD. Mutation or oxidation of mtDNA is also closely related to the immune response associated with the pathology of autism. With mtDNA identified as a causal factor, much interest has focused on how its production affects neurodevelopment and neurophysiology. Here, we review how mtDNA leads to dysfunction of cellular mitochondria and immune response. We also illustrate the relationship between mtDNA alterations and the pathology of autism. Finally, we discuss the existing evidence on cell-free mtDNA associated with ASD and look forward to its application in clinical diagnosis and treatment.
Collapse
Affiliation(s)
- Wenxuan Qu
- Department of Central Laboratory, School of Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, Putuo District, China
| | - Ge Yan
- Department of Central Laboratory, School of Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, Putuo District, China
| | - Yajuan Du
- Department of Central Laboratory, School of Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, Putuo District, China
| | - Xinyang Zhou
- Department of Central Laboratory, School of Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, Putuo District, China
| | - Chutian Huang
- Department of Central Laboratory, School of Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, Putuo District, China
| | - Bei Li
- Department of Central Laboratory, School of Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, Putuo District, China
| | - Junmei Zhou
- Department of Central Laboratory, School of Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, Putuo District, China
| | - Qian Li
- Department of Central Laboratory, School of Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, Putuo District, China.
| |
Collapse
|
3
|
Liu Z, Wang L, Yu L, Zhao Y, Zhu M, Wang Y, Cao A. Identification of immune cells and circulating inflammatory factors associated with neurodevelopmental disorders by bidirectional Mendelian randomization and mediation analysis. Sci Rep 2025; 15:12840. [PMID: 40229469 PMCID: PMC11997206 DOI: 10.1038/s41598-025-98020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 04/08/2025] [Indexed: 04/16/2025] Open
Abstract
The roles of various immune cells and circulating inflammatory factors in neurodevelopmental disorders (NDDs) remain controversial. Therefore we employed a two-sample and bidirectional Mendelian randomization and mediation method to explore the causal relationships between immune cells, circulating inflammatory factors, and NDDs. All data were originated from Genome-Wide Association Study (GWAS) datasets. We found a significant positive causal relationship between 13 immune cells and autism spectrum disorder (ASD), including six CD8+ T cells, one CD3+ T cell, two CD20+ B cells, one CD38+ B cell, and two plasmacytoid DC. 9 inflammatory factors showed significant causal relationships with ASD: interleukins-7 (IL-7), interleukins-2 (IL-2), Interleukin-2 receptor subunit beta levels( IL-2β) and interleukins-18 receptor 1 levels (IL-18-R1) were negatively associated. In contrast, five inflammatory factors were positively associated, such as tumor necrosis factor-α (TNF-α). 14 immune cells exhibited significant causal relationships with attention deficit hyperactivity disorder (ADHD). CD3 on naive CD8br and CD4 on activated Treg were positively associated, while four CD27-expressing B cells were positively associated with ASD. Four CD40-expressing monocytes were negatively associated with ADHD. 7 inflammatory factors had significant causal relationships with ADHD: Fibroblast Growth Factor 23 levels (FGF-23), CD40L receptor levels, Glial Cell Line-Derived Neurotrophic Factor levels (GDNF), TNF-α were more important among these. Mediation analysis identified 12 mediating relationships, with three showing strong evidence: Natural killer cell receptor 2B4 levels (19.9%), FGF-23 (11%), and Eotaxin levels (- 5.95%). Strong causal relationships existed between immune cells, circulating inflammatory factors, and NDDs. Inflammatory factors mediated the pathways between immune cells and NDDs.
Collapse
Affiliation(s)
- Zhiyue Liu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Lihong Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Lianhu Yu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Yongheng Zhao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Mengna Zhu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Yu Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Aihua Cao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China.
| |
Collapse
|
4
|
Ju XD, Zhang PH, Li Q, Bai QY, Hu B, Xu J, Lu C. Peripheral Blood Monocytes as Biomarkers of Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis. Res Child Adolesc Psychopathol 2025; 53:583-595. [PMID: 40053221 DOI: 10.1007/s10802-025-01303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2025] [Indexed: 04/26/2025]
Abstract
Accumulating evidence implicates immune dysregulation and chronic inflammation in neurodevelopmental disorders (NDDs), often manifesting as abnormal alterations in peripheral blood immune cell levels. The mononuclear phagocyte system, including monocytes and microglia, has been increasingly recognized for its involvement in the pathogenesis of NDDs. However, due to inconsistent findings in the literature, whether monocytes can serve as a reliable biomarker for NDDs remains controversial. To address this issue, we conducted a systematic review and meta-analysis of studies examining monocyte counts in NDD individuals. A comprehensive search was conducted across PubMed, Web of Science, and Scopus databases. Variables extracted for analysis encompassed the author's name, year of study, sample size, patient's age, type of disease, mean, standard deviation of monocytes and sex ratio. A total of 2503 articles were found by searching the three databases. After removed duplicates and screening titles, abstracts, and full texts, 17 articles met the inclusion criteria, and 20 independent studies were included in the meta-analysis. The results indicated significantly increased monocyte counts in 5 type NDDs compared to Typical Development (TD) groups (g = 0.36, 95%CI [0.23, 0.49]). Subgroup analyses revealed no significant differences in monocyte counts across different NDD types, gender, or age. These findings suggest that aberrant alterations in monocyte counts are common in NDD cases, indicating their potential as biomarkers for these conditions. Future research should further investigate the role of monocyte in understanding the mechanisms, early detection, and clinical diagnosis of NDDs.
