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Chacko TP, Toole JT, Morris MC, Page J, Forsten RD, Barrett JP, Reinhard MJ, Brewster RC, Costanzo ME, Broderick G. A regulatory pathway model of neuropsychological disruption in Havana syndrome. Front Psychiatry 2023; 14:1180929. [PMID: 37965360 PMCID: PMC10642174 DOI: 10.3389/fpsyt.2023.1180929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction In 2016 diplomatic personnel serving in Havana, Cuba, began reporting audible sensory phenomena paired with onset of complex and persistent neurological symptoms consistent with brain injury. The etiology of these Anomalous Health Incidents (AHI) and subsequent symptoms remains unknown. This report investigates putative exposure-symptom pathology by assembling a network model of published bio-behavioral pathways and assessing how dysregulation of such pathways might explain loss of function in these subjects using data available in the published literature. Given similarities in presentation with mild traumatic brain injury (mTBI), we used the latter as a clinically relevant means of evaluating if the neuropsychological profiles observed in Havana Syndrome Havana Syndrome might be explained at least in part by a dysregulation of neurotransmission, neuro-inflammation, or both. Method Automated text-mining of >9,000 publications produced a network consisting of 273 documented regulatory interactions linking 29 neuro-chemical markers with 9 neuropsychological constructs from the Brief Mood Survey, PTSD Checklist, and the Frontal Systems Behavior Scale. Analysis of information flow through this network produced a set of regulatory rules reconciling to within a 6% departure known mechanistic pathways with neuropsychological profiles in N = 6 subjects. Results Predicted expression of neuro-chemical markers that jointly satisfy documented pathways and observed symptom profiles display characteristically elevated IL-1B, IL-10, NGF, and norepinephrine levels in the context of depressed BDNF, GDNF, IGF1, and glutamate expression (FDR < 5%). Elevations in CRH and IL-6 were also predicted unanimously across all subjects. Furthermore, simulations of neurological regulatory dynamics reveal subjects do not appear to be "locked in" persistent illness but rather appear to be engaged in a slow recovery trajectory. Discussion This computational analysis of measured neuropsychological symptoms in Havana-based diplomats proposes that these AHI symptoms may be supported in part by disruption of known neuroimmune and neurotransmission regulatory mechanisms also associated with mTBI.
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Affiliation(s)
- Thomas P. Chacko
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - J. Tory Toole
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Matthew C. Morris
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Jeffrey Page
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Robert D. Forsten
- War Related Illness and Injury Study Center (WRIISC), Department of Veterans Affairs, Washington, DC, United States
| | - John P. Barrett
- War Related Illness and Injury Study Center (WRIISC), Department of Veterans Affairs, Washington, DC, United States
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States
| | - Matthew J. Reinhard
- War Related Illness and Injury Study Center (WRIISC), Department of Veterans Affairs, Washington, DC, United States
- Complex Exposures Threats Center, Department of Veterans Affairs, Washington, DC, United States
| | - Ryan C. Brewster
- War Related Illness and Injury Study Center (WRIISC), Department of Veterans Affairs, Washington, DC, United States
| | - Michelle E. Costanzo
- War Related Illness and Injury Study Center (WRIISC), Department of Veterans Affairs, Washington, DC, United States
- Complex Exposures Threats Center, Department of Veterans Affairs, Washington, DC, United States
- Department of Medicine, Uniformed Services University, Bethesda, MD, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
- Complex Exposures Threats Center, Department of Veterans Affairs, Washington, DC, United States
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Chacko T, Toole JT, Oh H, Lu C, Reinhard M, Brewster R, Forsten R, Barrett J, Costanzo M, Broderick G. A - 6 Applying Artificial Intelligence Language Models for Knowledge Integration of Neuroimaging, Health Behavioral Assessment, and Clinical Intervention: Potential Impact on Brain Health in Special Operators. Arch Clin Neuropsychol 2023; 38:1151-1152. [PMID: 37807123 DOI: 10.1093/arclin/acad067.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Specialized military groups like Explosive Ordnance Disposal (EOD) personnel can suffer allostatic overload leading to complex health outcomes characterized as Operator Syndrome (OS). Here we (1) evaluate Brodmann's Areas (BA) brain regions associated with OS-related behavioral health symptoms then (2) explore how DoD/VA-recommended clinical interventions relate to these brain regions using large-scale automated text mining. DATA SELECTION Neuroimaging reported by Brodmann's Areas and 9 behavioral symptom measures and constructs of interest were extracted from full-text peer-reviewed publications using both rule-based and generative AI natural language processing (NLP) engines. The relationships linking BA regions with behavioral symptoms and the 7 interventions were assessed, with a focus on post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) severity. DATA SYNTHESIS The network connected behavioral health symptoms and 39 of 52 BA regions through 131 interactions. Co-occurring PTSD and TBI associations to BA (counting ≥3 citations) were detected with the precentral gyrus (BA4), premotor cortex and supplementary motor cortex (BA6), middle temporal gyrus (BA21), superior temporal gyrus (BA22), angular gyrus (BA39), and dorsolateral prefrontal cortex (BA46). Behavioral interventions of Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy, Cognitive Behavioral Therapy were found to modulate BA 6, with CPT alone also modulating BA 46. Only the pharmacotherapy fluoxetine (SSRI) related to BA6. CONCLUSIONS NLP offers a rapid means of exploring complex injuries in Veterans. Future investigations will test these models using acquired data from EOD veterans and specific neuroimaging modalities (e.g., BOLD fMRI) to determine how they might improve understanding of health sequelae of environmental exposures and inform intervention.
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Chacko TP, Toole JT, Richman S, Spink GL, Reinhard MJ, Brewster RC, Costanzo ME, Broderick G. Mapping the network biology of metabolic response to stress in posttraumatic stress disorder and obesity. Front Psychol 2022; 13:941019. [PMID: 35959009 PMCID: PMC9362840 DOI: 10.3389/fpsyg.2022.941019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
The co-occurrence of stress-induced posttraumatic stress disorder (PTSD) and obesity is common, particularly among military personnel but the link between these conditions is unclear. Individuals with comorbid PTSD and obesity manifest other physical and psychological problems, which significantly diminish their quality of life. Current understanding of the pathways connecting stress to PTSD and obesity is focused largely on behavioral mediators alone with little consideration of the biological regulatory mechanisms that underlie their co-occurrence. In this work, we leverage prior knowledge to systematically highlight such bio-behavioral mechanisms and inform on the design of confirmatory pilot studies. We use natural language processing (NLP) to extract documented regulatory interactions involved in the metabolic response to stress and its impact on obesity and PTSD from over 8 million peer-reviewed papers. The resulting network describes the propagation of stress to PTSD and obesity through 34 metabolic mediators using 302 documented regulatory interactions supported by over 10,000 citations. Stress jointly affected both conditions through 21 distinct pathways involving only two intermediate metabolic mediators out of a total of 76 available paths through this network. Moreover, oxytocin (OXT), Neuropeptide-Y (NPY), and cortisol supported an almost direct propagation of stress to PTSD and obesity with different net effects. Although stress upregulated both NPY and cortisol, the downstream effects of both markers are reported to relieve PTSD severity but exacerbate obesity. The stress-mediated release of oxytocin, however, was found to concurrently downregulate the severity of both conditions. These findings highlight how a network-informed approach that leverages prior knowledge might be used effectively in identifying key mediators like OXT though experimental verification of signal transmission dynamics through each path will be needed to determine the actual likelihood and extent of each marker’s participation.