Collapse
Affiliation(s)
- Xing-Da Ju
- School of Psychology, Northeast Normal University, Changchun, China
- Jilin Provincial Key Laboratory of Cognitive Neuroscience and Brain Development, Changchun, China
- Autism Centre of Excellence, Northeast Normal University, Changchun, China
| | - Pai-Hao Zhang
- School of Psychology, Northeast Normal University, Changchun, China
| | - Qiang Li
- School of Psychology, Northeast Normal University, Changchun, China
| | - Qiu-Yu Bai
- Yancheng College of Mechatronic Technology, Yancheng, China
| | - Bo Hu
- School of Psychology, Northeast Normal University, Changchun, China
- School of Social and Behavioral Science, Nanjing University, Nanjing, China
| | - Jing Xu
- School of Life Sciences, Northeast Normal University, Changchun, China
| | - Chang Lu
- School of Psychology, Northeast Normal University, Changchun, China.
- Jilin Provincial Key Laboratory of Cognitive Neuroscience and Brain Development, Changchun, China.
| |
Collapse
|
5
|
Bortoletto R, Comacchio C, Garzitto M, Piscitelli F, Balestrieri M, Colizzi M. Palmitoylethanolamide supplementation for human health: A state-of-the-art systematic review of Randomized Controlled Trials in patient populations. Brain Behav Immun Health 2025; 43:100927. [PMID: 39839988 PMCID: PMC11745966 DOI: 10.1016/j.bbih.2024.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 12/11/2024] [Accepted: 12/21/2024] [Indexed: 01/03/2025] Open
Abstract
Interest in preventative dietary interventions for human health has increasingly focused on the endocannabinoid (eCB)-like compound palmitoylethanolamide (PEA), a bioactive lipid mediator with anti-inflammatory, analgesic, and neuroprotective properties. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review aimed at collecting and comprehensively discussing all available data from Randomized Controlled Trials (RCTs) evaluating the efficacy and tolerability of PEA supplementation across human illnesses in patient populations. Overall, 48 eligible outputs from 47 RCTs were extracted, covering neuropsychiatric (n = 15), neurological (n = 17), somatic (n = 13), and visceral (n = 11) disturbances, as well as PEA effects on blood/plasma or other tissue biomarkers (n = 10). The strongest evidence emerged from RCTs exploring PEA impact on pain management and measures of general wellbeing, especially in its ultramicronized/micronized or cold-water dispersible formulations, showing good tolerability compared to controls. Also, alongside symptom improvement, PEA demonstrated to modulate biomarkers early altered in the initial phases of an illness or contributing to its progression, suggesting a disease-modifying potential. This systematic review provided a comprehensive overview of the therapeutic potential of PEA across RCTs, highlighting its versatility either as monotherapy or add-on treatment for various clinical conditions.
Collapse
Affiliation(s)
- R. Bortoletto
- Unit of Psychiatry and Eating Disorders, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - C. Comacchio
- Unit of Psychiatry and Eating Disorders, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - M. Garzitto
- Unit of Psychiatry and Eating Disorders, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - F. Piscitelli
- Institute of Biomolecular Chemistry, National Research Council (CNR), Pozzuoli, Italy
| | - M. Balestrieri
- Unit of Psychiatry and Eating Disorders, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - M. Colizzi
- Unit of Psychiatry and Eating Disorders, Department of Medicine (DMED), University of Udine, Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
6
|
Llorca-Bofí V, Mur M, Font M, Palacios-Garrán R, Sellart M, del Agua-Martínez E, Bioque M, Arteaga-Henríquez G. Differences in total and differential white blood cell counts and in inflammatory parameters between psychiatric inpatients with and without recent consumption of cannabinoids, opioids, or cocaine: A retrospective single-center study. Brain Behav Immun Health 2024; 42:100898. [PMID: 39634076 PMCID: PMC11615885 DOI: 10.1016/j.bbih.2024.100898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 07/08/2024] [Accepted: 10/27/2024] [Indexed: 12/07/2024] Open
Abstract
Several drugs of abuse may exert their action by modulating the immune system. Despite this, individuals using substances of abuse are often excluded from immunopsychiatry studies. We conducted a retrospective, single-center study to examine differences in circulating immune/inflammatory parameters (i.e., total and differential white blood cell (WBC) counts, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte (MLR) ratio, platelet-to-lymphocyte ratio, and C-reactive protein) between psychiatric inpatients with a positive urine test to cannabinoids, opioids, or cocaine, and those with negative toxicology. A total of 927 inpatients were included. Patients with positive toxicology (n = 208) had significantly higher WBC counts (P < 0.001, η 2p = 0.02), as well as increased neutrophils (P = 0.002, η 2p = 0.01), monocytes (P < 0.001, η 2p = 0.02), lymphocytes (P < 0.001, η 2p = 0.02), and eosinophils (P = 0.01, η 2p = 0.01) compared to those with negative toxicology (n = 719). The increase in neutrophil counts was particularly evident in patients who tested positive for cannabinoids (n = 168; P < 0.001, η 2p = 0.02). In contrast, eosinophil counts were particularly increased in the cocaine-positive subgroup (n = 27; P = 0.004, η 2p = 0.01). Patients with a positive urine test to opioids (n = 13) were characterized by a significantly lower MLR (P = 0.03, η 2p = 0.005). The type of psychiatric diagnosis moderated the differences in neutrophil counts between patients with a positive and negative toxicology to cannabinoids. Notably, significantly higher neutrophil counts were found only in patients diagnosed with a psychotic disorder (P < 0.001, η 2p = 0.03). Taken together, our findings suggest that drugs of abuse may differently impact the immune/inflammatory response system in individuals diagnosed with psychiatric conditions. Specifically, recent cannabinoids use may be associated with an acute activation of the inflammatory response system, particularly in individuals with a psychotic disorder, while cocaine and opioid use may be associated with eosinophilia and a decrease in the MLR, respectively, regardless of the primary psychiatric diagnosis.
Collapse
Affiliation(s)
- Vicent Llorca-Bofí
- Department of Psychiatry, Hospital Universitari Santa Maria, Lleida, Spain
- Department of Medicine, University of Barcelona, Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Medicine and Surgery, Universitat de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Spain
| | - Maria Mur
- Department of Psychiatry, Hospital Universitari Santa Maria, Lleida, Spain
- Department of Medicine and Surgery, Universitat de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Spain
| | - Maria Font
- Laboratory Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Roberto Palacios-Garrán
- Department of Psychiatry, Hospital Universitari Santa Maria, Lleida, Spain
- Mental Health Unit, Hospital Universitario Jerez de la Frontera, University of Cádiz, Cádiz, Spain
| | - Maite Sellart
- Department of Psychiatry, Hospital Universitari Santa Maria, Lleida, Spain
| | | | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Medicine, University of Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Gara Arteaga-Henríquez
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- NCRR-National Center for Register-based Research, Aahrus University, Aahrus, Denmark
| |
Collapse
|
7
|
Gaspar JM, Ferreira JP, Carvalho HM, Toscano CVA. Metabolic and Inflammatory Profiles in Children and Adolescents with Autism Spectrum Disorder: A Cross-Sectional Study. Brain Sci 2024; 14:1052. [PMID: 39595815 PMCID: PMC11592014 DOI: 10.3390/brainsci14111052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/17/2024] [Accepted: 10/22/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Autism spectrum disorder (ASD) is associated with several coexisting diseases or comorbidities, including inflammatory and metabolic disorders. In fact, ASD symptoms may be associated with immune system dysfunction. However, studies investigating the peripheral blood levels of immune cells are lacking and have provided mixed findings. In this study, we evaluated the relationship between the intensity level of ASD symptoms and the inflammatory and metabolic profiles in 154 children and adolescents (2-17 years). METHODS Bayesian multilevel models were used to examine the relationship between their symptom intensities and inflammatory/metabolic profiles. RESULTS Heavier children had higher values for triglyceride and insulin levels. Children with a level 3 of ASD intensity had higher free fatty acids levels. However, when adjusting for ASD intensity, gender, medication use, or weight status, older children appeared to have higher values of triglycerides, insulin levels, and free fatty acids. CONCLUSIONS We concluded that as Brazilian children with ASD became older, they had a higher risk for insulin resistance.
Collapse
Affiliation(s)
- Joana M. Gaspar
- Laboratory of Neuroimmune-Metabolism, Federal University of Santa Catarina, Florianópolis 88037-000, SC, Brazil
- Graduate Program in Biochemistry, Federal University of Santa Catarina, Florianópolis 88037-000, SC, Brazil
| | - José Pedro Ferreira
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3004-531 Coimbra, Portugal;
| | - Humberto M. Carvalho
- Department of Physical Education, School of Sports, Federal University of Santa Catarina, Florianópolis 88040-900, SC, Brazil;
| | - Chrystiane V. A. Toscano
- Institute of Physical Education and Sport, Federal University of Alagoas, Maceió 57072-970, AL, Brazil
| |
Collapse
|
8
|
Bortoletto R, Piscitelli F, Basaldella M, Scipioni C, Comacchio C, Fiorino R, Fornasaro S, Barbieri P, Pagliaro D, Sepulcri O, Fabris M, Curcio F, Balestrieri M, Colizzi M. Assessing the biobehavioral effects of ultramicronized-palmitoylethanolamide monotherapy in autistic adults with different severity levels: a report of two cases. Front Psychiatry 2024; 15:1463849. [PMID: 39502301 PMCID: PMC11536324 DOI: 10.3389/fpsyt.2024.1463849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 09/13/2024] [Indexed: 11/08/2024] Open
Abstract
Despite promise of its supplementation as both monotherapy and add-on treatment in autism spectrum disorder (ASD), the biobehavioral effects of Palmitoylethanolamide (PEA) in autistic adults have never been explored so far. We discussed the cases of two autistic adults with different degrees of severity (level 1 and level 2) presenting with symptoms of psychic distress, who were treated with ultramicronized-PEA (um-PEA) 600 mg/day monotherapy for a sustained period of 4 months. The level 1 autistic patient showed improved depressive symptoms and social engagement at a 12-week follow-up, in parallel to a tendency toward reduced inflammatory response and enhanced endocannabinoid (eCB) signaling, partially relapsing after um-PEA discontinuation at four months. Opposedly, the level 2 autistic patient exhibited a generally stable psychosocial functioning for the initial 12 weeks, consistent with basically unchanged immune and eCBs levels, abruptly deteriorating and leading to antipsychotic initiation afterwards. No significant side effects were reported in both cases during the observation period. The two cases suggest that um-PEA could be an effective option for the treatment of psychic distress in level 1 autistic adults, warranting further investigation of its age- and level-specificity and of the biological underpinnings of its therapeutic effect in ASD.