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Affiliation(s)
- Thomas P. Chacko
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
- Institute of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States
| | - J. Tory Toole
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
- Institute of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States
| | - Spencer Richman
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Garry L. Spink
- Rochester Regional Behavioral Health, Rochester, NY, United States
| | - Matthew J. Reinhard
- War Related Illness and Injury Study Center, United States Department of Veterans Affairs, Washington, DC, United States
| | - Ryan C. Brewster
- War Related Illness and Injury Study Center, United States Department of Veterans Affairs, Washington, DC, United States
| | - Michelle E. Costanzo
- War Related Illness and Injury Study Center, United States Department of Veterans Affairs, Washington, DC, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
- *Correspondence: Gordon Broderick,
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Shinn EH, Busch BE, Jasemi N, Lyman CA, Toole JT, Richman SC, Symmans WF, Chavez-MacGregor M, Peterson SK, Broderick G. Network Modeling of Complex Time-Dependent Changes in Patient Adherence to Adjuvant Endocrine Treatment in ER+ Breast Cancer. Front Psychol 2022; 13:856813. [PMID: 35903747 PMCID: PMC9315289 DOI: 10.3389/fpsyg.2022.856813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Early patient discontinuation from adjuvant endocrine treatment (ET) is multifactorial and complex: Patients must adapt to various challenges and make the best decisions they can within changing contexts over time. Predictive models are needed that can account for the changing influence of multiple factors over time as well as decisional uncertainty due to incomplete data. AtlasTi8 analyses of longitudinal interview data from 82 estrogen receptor-positive (ER+) breast cancer patients generated a model conceptualizing patient-, patient-provider relationship, and treatment-related influences on early discontinuation. Prospective self-report data from validated psychometric measures were discretized and constrained into a decisional logic network to refine and validate the conceptual model. Minimal intervention set (MIS) optimization identified parsimonious intervention strategies that reversed discontinuation paths back to adherence. Logic network simulation produced 96 candidate decisional models which accounted for 75% of the coordinated changes in the 16 network nodes over time. Collectively the models supported 15 persistent end-states, all discontinued. The 15 end-states were characterized by median levels of general anxiety and low levels of perceived recurrence risk, quality of life (QoL) and ET side effects. MIS optimization identified 3 effective interventions: reducing general anxiety, reinforcing pill-taking routines, and increasing trust in healthcare providers. Increasing health literacy also improved adherence for patients without a college degree. Given complex regulatory networks’ intractability to end-state identification, the predictive models performed reasonably well in identifying specific discontinuation profiles and potentially effective interventions.
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Affiliation(s)
- Eileen H. Shinn
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Eileen H. Shinn,
| | - Brooke E. Busch
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Neda Jasemi
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cole A. Lyman
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - J. Tory Toole
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Spencer C. Richman
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - William Fraser Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
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Baird B, Broderick G. Pre- and post-injection pain in patients undergoing first intracavernosal injection. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baird B, Broderick G. Standardizing sonographic descriptors of Peyronie's plaques. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mammen MJ, Tu C, Morris MC, Richman S, Mangione W, Falls Z, Qu J, Broderick G, Sethi S, Samudrala R. Proteomic Network Analysis of Bronchoalveolar Lavage Fluid in Ex-Smokers to Discover Implicated Protein Targets and Novel Drug Treatments for Chronic Obstructive Pulmonary Disease. Pharmaceuticals (Basel) 2022; 15:566. [PMID: 35631392 PMCID: PMC9147475 DOI: 10.3390/ph15050566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/23/2022] Open
Abstract
Bronchoalveolar lavage of the epithelial lining fluid (BALF) can sample the profound changes in the airway lumen milieu prevalent in chronic obstructive pulmonary disease (COPD). We compared the BALF proteome of ex-smokers with moderate COPD who are not in exacerbation status to non-smoking healthy control subjects and applied proteome-scale translational bioinformatics approaches to identify potential therapeutic protein targets and drugs that modulate these proteins for the treatment of COPD. Proteomic profiles of BALF were obtained from (1) never-smoker control subjects with normal lung function (n = 10) or (2) individuals with stable moderate (GOLD stage 2, FEV1 50−80% predicted, FEV1/FVC < 0.70) COPD who were ex-smokers for at least 1 year (n = 10). After identifying potential crucial hub proteins, drug−proteome interaction signatures were ranked by the computational analysis of novel drug opportunities (CANDO) platform for multiscale therapeutic discovery to identify potentially repurposable drugs. Subsequently, a literature-based knowledge graph was utilized to rank combinations of drugs that most likely ameliorate inflammatory processes. Proteomic network analysis demonstrated that 233 of the >1800 proteins identified in the BALF were significantly differentially expressed in COPD versus control. Functional annotation of the differentially expressed proteins was used to detail canonical pathways containing the differential expressed proteins. Topological network analysis demonstrated that four putative proteins act as central node proteins in COPD. The drugs with the most similar interaction signatures to approved COPD drugs were extracted with the CANDO platform. The drugs identified using CANDO were subsequently analyzed using a knowledge-based technique to determine an optimal two-drug combination that had the most appropriate effect on the central node proteins. Network analysis of the BALF proteome identified critical targets that have critical roles in modulating COPD pathogenesis, for which we identified several drugs that could be repurposed to treat COPD using a multiscale shotgun drug discovery approach.
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Affiliation(s)
- Manoj J. Mammen
- Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
- Department of Biomedical Informatics, Jacobs School of Medicine and Biological Sciences, State University of New York, Buffalo, NY 14214, USA; (W.M.); (Z.F.)
| | - Chengjian Tu
- Department of Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY 14260, USA; (C.T.); (J.Q.)
- New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203, USA
| | - Matthew C. Morris
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY 14621, USA; (M.C.M.); (S.R.); (G.B.)
| | - Spencer Richman
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY 14621, USA; (M.C.M.); (S.R.); (G.B.)
| | - William Mangione
- Department of Biomedical Informatics, Jacobs School of Medicine and Biological Sciences, State University of New York, Buffalo, NY 14214, USA; (W.M.); (Z.F.)
| | - Zackary Falls
- Department of Biomedical Informatics, Jacobs School of Medicine and Biological Sciences, State University of New York, Buffalo, NY 14214, USA; (W.M.); (Z.F.)
| | - Jun Qu
- Department of Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY 14260, USA; (C.T.); (J.Q.)