Collapse
Affiliation(s)
- Riccardo Bortoletto
- Unit of Psychiatry, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Fabiana Piscitelli
- Institute of Biomolecular Chemistry, National Research Council (CNR), Pozzuoli, Italy
| | - Marta Basaldella
- Unit of Psychiatry, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Claudia Scipioni
- Unit of Psychiatry, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Carla Comacchio
- Unit of Psychiatry, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Roberta Fiorino
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Institute of Clinical Pathology, Friuli Centrale Health University Authority (ASUFC), Udine, Italy
| | - Stefano Fornasaro
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Trieste, Italy
| | - Pierluigi Barbieri
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Trieste, Italy
| | - Daniele Pagliaro
- Unit of Psychiatry, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Orietta Sepulcri
- Unit of Psychiatry, Friuli Centrale Health University Authority (ASUFC), Udine, Italy
| | - Martina Fabris
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Institute of Clinical Pathology, Friuli Centrale Health University Authority (ASUFC), Udine, Italy
| | - Francesco Curcio
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Institute of Clinical Pathology, Friuli Centrale Health University Authority (ASUFC), Udine, Italy
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DMED), University of Udine, Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| |
Collapse
|
9
|
Chen J, Zhang Y, Wu R, Li Z, Zhang T, Yang X, Lu M. Inflammatory biomarkers mediate the association between polycyclic aromatic hydrocarbon exposure and dyslipidemia: A national population-based study. CHEMOSPHERE 2024; 362:142626. [PMID: 38908446 DOI: 10.1016/j.chemosphere.2024.142626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
Exploring the association between exposure to polycyclic aromatic hydrocarbons (PAHs) and the risk of dyslipidemia and possible mediating effects is essential for conducting epidemiological health studies on related lipid disorders. Therefore, our study aimed to elucidate the potential association between PAH exposure and dyslipidemia risk and further identify the mediating effects based on blood cell-based inflammatory biomarkers. This cross-sectional study was conducted on 8380 individuals with complete survey data from the National Health and Nutrition Examination Survey (2001-2016). Multiple models (generalized linear regression model, restricted cubic spline model, Bayesian kernel machine regression, weighted quantiles sum regression) were used to assess the relationship between PAH co-exposure and the dyslipidemia risk and further identify potential mediating effects. Among the 8380 subjects, 2886 (34.44 %) had dyslipidemia. After adjusting for the confounding factors, the adjusted OR and 95% CI for dyslipidemia in the highest quartile of subjects were 1.30 (1.11, 1.51), 1. 22 (1.04, 1.43), 1.21 (1.03, 1.42), 1.29 (1.10, 1.52), 1.18 (1.01, 1.37), and 1.04 (0.89, 1.23) for 1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene (2-FLU), 1-hydroxyphenanthrene, and 1-hydroxypyrene. The Bayesian kernel machine regression model also showed a positive correlation between PAH mixtures and dyslipidemia, and 2-FLU has the highest contribution. Mediation effect analyses showed that white blood cells and neutrophils were statistically significant in the association between PAHs and dyslipidemia. The present study suggests that individual and mixed PAH exposures may increase the risk of dyslipidemia in adults. Inflammatory biomarkers significantly mediated the relationship between PAH exposure and dyslipidemia. Environmental pollutants and their mechanisms should be more intensively monitored and studied.
Collapse
Affiliation(s)
- Jiaqi Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China; Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Yurong Zhang
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ruijie Wu
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zilin Li
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tongchao Zhang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China; Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China; Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Ming Lu
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China; Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| |
Collapse
|
10
|
Buxbaum Grice AS, Sloofman L, Levy T, Walker H, Ganesh G, Rodriguez de Los Santos M, Amini P, Buxbaum JD, Kolevzon A, Kostic A, Breen MS. Transient peripheral blood transcriptomic response to ketamine treatment in children with ADNP syndrome. Transl Psychiatry 2024; 14:307. [PMID: 39054328 PMCID: PMC11272924 DOI: 10.1038/s41398-024-03005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 06/26/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024] Open
Abstract
Activity-dependent neuroprotective protein (ADNP) syndrome is a rare neurodevelopmental disorder resulting in intellectual disability, developmental delay and autism spectrum disorder (ASD) and is due to mutations in the ADNP gene. Ketamine treatment has emerged as a promising therapeutic option for ADNP syndrome, showing safety and apparent behavioral improvements in a first open label study. However, the molecular perturbations induced by ketamine remain poorly understood. Here, we investigated the longitudinal effect of ketamine on the blood transcriptome of 10 individuals with ADNP syndrome. Transcriptomic profiling was performed before and at multiple time points after a single low-dose intravenous ketamine infusion (0.5 mg/kg). We show that ketamine triggers immediate and profound gene expression alterations, with specific enrichment of monocyte-related expression patterns. These acute alterations encompass diverse signaling pathways and co-expression networks, implicating upregulation of immune and inflammatory-related processes and down-regulation of RNA processing mechanisms and metabolism. Notably, these changes exhibit a transient nature, returning to baseline levels 24 hours to 1 week after treatment. These findings enhance our understanding of ketamine's molecular effects and lay the groundwork for further research elucidating its specific cellular and molecular targets. Moreover, they contribute to the development of therapeutic strategies for ADNP syndrome and potentially, ASD more broadly.
Collapse
Affiliation(s)
- Ariela S Buxbaum Grice
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura Sloofman
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tess Levy
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah Walker
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gauri Ganesh
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Miguel Rodriguez de Los Santos
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pardis Amini
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph D Buxbaum
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Kolevzon
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana Kostic
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael S Breen
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
11
|
Fang C, Sun Y, Fan C, Lei D. The relationship of immune cells with autism spectrum disorder: a bidirectional Mendelian randomization study. BMC Psychiatry 2024; 24:477. [PMID: 38937836 PMCID: PMC11212275 DOI: 10.1186/s12888-024-05927-5] [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: 11/01/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Observational studies have indicated a correlation between immunological inflammation and the risk of autism spectrum disorder (ASD). However, the causal relationship between immunological inflammation and ASD remains uncertain. METHODS Immunity-wide data sources were retrieved from the GWAS catalog. Genetic summary data on ASD were retrieved from two independent GWAS. We performed two independent bi-directional, two-sample Mendelian randomization (MR) analyses and a meta-analysis based on the two independent MR estimates to assess the causal relationship between ASD and immune cell signatures. RESULTS We have discovered 26 potential correlations between genetic predisposition in the immunophenotypes and ASD. The meta-analysis of the two inverse variance weighted (IVW)-produced estimates provided further evidence supporting the potential causal relationship between immunophenotypes and ASD. Based on the findings of the reverse MR analysis, it was determined that there are two potential negative causal relationships between ASD and immunophenotypes. However, the meta-analysis of the two IVW-derived MR estimates indicated that immunophenotypes were not significantly influenced by ASD (OR = 0.87, 95% CI = 0.73 -1.03, P = 0.09; OR = 0.91, 95% CI = 0.81-1.01, P = 0.08). CONCLUSIONS This study expanded immune cell subtypes that were potentially causally associated with ASD risk as well as identified ASD-specific immune cell subtypes. The discovery has the potential to lead to earlier detection and more effective treatment techniques.
Collapse
Affiliation(s)
- Congcong Fang
- Outpatient Department, Renmin Hospital of Wuhan University, Wuhan, 430000, China
| | - Yonghao Sun
- Fujian Provincial Key Laboratory of Reproductive Health Research, School of Medicine, Xiamen University, Xiamen, China
| | - Cuifang Fan
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430000, China.
| | - Di Lei
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430000, China.
| |
Collapse
|
12
|
Lyu K, Li J, Chen M, Li W, Zhang W, Hu M, Zhang Y, Feng X. A bibliometric analysis of autism spectrum disorder signaling pathways research in the past decade. Front Psychiatry 2024; 15:1304916. [PMID: 38410675 PMCID: PMC10895046 DOI: 10.3389/fpsyt.2024.1304916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Background This study employs bibliometric methods to comprehensively understand the fundamental structure of research about Autism Spectrum Disorder (ASD) Signaling Pathways by examining key indicators such as nations, institutions, journals, authors, and keywords. Methodology We utilized the WoScc database to retrieve literature relevant to ASD Signaling Pathways published between 2013 and 2023. Through visual analysis and tools like CiteSpace and VosViewer, we explored nations, institutions, journals, authors, and keywords, thereby constructing relevant networks. Results 26 The study encompasses 1,396 articles, revealing a consistent increase in publications. The United States, China, and Germany are leading nations in this literature. Regarding research institutions, the University of California system and Eric Klann have garnered significant attention due to their substantial contributions to the field of ASD Signaling Pathways. Most relevant research is published in the journal "Molecular Autism." Research interests are concentrated across various themes, including "elevating neuronal β-catenin levels," "Tunisian children," "Fmr1 knockout (KO) mice," "de novo mutations," "autistic children," "local translation," "propionic acid-induced mouse models," "neurosystems," "glucose metabolism," and "neuronal migration." Future research may emphasize exploring aspects such as gut microbiota, genes, stress, maternal immune activation, memory, and neurodevelopmental disorders of ASD. Conclusion This study, through bibliometric analysis of key indicators such as nations, institutions, journals, authors, and keywords, provides a comprehensive overview of the current state of research on ASD Signaling Pathways. These investigations predominantly focus on molecular mechanisms, animal model studies, population-based research, and the structure and function of neurosystems. Future research directions are also clearly proposed. First, in-depth research on the genes and neurodevelopmental disorders associated with ASD will continue to reveal the genetic basis and provide support for precise treatments. At the same time, attention to the gut microbiota will help explore its association with ASD, which may provide clues for new treatments. In addition, the relationship between stress and ASD will become the focus of research to understand better the emotional and behavioral characteristics of ASD patients in stressful situations. Maternal immune activation will also be further studied to explore how environmental factors influence the risk and development of ASD. Finally, a deeper understanding of the cognitive functions of patients with ASD, especially memory and learning, will help develop individualized treatment strategies to improve patients' quality of life. These directions will work together and are expected to provide a more comprehensive understanding of Signaling Pathways research in ASD and provide new ideas and opportunities for future intervention and treatment.
Collapse
Affiliation(s)
- Kaifeng Lyu
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Jiangshan Li
- College of Acupuncture, Moxibustion, Massage, and Rehabilitation, Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Min Chen
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, China
| | - Wu Li
- College of Acupuncture, Moxibustion, Massage, and Rehabilitation, Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Wei Zhang
- Pediatrics One, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Meichao Hu
- Rehabilitation Department, Chifeng Obstetrics and Gynecology Hospitalal, Chifeng, China
| | - Yuxing Zhang
- College of Acupuncture, Moxibustion, Massage, and Rehabilitation, Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Xiang Feng
- College of Acupuncture, Moxibustion, Massage, and Rehabilitation, Hunan University of Traditional Chinese Medicine, Changsha, China
| |
Collapse
|
13
|
Grice ASB, Sloofman L, Levy T, Walker H, Ganesh G, de Los Santos MR, Armini P, Buxbaum JD, Kolevzon A, Kostic A, Breen MS. Transient peripheral blood transcriptomic response to ketamine treatment in children with ADNP syndrome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.29.24301949. [PMID: 38352457 PMCID: PMC10863029 DOI: 10.1101/2024.01.29.24301949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Activity-dependent neuroprotective protein (ADNP) syndrome is a rare neurodevelopmental disorder resulting in intellectual disability, developmental delay and autism spectrum disorder (ASD) and is due to mutations in the ADNP gene. Ketamine treatment has emerged as a promising therapeutic option for ADNP syndrome, showing safety and apparent behavioral improvements in a first open label study. However, the molecular perturbations induced by ketamine remain poorly understood. Here, we investigated the longitudinal effect of ketamine on the blood transcriptome of 10 individuals with ADNP syndrome. Transcriptomic profiling was performed before and at multiple time points after a single low-dose intravenous ketamine infusion (0.5mg/kg). We show that ketamine triggers immediate and profound gene expression alterations, with specific enrichment of monocyte-related expression patterns. These acute alterations encompass diverse signaling pathways and co-expression networks, implicating up-regulation of immune and inflammatory-related processes and down-regulation of RNA processing mechanisms and metabolism. Notably, these changes exhibit a transient nature, returning to baseline levels 24 hours to 1 week after treatment. These findings enhance our understanding of ketamine's molecular effects and lay the groundwork for further research elucidating its specific cellular and molecular targets. Moreover, they contribute to the development of therapeutic strategies for ADNP syndrome and potentially, ASD more broadly.