- New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203, USA
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY 14621, USA; (M.C.M.); (S.R.); (G.B.)
| | - Sanjay Sethi
- WNY VA Healthcare System, Buffalo, NY 14215, USA;
- Department of Medicine, Jacobs School of Medicine and Biological Sciences, State University of New York at Buffalo, Buffalo, NY 14214, USA
| | - Ram Samudrala
- Department of Biomedical Informatics, Jacobs School of Medicine and Biological Sciences, State University of New York, Buffalo, NY 14214, USA; (W.M.); (Z.F.)
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Ericson C, Haehn D, Baird B, Broderick G. CT Imaging of Complex Calcified Peyronie's Disease. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haehn D, Baird B, Ball C, Broderick G. Characteristics of Patients with Erectile Complaints Referred to a Center of Excellence – Defining Complex Erectile Dysfunction. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Baird B, Haehn D, Broderick G. Standardizing Sonographic Descriptors of Peyronie's Plaques. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cheema AK, McNeil RB, Craddock T, Broderick G, Abreu MM, Aenlle K, Helmer DA, Ashford JW, Sullivan K, Bested A, Cohen DE, Shungu D, Chandler H, Fletcher MA, Krengel M, Klimas N. Gulf War Illness Clinical Trials and Interventions Consortium (GWICTIC): A collaborative research infrastructure for intervention and implementation. Life Sci 2021; 278:119636. [PMID: 34015289 DOI: 10.1016/j.lfs.2021.119636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022]
Abstract
AIMS There is an inadequate portfolio of treatments for Gulf War Illness (GWI), a complex disease involving multiple organ systems, and early-phase clinical trials are hampered by many logistical problems. To address these challenges, the Gulf War Illness Clinical Trials and Interventions Consortium (GWICTIC) was formed with the aims of (i) creating a collaborative consortium of clinical and scientific researchers that will rapidly implement rigorous and innovative phase I and II clinical trials for GWI, (ii) perform at least four phase I or II clinical trials, (iii) provide a foundation of scalable infrastructure and management in support of the efficient and successful operation of the GWICTIC, and (iv) partner with the Boston Biorepository, Recruitment & Integrated Network for GWI and other GWI investigators to develop a common data element platform for core assessments and outcomes. MAIN METHODS The GWICTIC brings together a multidisciplinary team of researchers at several institutions to provide scientific innovation, statistical and computational rigor, and logistical efficiency in the development and implementation of early-phase low-risk clinical trials for GWI. The GWICTIC core trials adhere to a Veteran-centered philosophy and focus on interventions with multiple mechanistic targets to maximize the likelihood of efficacy. To support rapid and efficient study startup and implementation across the GWI research community, the GWICTIC will share infrastructure with investigator-initiated research studies funded under separate mechanisms. SIGNIFICANCE The GWICTIC will leverage the efficiencies of centralized research support and innovative trial designs to address several longstanding needs in the GWI interventions research community.
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Affiliation(s)
- Amanpreet K Cheema
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Department of Nutrition, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Halmos College of Natural Sciences and Oceanography, Nova Southeastern University, Fort Lauderdale, FL, United States.
| | | | - Travis Craddock
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, United States; Department of Computer Science, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Maria M Abreu
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Kristina Aenlle
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - J Wesson Ashford
- War Related Illness & Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States; Department of Psychiatry & Behavioral Sciences, College of Medicine, Stanford University, Palo Alto, CA, United States
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Alison Bested
- Department of Integrative Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, United States
| | - Devra E Cohen
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Dikoma Shungu
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Helena Chandler
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States
| | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Maxine Krengel
- VA Boston Healthcare System, Boston, MA, United States; Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Nancy Klimas
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
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Collins C, Yang D, Lipworth R, Broderick G, Ziegelmann M, Helo S, Kopecky S, Kohler T. 095 Utility of Ceramide Testing in Men with Erectile Dysfunction. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gonzalez Albo G, Broderick G, Cockerill K, Baird B, Thomas C. 049 Does the Clasification of Peyronie's Disease with Doppler US Affect Surgical Intervention Pursued by the Patient? J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Parikh K, Pathak R, Wilson R, Broderick G. 165 Pre-operative Imaging for Revision Penile Prosthesis Surgery: When Exam Alone is not Enough. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Myers A, Bullock J, Ball C, Broderick G. 103 Diabetes and Erectile Dysfunction: Does Evidence based Testing Inform Us? J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Towe M, Osman M, Huynh L, El-Khatib F, Andrianne R, Broderick G, Burnett A, Clavell-Hernandez J, Gross M, Guise A, Hatzichristodoulou G, Henry G, Hsieh T, Jenkins L, Lentz A, Munarriz R, Osmonov D, Sung Hun P, Perito P, Sadeghi-Nejad H, Simhan J, Wang R, Yafi F. Effect of antimicrobial dipping solutions on post-operative infection rates in diabetic patients undergoing primary insertion of a Coloplast titan inflatable penile prosthesis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Shinn EH, Broderick G, Fellman B, Johnson A, Wieland E, Moulder S, Symmans WF. Simulating Time-Dependent Patterns of Nonadherence by Patients With Breast Cancer to Adjuvant Oral Endocrine Therapy. JCO Clin Cancer Inform 2020; 3:1-9. [PMID: 31002563 PMCID: PMC6873985 DOI: 10.1200/cci.18.00091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Nearly 40% of patients with breast cancer discontinue their adjuvant oral endocrine treatment (ET). We measured discontinuation rates of ET at a comprehensive cancer center. We then used an iterative approach to model patterns of determinants associated with discontinuation of ET. METHODS Patients with nonmetastatic breast cancer receiving active adjuvant ET were approached by nurse practitioners to complete an anonymous survey at one time point. We simulated a prospective model by iteratively regressing adverse effects onto adherence status across windowed time periods of 2 to 3 consecutive years, bootstrapping the smaller group of nonadherent patients and subsampling the larger adherent group. RESULTS From February to April 2013, 216 participants were enrolled in the study. Forty patients (18.5%) reported that they had discontinued ET during the first 5 years of ET, and an additional four patients (1.9%) missed > 20% of their doses. Using two-sided significance tests, simulations showed that all 13 ET adverse effects and reasons for discontinuation were significantly related to discontinuation at some time point during ET. Worry about ET cost (odds ratio [OR], 1.79), emotional distress (OR, 1.72), and bone and joint pain (OR, 1.69) were the three most impactful reasons for discontinuation, with varying patterns of influence over time. CONCLUSION These analyses provide preliminary evidence that there are varying patterns of discontinuation of ET. Although some reasons for discontinuation exerted a steady influence over the 6-year ET trajectory (ie, bone and joint pain), other reasons, such as cost, cognitive complaints, and general dislike of pills, became more important in the later years of ET.
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Affiliation(s)
- Eileen H Shinn
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Bryan Fellman
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Stacy Moulder
- University of Texas MD Anderson Cancer Center, Houston, TX
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Morris MC, Chapman TJ, Pichichero ME, Broderick G. Immune Network Modeling Predicts Specific Nasopharyngeal and Peripheral Immune Dysregulation in Otitis-Prone Children. Front Immunol 2020; 11:1168. [PMID: 32595639 PMCID: PMC7301607 DOI: 10.3389/fimmu.2020.01168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
Acute otitis media (AOM) pathogenesis involves nasopharyngeal colonization by potential otopathogens and a viral co-infection. Stringently-defined otitis prone (sOP) children show characteristic patterns of immune dysfunction. We hypothesized that otitis proneness is largely a result of altered signaling between immune components that are otherwise competent, resulting in increased susceptibility to infection by bacterial otopathogens. To test this, we constructed a regulatory immune network model linking immune cells and signaling elements known to be involved in AOM and/or dysregulated in sOP children. The alignment of immune response mechanisms with data from in vivo and in vitro experimental observations produced 82 putative immune network models, each describing variants of immune regulatory networks consistent with available observations. Analysis of these models suggested that new measurements of serum levels of IL-4 and CXCL8 could refine competing models and resulted in the elimination of 38 of the models. Further analysis of the remaining 44 models suggested specific deviations in the predicted regulation of nasopharyngeal and peripheral immunity during response to AOM. Specifically, immune responses active in sOP children during AOM were characterized by early and constitutive activation of pro-inflammatory signaling in the nasopharynx and a Th2- and Treg-dominated profile in the periphery. We conclude that sOP children have altered regulation of key immune mediators during both health and pathogenesis. This altered regulation may be amenable to therapeutic intervention.
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Affiliation(s)
- Matthew C. Morris
- Center for Clinical Systems Biology, Research Institute, Rochester General Hospital, Rochester, NY, United States
| | - Timothy J. Chapman
- Center for Infectious Diseases and Immunology, Research Institute, Rochester General Hospital, Rochester, NY, United States
| | - Michael E. Pichichero
- Center for Infectious Diseases and Immunology, Research Institute, Rochester General Hospital, Rochester, NY, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Research Institute, Rochester General Hospital, Rochester, NY, United States
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, United States
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19
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Morris M, Clark J, Lyman C, Brown Broderick J, Kramer ZB, Skuse G, Broderick G. Capturing the pathway logic of cell signaling for epithelial-mesenchymal transition in ovarian cancer cell lines. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e18063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18063 Background: Epithelial-to- mesenchymal transition (EMT) plays a key role not only in cancer invasiveness and progression but also in treatment resistance. Experimental models suggest that epithelial and mesenchymal phenotypes may represent steady states supported by the regulatory logic of intracellular signaling networks. Using known regulatory interactions between intracellular signaling molecules as a framework, we explored EMT in silico with the aim of identifying potentially novel means of inhibiting metastasis in ovarian cancer. Methods: A mathematical model connecting 27 genes involved in EMT through 153 regulatory interactions was assembled from the Mogrify, Reactome, String and Pathway Studio (PS) databases, the last of which used the MedScan natural language processing (NLP) engine to process over 8,000 full-text publications. Logic model parameters dictating the regulatory response dynamics of the EMT circuit were constrained to values that accurately predicted the proteomic profiles characterized as either epithelial or mesenchymal in 30 cell lines in the publicly available MaxQB database. Results: A total of 94,672 candidate models predicted the protein expression in stable epithelial and mesenchymal cells equally well, clustering into 24 classes of slightly different EMT transition kinetics. Discrete event simulations based on these models identified 7 unique combinations, involving the concurrent modulation of at least 3 gene products capable of effecting this transition successfully even in the presence of noise. Every combination required inactivation of ZEB2, along with 2 other manipulations. Inactivation of TP53, HOXA5, or IRF7 was required in 3 combinations, while inactivation of ICAM1 was required in 2 cases. Only BCL2 was required to be activated in any of these scenarios. Interestingly, BCL2 inhibition is now applied clinically in some hematologic cancers and proving effective in patient-derived cell lines for high-grade serous ovarian cancer when combined with MEK inhibition. Conclusions: This work suggests that EMT might at least in part be driven by normal regulatory interactions between specific proteins in a network of pathways, without the requirement for additional mutations or alterations in the underlying circuitry. Maintenance of ZEB2 or TP53 activation as well as BCL2 inhibition may thus represent promising avenues for future research in arresting EMT and associated chemo-resistance.
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Affiliation(s)
| | | | | | | | | | - Gary Skuse
- Rochester Institute of Technology, Rochester, NY
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20
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Vashishtha S, Broderick G, Craddock TJA, Barnes ZM, Collado F, Balbin EG, Fletcher MA, Klimas NG. Leveraging Prior Knowledge to Recover Characteristic Immune Regulatory Motifs in Gulf War Illness. Front Physiol 2020; 11:358. [PMID: 32411011 PMCID: PMC7198798 DOI: 10.3389/fphys.2020.00358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
Potentially linked to the basic physiology of stress response, Gulf War Illness (GWI) is a debilitating condition presenting with complex immune, endocrine and neurological symptoms. Here we interrogate the immune response to physiological stress by measuring 16 blood-borne immune markers at 8 time points before, during and after maximum exercise challenge in n = 12 GWI veterans and n = 11 healthy veteran controls deployed to the same theater. Immune markers were combined into functional sets and the dynamics of their joint expression described as classical rate equations. These empirical networks were further informed structurally by projection onto prior knowledge networks mined from the literature. Of the 49 literature-informed immune signaling interactions, 21 were found active in the combined exercise response data. However, only 4 signals were common to both subject groups while 7 were uniquely active in GWI and 10 uniquely active in healthy veterans. Feedforward mediation of IL-23 and IL-17 by IL-6 and IL-10 emerged as distinguishing control elements that were characteristically active in GWI versus healthy subjects. Simulated restructuring of the regulatory circuitry in GWI as a result of applying an IL-6 receptor antagonist in combination with either a Th1 (IL-2, IFNγ, and TNFα) or IL-23 receptor antagonist predicted a partial rescue of immune response elements previously associated with illness severity. Overall, results suggest that pharmacologically altering the topology of the immune response circuitry identified as active in GWI can inform on strategies that while not curative, may nonetheless deliver a reduction in symptom burden. A lasting and more complete remission in GWI may therefore require manipulation of a broader physiology, namely one that includes endocrine oversight of immune function.