Collapse
Affiliation(s)
- Ariela S Buxbaum Grice
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura Sloofman
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tess Levy
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah Walker
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gauri Ganesh
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Miguel Rodriguez de Los Santos
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pardis Armini
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph D Buxbaum
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Kolevzon
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana Kostic
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael S Breen
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
14
|
Huang W, Liu Z, Li Z, Meng S, Huang Y, Gao M, Zhong N, Zeng S, Wang L, Zhao W. Identification of Immune Infiltration and Iron Metabolism-Related Subgroups in Autism Spectrum Disorder. J Mol Neurosci 2024; 74:12. [PMID: 38236354 DOI: 10.1007/s12031-023-02179-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/01/2023] [Indexed: 01/19/2024]
Abstract
Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder with a broad spectrum of symptoms and prognoses. Effective therapy requires understanding this variability. ASD children's cognitive and immunological development may depend on iron homoeostasis. This study employs a machine learning model that focuses on iron metabolism hub genes to identify ASD subgroups and describe immune infiltration patterns. A total of 97 control and 148 ASD samples were obtained from the GEO database. Differentially expressed genes (DEGs) and an iron metabolism gene collection achieved the intersection of 25 genes. Unsupervised cluster analysis determined molecular subgroups in individuals with ASD based on 25 genes related to iron metabolism. We assessed gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, gene set variation analysis (GSVA), and immune infiltration analysis to compare iron metabolism subtype effects. We employed machine learning to identify subtype-predicting hub genes and utilized both training and validation sets to assess gene subtype prediction accuracy. ASD can be classified into two iron-metabolizing molecular clusters. Metabolic enrichment pathways differed between clusters. Immune infiltration showed that clusters differed immunologically. Cluster 2 had better immunological scores and more immune cells, indicating a stronger immune response. Machine learning screening identified SELENBP1 and CAND1 as important genes in ASD's iron metabolism signaling pathway. These genes express in the brain and have AUC values over 0.8, implying significant predictive power. The present study introduces iron metabolism signaling pathway indicators to predict ASD subtypes. ASD is linked to immune cell infiltration and iron metabolism disorders.
Collapse
Affiliation(s)
- Wenyan Huang
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510080, Guangdong, China
- Department of Pedodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, 510182, Guangdong, China
| | - Zhenni Liu
- Department of Pedodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, 510182, Guangdong, China
| | - Ziling Li
- Department of Pedodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, 510182, Guangdong, China
| | - Si Meng
- Department of Pedodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, 510182, Guangdong, China
| | - Yuhang Huang
- Department of Pedodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, 510182, Guangdong, China
| | - Min Gao
- Department of Pedodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, 510182, Guangdong, China
| | - Ning Zhong
- Department of Pedodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, 510182, Guangdong, China
| | - Sujuan Zeng
- Department of Pedodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, 510182, Guangdong, China
| | - Lijing Wang
- Department of Pedodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, 510182, Guangdong, China
| | - Wanghong Zhao
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510080, Guangdong, China.
| |
Collapse
|
15
|
Korkmaz ŞA, Kızgın S, Oğuz EF, Neşelioğlu S, Erel Ö. Thiol-disulphide homeostasis, ischemia-modified albumin, complete blood count-derived inflammatory markers and C-reactive protein from acute mania to early remission in bipolar disorder. J Affect Disord 2023; 339:426-434. [PMID: 37459969 DOI: 10.1016/j.jad.2023.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES There is much recent evidence that inflammation contributes to the pathophysiology of acute mania in bipolar disorder (BD). However, no study was evaluated in which the change in thiol-disulphide homeostasis, ischemia-modified albumin (IMA), complete blood count-derived inflammatory markers (CBC-IMs) and C-reactive protein (CRP) levels in bipolar patients was followed-up from acute mania to early remission. METHODS Seventy-seven bipolar patients in acute mania and ninety-one HC were enrolled. We measured levels of thiol-disulphide parameters, IMA, and CBC-IMs such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red-cell-distribution-width (RDW)-to-platelet ratio (RPR), systemic immune-inflammatory index (SII), and systemic inflammatory response index (SIRI), CRP and platelet-to-albumin ratio (PAR), after adjusting for age, gender, body-mass index (BMI) and smoking status, during acute mania to subsequent early remission. The results were compared with HC. RESULTS The levels or ratios of all thiol-disulphide parameters except for disulphide, IMA and CRP of bipolar patients in both acute mania and early remission were significantly different from HC, after adjusting for confounders. The NLR, SII, CRP and PAR values of bipolar patients were significantly higher in only acute mania compared to HC. Significant changes in thiol-disulphide parameters and IMA levels were not found in early remission after acute mania. LIMITATIONS Short follow-up period and lack of drug-naive patients. CONCLUSIONS Our results suggest that thiol-disulphide parameters, IMA level and SIRI value might be a trait biomarkers of inflammation in BD. In addition, NLR, SII and PAR values and CRP level might be a state biomarker of inflammation in bipolar patients in a manic phase.