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Affiliation(s)
- Saurabh Vashishtha
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States.,Department of Biomedical Engineering, Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.,Departments of Psychology & Neuroscience, Computer Science and Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Zachary M Barnes
- Diabetes Research Institute, University of Miami, Miami, FL, United States.,Miami Veterans Affairs Medical Center, Miami, FL, United States
| | - Fanny Collado
- Miami Veterans Affairs Medical Center, Miami, FL, United States
| | - Elizabeth G Balbin
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.,Miami Veterans Affairs Medical Center, Miami, FL, United States
| | - Mary Ann Fletcher
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.,Departments of Psychology & Neuroscience, Computer Science and Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States.,Miami Veterans Affairs Medical Center, Miami, FL, United States
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.,Departments of Psychology & Neuroscience, Computer Science and Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States.,Miami Veterans Affairs Medical Center, Miami, FL, United States
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21
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Jaundoo R, Bohmann J, Gutierrez GE, Klimas N, Broderick G, Craddock TJA. Towards a Treatment for Gulf War Illness: A Consensus Docking Approach. Mil Med 2020; 185:554-561. [PMID: 32074351 PMCID: PMC7029833 DOI: 10.1093/milmed/usz299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Gulf War Illness (GWI) currently has no known cure and affects soldiers deployed during the Persian Gulf War. It is thought to originate from exposure to neurotoxicants combined with battlefield stress, and previous research indicates that treatment first involves inhibition of interleukin-2 and tumor necrosis factor alpha, followed by the glucocorticoid receptor. However, the off-target effects of pharmaceuticals hinder development of a drug treatment therapy. Materials and Methods AutoDock 4.2, AutoDock Vina, and Schrodinger’s Glide were used to perform consensus docking, a computational technique where pharmaceuticals are screened against targets using multiple scoring algorithms to obtain consistent binding affinities. FDA approved pharmaceuticals were docked against the above-mentioned immune and stress targets to determine a drug therapy for GWI. Additionally, the androgen and estrogen targets were screened to avoid pharmaceuticals with off-target interactions. Results While suramin bound to both immune targets with high affinity, top binders of the hormonal and glucocorticoid targets were non-specific towards their respective proteins, possibly due to high structure similarity between these proteins. Conclusions Development of a drug treatment therapy for GWI is threatened by the tight interplay between the immune and hormonal systems, often leading to drug interactions. Increasing knowledge of these interactions can lead to break-through therapies.
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Affiliation(s)
- Rajeev Jaundoo
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Psychology & Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796
| | - Jonathan Bohmann
- Pharmaceuticals and Bioengineering Department, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78238-5166
| | - Gloria E Gutierrez
- Pharmaceuticals and Bioengineering, Chemistry and Chemical Engineering Division, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78238-5166
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Miami Veterans Affairs Medical Center, 1201 N.W. 16th Street, Miami, FL 33125
| | - Gordon Broderick
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Psychology & Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Rochester Institute of Technology, One Lomb Memorial Drive, Rochester, NY 14623-5603.,Centre for Clinical Systems Biology, Rochester General Hospital Research Institute, 100 Kings Highway South, Rochester, NY 14617
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Psychology & Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Computer Science, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796
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22
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Lomax S, Houghton P, Parikh K, Ball C, Broderick G. 319 Predicting Intracavernosal Injection Therapy Failure by Evaluating Medical Risk Factors in Men with Erectile Dysfunction. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Parikh K, Lomax S, Pathak R, Bullock J, Schnell J, Broderick G. 391 Revision Inflatable Penile Prosthesis (IPP) Failure Rates and Risk Factors for Failure. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Osman M, Andrianne R, Broderick G, Burnett A, Gross M, Guise A, Hatzichristodoulou G, Henry G, Hsieh T, Jenkins L, Lentz A, Munarriz R, Osmonov D, Park S, Perito P, Sadeghi-Nejad H, Simhan J, Wang R, Yafi F, Collaborators D. 106 Immediate Preoperative Blood Glucose and Hemoglobin A1c Levels are not Predictive of Post-Operative Infections in Diabetic Men Undergoing Penile Prosthesis Placement. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Parikh K, Lomax S, Bullock J, Schnell J, Broderick G. 037 Preoperative Urine Culture and its Affect on Penile Prosthesis Infection. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Michalovicz LT, Kelly KA, Vashishtha S, Ben‐Hamo R, Efroni S, Miller JV, Locker AR, Sullivan K, Broderick G, Miller DB, O’Callaghan JP. Astrocyte-specific transcriptome analysis using the ALDH1L1 bacTRAP mouse reveals novel biomarkers of astrogliosis in response to neurotoxicity. J Neurochem 2019; 150:420-440. [PMID: 31222732 PMCID: PMC6771645 DOI: 10.1111/jnc.14800] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022]
Abstract
Neurotoxicology is hampered by the inability to predict regional and cellular targets of toxicant-induced damage. Evaluating astrogliosis overcomes this problem because reactive astrocytes highlight the location of toxicant-induced damage. While enhanced expression of glial fibrillary acidic protein is a hallmark of astrogliosis, few other biomarkers have been identified. However, bacterial artificial chromosome - translating ribosome affinity purification (bacTRAP) technology allows for characterization of the actively translating transcriptome of a particular cell type; use of this technology in aldehyde dehydrogenase 1 family member L1 (ALDH1L1) bacTRAP mice can identify genes selectively expressed in astrocytes. The aim of this study was to characterize additional biomarkers of neurotoxicity-induced astrogliosis using ALDH1L1 bacTRAP mice. The known dopaminergic neurotoxicant 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP; 12.5 mg/kg s.c.) was used to induce astrogliosis. Striatal tissue was obtained 12, 24, and 48 h following exposure for the isolation of actively translating RNA. Subsequently, MPTP-induced changes in this RNA pool were analyzed by microarray and 184 statistically significant, differentially expressed genes were identified. The dataset was interrogated by gene ontology, pathway, and co-expression network analyses, which identified novel genes, as well as those with known immune and inflammatory functions. Using these analyses, we were directed to several genes associated with reactive astrocytes. Of these, TIMP1 and miR-147 were identified as candidate biomarkers because of their robust increased expression following both MPTP and trimethyl tin exposures. Thus, we have demonstrated that bacTRAP can be used to identify new biomarkers of astrogliosis and aid in the characterization of astrocyte phenotypes induced by toxicant exposures. OPEN SCIENCE BADGES: This article has received a badge for *Open Materials* because it provided all relevant information to reproduce the study in the manuscript. The complete Open Science Disclosure form for this article can be found at the end of the article. More information about the Open Practices badges can be found at https://cos.io/our-services/open-science-badges/. Cover Image for this issue: doi: 10.1111/jnc.14518.
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Affiliation(s)
- Lindsay T. Michalovicz
- Health Effects Laboratory Division, Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthMorgantownWest VirginiaUSA
| | - Kimberly A. Kelly
- Health Effects Laboratory Division, Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthMorgantownWest VirginiaUSA
| | - Saurabh Vashishtha
- Center for Clinical Systems BiologyRochester General Hospital Research InstituteRochesterNew YorkUSA
| | - Rotem Ben‐Hamo
- The Mina and Everard Goodman Faculty of Life SciencesBar‐Ilan UniversityRamat‐GanIsrael
| | - Sol Efroni
- The Mina and Everard Goodman Faculty of Life SciencesBar‐Ilan UniversityRamat‐GanIsrael
| | - Julie V. Miller
- Health Effects Laboratory Division, Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthMorgantownWest VirginiaUSA
| | - Alicia R. Locker
- Health Effects Laboratory Division, Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthMorgantownWest VirginiaUSA
| | | | - Gordon Broderick
- Center for Clinical Systems BiologyRochester General Hospital Research InstituteRochesterNew YorkUSA
| | - Diane B. Miller
- Health Effects Laboratory Division, Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthMorgantownWest VirginiaUSA
| | - James P. O’Callaghan
- Health Effects Laboratory Division, Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthMorgantownWest VirginiaUSA
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Shumate A, Schommer E, Edwards G, Cannizzo P, Thomas C, Custer K, Broderick G. 194 Diabetes and Erectile Dysfunction: A Special Population Analysis from a Penile Doppler Cohort of 1000 Patients. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Cockerill K, Broderick G, Edwards G, Cannizzo P. 279 Comparing Vascular Diagnoses using Color Doppler Duplex Ultrasound Evaluation Before and After Treatment of Peyronie’s disease using Intralesional Collagenase Clostridium Histolyticum. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Morris MC, Cooney KE, Sedghamiz H, Abreu M, Collado F, Balbin EG, Craddock TJA, Klimas NG, Broderick G, Fletcher MA. Leveraging Prior Knowledge of Endocrine Immune Regulation in the Therapeutically Relevant Phenotyping of Women With Chronic Fatigue Syndrome. Clin Ther 2019; 41:656-674.e4. [PMID: 30929860 DOI: 10.1016/j.clinthera.2019.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/28/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE The complex and varied presentation of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has made it difficult to diagnose, study, and treat. Its symptoms and likely etiology involve multiple components of endocrine and immune regulation, including the hypothalamic-pituitary-adrenal axis, the hypothalamic-pituitary-gonadal axis, and their interactive oversight of immune function. We propose that the persistence of ME/CFS may involve changes in the regulatory interactions across these physiological axes. We also propose that the robustness of this new pathogenic equilibrium may at least in part explain the limited success of conventional single-target therapies. METHODS A comprehensive model was constructed of female endocrine-immune signaling consisting of 28 markers linked by 214 documented regulatory interactions. This detailed model was then constrained to adhere to experimental measurements in a subset of 17 candidate immune markers measured in peripheral blood of patients with ME/CFS and healthy control subjects before, during, and after a maximal exercise challenge. A set of 26 competing numerical models satisfied these data to within 5% error. FINDINGS Mechanistically informed predictions of endocrine and immune markers that were either unmeasured or exhibited high subject-to-subject variability pointed to possible context-specific overexpression in ME/CFS at rest of corticotropin-releasing hormone, chemokine (C-X-C motif) ligand 8, estrogen, follicle-stimulating hormone (FSH), gonadotropin-releasing hormone 1, interleukin (IL)-23, and luteinizing hormone, and underexpression of adrenocorticotropic hormone, cortisol, interferon-γ, IL-10, IL-17, and IL-1α. Simulations of rintatolimod and rituximab treatment predicted a shift in the repertoire of available endocrine-immune regulatory regimens. Rintatolimod was predicted to make available substantial remission in a significant subset of subjects, in particular those with low levels of IL-1α, IL-17, and cortisol; intermediate levels of progesterone and FSH; and high estrogen levels. Rituximab treatment was predicted to support partial remission in a smaller subset of patients with ME/CFS, specifically those with low norepinephrine, IL-1α, chemokine (C-X-C motif) ligand 8, and cortisol levels; intermediate FSH and gonadotropin-releasing hormone 1 levels; and elevated expression of tumor necrosis factor-α, luteinizing hormone, IL-12, and B-cell activation. IMPLICATIONS Applying a rigorous filter of known signaling mechanisms to experimentally measured immune marker expression in ME/CFS has highlighted potential new context-specific markers of illness. These novel endocrine and immune markers may offer useful candidates in delineating new subtypes of ME/CFS and may inform on refinements to the inclusion criteria and instrumentation of new and ongoing trials involving rintatolimod and rituximab treatment protocols.
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Affiliation(s)
- Matthew C Morris
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, USA
| | - Katherine E Cooney
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, USA
| | - Hooman Sedghamiz
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, USA
| | - Maria Abreu
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Fanny Collado
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Elizabeth G Balbin
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Travis J A Craddock
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Departments of Psychology and Neuroscience, Computer Science, and Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Nancy G Klimas
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, USA; Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA.
| | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Miami Veterans Affairs Medical Center, Miami, FL, USA
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Sedghamiz H, Morris M, Craddock TJA, Whitley D, Broderick G. Bio-ModelChecker: Using Bounded Constraint Satisfaction to Seamlessly Integrate Observed Behavior With Prior Knowledge of Biological Networks. Front Bioeng Biotechnol 2019; 7:48. [PMID: 30972331 PMCID: PMC6443719 DOI: 10.3389/fbioe.2019.00048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/28/2019] [Indexed: 01/31/2023] Open
Abstract
The in silico study and reverse engineering of regulatory networks has gained in recognition as an insightful tool for the qualitative study of biological mechanisms that underlie a broad range of complex illness. In the creation of reliable network models, the integration of prior mechanistic knowledge with experimentally observed behavior is hampered by the disparate nature and widespread sparsity of such measurements. The former challenges conventional regression-based parameter fitting while the latter leads to large sets of highly variable network models that are equally compliant with the data. In this paper, we propose a bounded Constraint Satisfaction (CS) based model checking framework for parameter set identification that readily accommodates partial records and the exponential complexity of this problem. We introduce specific criteria to describe the biological plausibility of competing multi-valued regulatory networks that satisfy all the constraints and formulate model identification as a multi-objective optimization problem. Optimization is directed at maximizing structural parsimony of the regulatory network by mitigating excessive control action selectivity while also favoring increased state transition efficiency and robustness of the network's dynamic response. The framework's scalability, computational time and validity is demonstrated on several well-established and well-studied biological networks.