Collapse
Affiliation(s)
- Şükrü Alperen Korkmaz
- Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Psychiatry, Çanakkale, Turkey.
| | - Sadice Kızgın
- Ankara City Hospital, Department of Psychiatry, Ankara, Turkey
| | - Esra Fırat Oğuz
- Ankara Yıldırım Beyazıt University, Faculty of Medicine, Department of Biochemistry, Ankara/Turkey
| | - Salim Neşelioğlu
- Ankara Yıldırım Beyazıt University, Faculty of Medicine, Department of Biochemistry, Ankara/Turkey
| | - Özcan Erel
- Ankara Yıldırım Beyazıt University, Faculty of Medicine, Department of Biochemistry, Ankara/Turkey
| |
Collapse
|
16
|
Ferencova N, Visnovcova Z, Ondrejka I, Hrtanek I, Bujnakova I, Kovacova V, Macejova A, Tonhajzerova I. Peripheral Inflammatory Markers in Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder at Adolescent Age. Int J Mol Sci 2023; 24:11710. [PMID: 37511467 PMCID: PMC10380731 DOI: 10.3390/ijms241411710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are associated with immune dysregulation. We aimed to estimate the pro- and anti-inflammatory activity/balance in ASD and ADHD patients at a little-studied adolescent age with respect to sex. We evaluated 20 ASD patients (5 girls, average age: 12.4 ± 1.9 y), 20 ADHD patients (5 girls, average age: 13.4 ± 1.8 y), and 20 age- and gender-matched controls (average age: 13.2 ± 1.9 y). The evaluated parameters included (1) white blood cells (WBCs), neutrophils, monocytes, lymphocytes, platelets, platelet distribution width (PDW), mean platelet volume, and derived ratios, as well as (2) cytokines-interferon-gamma, interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, and IL-10, tumor necrosis factor-alpha (TNF-α), and derived profiles and ratios. ASD adolescents showed higher levels of WBC, monocytes, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, and IL-10, macrophages (M)1 profile, and anti-inflammatory profile than the controls, with ASD males showing higher monocytes, IL-6 and IL-10, anti-inflammatory profile, and a lower T-helper (Th)1/Th2+T-regulatory cell ratio than control males. The ADHD adolescents showed higher levels of PDW, IL-1β and IL-6, TNF-α, M1 profile, proinflammatory profile, and pro-/anti-inflammatory ratio than the controls, with ADHD females showing a higher TNF-α and pro-/anti-inflammatory ratio than the control females and ADHD males showing higher levels of IL-1β and IL-6, TNF-α, and M1 profile than the control males. Immune dysregulation appeared to be different for both neurodevelopmental disorders in adolescence.
Collapse
Affiliation(s)
- Nikola Ferencova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Zuzana Visnovcova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Igor Ondrejka
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, 03601 Martin, Slovakia
| | - Igor Hrtanek
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, 03601 Martin, Slovakia
| | - Iveta Bujnakova
- Society to Help People with Autism (SPOSA-Turiec), 03601 Martin, Slovakia
| | - Veronika Kovacova
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, 03601 Martin, Slovakia
| | - Andrea Macejova
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, 03601 Martin, Slovakia
| | - Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| |
Collapse
|
17
|
Lucius K. Novel and Emerging Markers of Chronic or Low-Grade Inflammation. INTEGRATIVE AND COMPLEMENTARY THERAPIES 2023; 29:130-142. [DOI: 10.1089/ict.2023.29075.klu] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
- Khara Lucius
- Khara Lucius, ND, FABNO, is a naturopathic doctor at the Center for Integrative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
18
|
Heneberk O, Wurfelova E, Radochova V. Neopterin, the Cell-Mediated Immune Response Biomarker, in Inflammatory Periodontal Diseases: A Narrative Review of a More than Fifty Years Old Biomarker. Biomedicines 2023; 11:biomedicines11051294. [PMID: 37238968 DOI: 10.3390/biomedicines11051294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Neopterin is a biomarker of the activation of cellular immunity. The purpose of this review is to summarise neopterin metabolism, methods of its detection, and its role in inflammation, focusing on periodontal inflammatory diseases. This derivative of guanosine is a non-enzymatic product of 7,8-dihydroneopterin oxidation caused by free radicals which protect activated macrophages from oxidative stress. Various methods, usually based on enzyme-linked immunosorbent essay, high-performance liquid chromatography, or radioimmunoassay were developed for the isolation of neopterin. A wide spectrum of diseases and conditions are known to affect neopterin levels, including cardiovascular, bacterial, viral, and degenerative diseases, as well as malignant tumours. Neopterin levels were found to increase in subjects with periodontitis, especially when the oral fluid and gingival crevicular fluid were evaluated. These findings confirm the role of activated macrophages and cellular immunity in periodontal inflammatory diseases. The gingival crevicular fluid and the oral fluid appear to be the most valuable biologic fluids for the evaluation of neopterin levels in periodontitis. For gingival crevicular fluid, neopterin can be determined as the concentration or the so-called total amount. Nonsurgical periodontal treatment was associated with a decrease in neopterin levels, but an increase was also reported, suggesting the possible role of macrophages in the resolution of the periodontal lesion.
Collapse
Affiliation(s)
- Ondrej Heneberk
- Department of Dentistry, Faculty of Medicine in Hradec Kralove, Charles University, Šimkova 870, 500 03 Hradec Kralove, Czech Republic
- Department of Dentistry, University Hospital Hradec Kralove, Sokolská 581, 500 05 Hradec Kralove, Czech Republic
| | - Eliska Wurfelova
- Department of Dentistry, Faculty of Medicine in Hradec Kralove, Charles University, Šimkova 870, 500 03 Hradec Kralove, Czech Republic
- Department of Dentistry, University Hospital Hradec Kralove, Sokolská 581, 500 05 Hradec Kralove, Czech Republic
| | - Vladimira Radochova
- Department of Dentistry, Faculty of Medicine in Hradec Kralove, Charles University, Šimkova 870, 500 03 Hradec Kralove, Czech Republic
- Department of Dentistry, University Hospital Hradec Kralove, Sokolská 581, 500 05 Hradec Kralove, Czech Republic
| |
Collapse
|
19
|
Flórez-Fernández N, Vaamonde-García C, Torres MD, Buján M, Muíños A, Muiños A, Lamas-Vázquez MJ, Meijide-Faílde R, Blanco FJ, Domínguez H. Relevance of the Extraction Stage on the Anti-Inflammatory Action of Fucoidans. Pharmaceutics 2023; 15:pharmaceutics15030808. [PMID: 36986669 PMCID: PMC10058023 DOI: 10.3390/pharmaceutics15030808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
The anti-inflammatory action of fucoidans is well known, based on both in vitro and some in vivo studies. The other biological properties of these compounds, their lack of toxicity, and the possibility of obtaining them from a widely distributed and renewable source, makes them attractive novel bioactives. However, fucoidans’ heterogeneity and variability in composition, structure, and properties depending on seaweed species, biotic and abiotic factors and processing conditions, especially during extraction and purification stages, make it difficult for standardization. A review of the available technologies, including those based on intensification strategies, and their influence on fucoidan composition, structure, and anti-inflammatory potential of crude extracts and fractions is presented.