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Affiliation(s)
- Hooman Sedghamiz
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Matthew Morris
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Travis J. A Craddock
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
- Departments of Psychology and Neuroscience, Computer Science, and Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Darrell Whitley
- School of Computer Science, Colorado State University, Fort Collins, CO, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, United States
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Sedghamiz H, Morris M, Whitley D, Craddock TJA, Pichichero M, Broderick G. Computation of Robust Minimal Intervention Sets in Multi-Valued Biological Regulatory Networks. Front Physiol 2019; 10:241. [PMID: 30941053 PMCID: PMC6433979 DOI: 10.3389/fphys.2019.00241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/25/2019] [Indexed: 02/06/2023] Open
Abstract
Enabled by rapid advances in computational sciences, in silico logical modeling of complex and large biological networks is more and more feasible making it an increasingly popular approach among biologists. Automated high-throughput, drug target identification is one of the primary goals of this in silico network biology. Targets identified in this way are then used to mine a library of drug chemical compounds in order to identify appropriate therapies. While identification of drug targets is exhaustively feasible on small networks, it remains computationally difficult on moderate and larger models. Moreover, there are several important constraints such as off-target effects, efficacy and safety that should be integrated into the identification of targets if the intention is translation to the clinical space. Here we introduce numerical constraints whereby efficacy is represented by efficiency in response and robustness of outcome. This paper introduces an algorithm that relies on a Constraint Satisfaction (CS) technique to efficiently compute the Minimal Intervention Sets (MIS) within a set of often complex clinical safety constraints with the aim of identifying the smallest least invasive set of targets pharmacologically accessible for therapy that most efficiently and reliably achieve the desired outcome.
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Affiliation(s)
- Hooman Sedghamiz
- Center for Clinical Systems Biology, Rochester General Hospital Research Institute, Rochester, NY, United States
| | - Matthew Morris
- Center for Clinical Systems Biology, Rochester General Hospital Research Institute, Rochester, NY, United States
| | - Darrell Whitley
- School of Computer Science, Colorado State University, Fort Collins, CO, United States
| | - Travis J A Craddock
- Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, United States.,Department of Computer Science, Nova Southeastern University, Fort Lauderdale, FL, United States.,Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, United States.,Clinical Systems Biology Group, Institute for NeuroImmune Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Michael Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital Research Institute, Rochester, NY, United States.,Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, United States
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Richman S, Morris MC, Broderick G, Craddock TJA, Klimas NG, Fletcher MA. Pharmaceutical Interventions in Chronic Fatigue Syndrome: A Literature-based Commentary. Clin Ther 2019; 41:798-805. [PMID: 30871727 DOI: 10.1016/j.clinthera.2019.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/11/2019] [Indexed: 12/22/2022]
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disorder characterized by prolonged periods of fatigue, chronic pain, depression, and a complex constellation of other symptoms. Currently, ME/CFS has no known cause, nor are the mechanisms of illness well understood. Therefore, with few exceptions, attempts to treat ME/CFS have been directed mainly toward symptom management. These treatments include antivirals, pain relievers, antidepressants, and oncologic agents as well as other single-intervention treatments. Results of these trials have been largely inconclusive and, in some cases, contradictory. Contributing factors include a lack of well-designed and -executed studies and the highly heterogeneous nature of ME/CFS, which has made a single etiology difficult to define. Because the majority of single-intervention treatments have shown little efficacy, it may instead be beneficial to explore broader-acting combination therapies in which a more focused precision-medicine approach is supported by a systems-level analysis of endocrine and immune co-regulation.
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Affiliation(s)
- Spencer Richman
- Gosnell School of Life Sciences, Rochester Institute of Technology, Rochester, NY, USA; Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, USA
| | - Matthew C Morris
- Gosnell School of Life Sciences, Rochester Institute of Technology, Rochester, NY, USA; Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, USA
| | - Gordon Broderick
- Gosnell School of Life Sciences, Rochester Institute of Technology, Rochester, NY, USA; Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, USA; Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA.
| | - Travis J A Craddock
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Departments of Psychology and Neuroscience, Computer Science, Nova Southeastern University, Fort Lauderdale, FL, USA; Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Nancy G Klimas
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA; Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA
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Jeffrey MG, Nathanson L, Aenlle K, Barnes ZM, Baig M, Broderick G, Klimas NG, Fletcher MA, Craddock TJA. Treatment Avenues in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Split-gender Pharmacogenomic Study of Gene-expression Modules. Clin Ther 2019; 41:815-835.e6. [PMID: 30851951 DOI: 10.1016/j.clinthera.2019.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/09/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisymptom illness impacting up to 1 million people in the United States. As the pathogenesis and etiology of this complex condition are unclear, prospective treatments are limited. Identifying US Food and Drug Administration-approved drugs that may be repositioned as treatments for ME/CFS may offer a rapid and cost-effective solution. METHODS Here we used gene-expression data from 33 patients with Fukuda-defined ME/CFS (23 females, 10 males) and 21 healthy demographically comparable controls (15 females, 6 males) to identify differential expression of predefined gene-module sets based on nonparametric statistics. Differentially expressed gene modules were then annotated via over-representation analysis using the Consensus Pathway database. Differentially expressed modules were then regressed onto measures of fatigue and cross-referenced with drug atlas and pharmacogenomics databases to identify putative treatment agents. FINDINGS The top 1% of modules identified in males indicated small effect sizes in modules associated with immune regulation and mitochondrial dysfunction. In females, modules identified included those related to immune factors and cardiac/blood factors, returning effect sizes ranging from very small to intermediate (0.147 < Cohen δ < 0.532). Regression analysis indicated that B-cell receptors, T-cell receptors, tumor necrosis factor α, transforming growth factor β, and metabolic and cardiac modules were strongly correlated with multiple composite measures of fatigue. Cross-referencing identified genes with pharmacogenomics data indicated immunosuppressants as potential treatments of ME/CFS symptoms. IMPLICATIONS The findings from our analysis suggest that ME/CFS symptoms are perpetuated by immune dysregulation that may be approached via immune modulation-based treatment strategies.
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Affiliation(s)
- Mary G Jeffrey
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA; College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Lubov Nathanson
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA; Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Kristina Aenlle
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA; Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, FL, USA; Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Zachary M Barnes
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA; Miami Veterans Affairs Medical Center, Miami, FL, USA; Miller School of Medicine, University of Miami, Miami, FL, USA; Diabetes Research Institute, University of Miami, Miami, FL, USA
| | - Mirza Baig
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Gordon Broderick
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA; College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA; Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, FL, USA; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, USA
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA; College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA; Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Mary Ann Fletcher
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA; Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, FL, USA; Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA; College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA; Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, FL, USA; Department of Computer Science, Nova Southeastern University, Ft. Lauderdale, FL, USA.