Collapse
Affiliation(s)
- Noelia Flórez-Fernández
- CINBIO, Departamento de Ingeniería Química, Campus Ourense, Universidade de Vigo, 32004 Ourense, Spain
| | - Carlos Vaamonde-García
- Grupo de Investigación de Reumatología y Salud (GIR-S), Departamento de Biología, Facultad de Ciencias, CICA-Centro Interdisciplinar de Química y Biología, INIBIC-Sergas, Universidade da Coruña, Campus da Zapateira, 15011 A Coruña, Spain
| | - Maria Dolores Torres
- CINBIO, Departamento de Ingeniería Química, Campus Ourense, Universidade de Vigo, 32004 Ourense, Spain
| | - Manuela Buján
- Portomuíños, Polígono Industrial, Rúa Acebedo, Parcela 14, Cerceda, 15185 A Coruña, Spain
| | - Alexandra Muíños
- Portomuíños, Polígono Industrial, Rúa Acebedo, Parcela 14, Cerceda, 15185 A Coruña, Spain
| | - Antonio Muiños
- Portomuíños, Polígono Industrial, Rúa Acebedo, Parcela 14, Cerceda, 15185 A Coruña, Spain
| | - María J. Lamas-Vázquez
- Grupo de Investigación de Reumatología y Salud (GIR-S), Departamento de Biología, Facultad de Ciencias, CICA-Centro Interdisciplinar de Química y Biología, INIBIC-Sergas, Universidade da Coruña, Campus da Zapateira, 15011 A Coruña, Spain
| | - Rosa Meijide-Faílde
- Grupo de Terapia Celular y Medicina Regenerativa, Universidade da Coruña, CICA-Centro Interdisciplinar de Química y Biología, Complexo Hospitalario Universitario A Coruña, Campus Oza, 15006 A Coruña, Spain
| | - Francisco J. Blanco
- Grupo de Investigación de Reumatología y Salud (GIR-S), Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Facultad de Fisioterapia, CICA-Centro Interdisciplinar de Química y Biología, INIBIC-Sergas, Universidade da Coruña, Campus de Oza, 15006 A Coruña, Spain
| | - Herminia Domínguez
- CINBIO, Departamento de Ingeniería Química, Campus Ourense, Universidade de Vigo, 32004 Ourense, Spain
- Correspondence:
| |
Collapse
|
20
|
Arteaga-Henríquez G, Gisbert L, Ramos-Quiroga JA. Immunoregulatory and/or Anti-inflammatory Agents for the Management of Core and Associated Symptoms in Individuals with Autism Spectrum Disorder: A Narrative Review of Randomized, Placebo-Controlled Trials. CNS Drugs 2023; 37:215-229. [PMID: 36913130 PMCID: PMC10024667 DOI: 10.1007/s40263-023-00993-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition with a so far poorly understood underlying pathogenesis, and few effective therapies for core symptoms. Accumulating evidence supports an association between ASD and immune/inflammatory processes, arising as a possible pathway for new drug intervention. However, current literature on the efficacy of immunoregulatory/anti-inflammatory interventions on ASD symptoms is still limited. The aim of this narrative review was to summarize and discuss the latest evidence on the use of immunoregulatory and/or anti-inflammatory agents for the management of this condition. During the last 10 years, several randomized, placebo-controlled trials on the effectiveness of (add-on) treatment with prednisolone, pregnenolone, celecoxib, minocycline, N-acetylcysteine (NAC), sulforaphane (SFN), and/or omega-3 fatty acids have been performed. Overall, a beneficial effect of prednisolone, pregnenolone, celecoxib, and/or omega-3 fatty acids on several core symptoms, such as stereotyped behavior, was found. (Add-on) treatment with prednisolone, pregnenolone, celecoxib, minocycline, NAC, SFN, and/or omega-3 fatty acids was also associated with a significantly higher improvement in other symptoms, such as irritability, hyperactivity, and/or lethargy when compared with placebo. The mechanisms by which these agents exert their action and improve symptoms of ASD are not fully understood. Interestingly, studies have suggested that all these agents may suppress microglial/monocyte proinflammatory activation and also restore several immune cell imbalances (e.g., T regulatory/T helper-17 cell imbalances), decreasing the levels of proinflammatory cytokines, such as interleukin (IL)-6 and/or IL-17A, both in the blood and in the brain of individuals with ASD. Although encouraging, the performance of larger randomized placebo-controlled trials, including more homogeneous populations, dosages, and longer periods of follow-up, are urgently needed in order to confirm the findings and to provide stronger evidence.
Collapse
Affiliation(s)
- Gara Arteaga-Henríquez
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- NCRR-The National Center for Register-Based Research, Aahrus University, Aahrus, Denmark
| | - Laura Gisbert
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain.
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain.
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
| |
Collapse
|