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Craddock TJA, Michalovicz LT, Kelly KA, Rice MA, Miller DB, Klimas NG, Morris M, O'Callaghan JP, Broderick G. A Logic Model of Neuronal-Glial Interaction Suggests Altered Homeostatic Regulation in the Perpetuation of Neuroinflammation. Front Cell Neurosci 2018; 12:336. [PMID: 30374291 PMCID: PMC6196274 DOI: 10.3389/fncel.2018.00336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
Aberrant inflammatory signaling between neuronal and glial cells can develop into a persistent sickness behavior-related disorders, negatively impacting learning, memory, and neurogenesis. While there is an abundance of literature describing these interactions, there still lacks a comprehensive mathematical model describing the complex feed-forward and feedback mechanisms of neural-glial interaction. Here we compile molecular and cellular signaling information from various studies and reviews in the literature to create a logically-consistent, theoretical model of neural-glial interaction in the brain to explore the role of neuron-glia homeostatic regulation in the perpetuation of neuroinflammation. Logic rules are applied to this connectivity diagram to predict the system's homeostatic behavior. We validate our model predicted homeostatic profiles against RNAseq gene expression profiles in a mouse model of stress primed neuroinflammation. A meta-analysis was used to calculate the significance of similarity between the inflammatory profiles of mice exposed to diisopropyl fluorophostphate (DFP) [with and without prior priming by the glucocorticoid stress hormone corticosterone (CORT)], with the equilibrium states predicted by the model, and to provide estimates of the degree of the neuroinflammatory response. Beyond normal homeostatic regulation, our model predicts an alternate self-perpetuating condition consistent with chronic neuroinflammation. RNAseq gene expression profiles from the cortex of mice exposed to DFP and CORT+DFP align with this predicted state of neuroinflammation, whereas the alignment to CORT alone was negligible. Simulations of putative treatment strategies post-exposure were shown to be theoretically capable of returning the system to a state of typically healthy regulation with broad-acting anti-inflammatory agents showing the highest probability of success. The results support a role for the brain's own homeostatic drive in perpetuating the chronic neuroinflammation associated with exposure to the organophosphate DFP, with and without CORT priming. The deviation of illness profiles from exact model predictions suggests the presence of additional factors or of lasting changes to the brain's regulatory circuitry specific to each exposure.
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Affiliation(s)
- Travis J A Craddock
- Department of Psychology & Neuroscience, Nova Southeastern University, Ft. Lauderdale, FL, United States.,Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States.,Department of Computer Science, Nova Southeastern University, Ft. Lauderdale, FL, United States.,Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Lindsay T Michalovicz
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Kimberly A Kelly
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Mark A Rice
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Diane B Miller
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States.,Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, FL, United States.,Miami Veterans Affairs Medical Center, Miami, FL, United States
| | - Mariana Morris
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States.,Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - James P O'Callaghan
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Gordon Broderick
- Department of Psychology & Neuroscience, Nova Southeastern University, Ft. Lauderdale, FL, United States.,Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States.,Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
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Sedghamiz H, Morris M, Craddock TJA, Whitley D, Broderick G. High-fidelity discrete modeling of the HPA axis: a study of regulatory plasticity in biology. BMC Syst Biol 2018; 12:76. [PMID: 30016990 PMCID: PMC6050677 DOI: 10.1186/s12918-018-0599-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/26/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal (HPA) axis is a central regulator of stress response and its dysfunction has been associated with a broad range of complex illnesses including Gulf War Illness (GWI) and Chronic Fatigue Syndrome (CFS). Though classical mathematical approaches have been used to model HPA function in isolation, its broad regulatory interactions with immune and central nervous function are such that the biological fidelity of simulations is undermined by the limited availability of reliable parameter estimates. METHOD Here we introduce and apply a generalized discrete formalism to recover multiple stable regulatory programs of the HPA axis using little more than connectivity between physiological components. This simple discrete model captures cyclic attractors such as the circadian rhythm by applying generic constraints to a minimal parameter set; this is distinct from Ordinary Differential Equation (ODE) models, which require broad and precise parameter sets. Parameter tuning is accomplished by decomposition of the overall regulatory network into isolated sub-networks that support cyclic attractors. Network behavior is simulated using a novel asynchronous updating scheme that enforces priority with memory within and between physiological compartments. RESULTS Consistent with much more complex conventional models of the HPA axis, this parsimonious framework supports two cyclic attractors, governed by higher and lower levels of cortisol respectively. Importantly, results suggest that stress may remodel the stability landscape of this system, favoring migration from one stable circadian cycle to the other. Access to each regime is dependent on HPA axis tone, captured here by the tunable parameters of the multi-valued logic. Likewise, an idealized glucocorticoid receptor blocker alters the regulatory topology such that maintenance of persistently low cortisol levels is rendered unstable, favoring a return to normal circadian oscillation in both cortisol and glucocorticoid receptor expression. CONCLUSION These results emphasize the significance of regulatory connectivity alone and how regulatory plasticity may be explored using simple discrete logic and minimal data compared to conventional methods.
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Affiliation(s)
- Hooman Sedghamiz
- Center for Clinical Systems Biology, Rochester General Hospital, 1425 Portland Ave, Rochester, 14621 US
| | - Matthew Morris
- Center for Clinical Systems Biology, Rochester General Hospital, 1425 Portland Ave, Rochester, 14621 US
| | - Travis J. A. Craddock
- Institute for Neuro Immune Medicine, Nova Southeastern University, 8501 SW 124th Avenue, Davie, 33183 US
- Departments of Psychology and Neuroscience, Computer Science, and Clinical Immunology, Nova Southeastern University, 8501 SW 124th Avenue, Davie, 33183 US
| | - Darrell Whitley
- School of Computer Science, Colorado State University, University Ave, Fort Collins, 80521 US
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, 1425 Portland Ave, Rochester, 14621 US
- Biomedical Engineering Department, Rochester Institute of Technology, One Lomb Memorial Drive, Rochester, 14623 US
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Ashbrook DG, Hing B, Michalovicz LT, Kelly KA, Miller JV, de Vega WC, Miller DB, Broderick G, O'Callaghan JP, McGowan PO. Epigenetic impacts of stress priming of the neuroinflammatory response to sarin surrogate in mice: a model of Gulf War illness. J Neuroinflammation 2018; 15:86. [PMID: 29549885 PMCID: PMC5857314 DOI: 10.1186/s12974-018-1113-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/01/2018] [Indexed: 12/12/2022] Open
Abstract
Background Gulf War illness (GWI) is an archetypal, medically unexplained, chronic condition characterised by persistent sickness behaviour and neuroimmune and neuroinflammatory components. An estimated 25–32% of the over 900,000 veterans of the 1991 Gulf War fulfil the requirements of a GWI diagnosis. It has been hypothesised that the high physical and psychological stress of combat may have increased vulnerability to irreversible acetylcholinesterase (AChE) inhibitors leading to a priming of the neuroimmune system. A number of studies have linked high levels of psychophysiological stress and toxicant exposures to epigenetic modifications that regulate gene expression. Recent research in a mouse model of GWI has shown that pre-exposure with the stress hormone corticosterone (CORT) causes an increase in expression of specific chemokines and cytokines in response to diisopropyl fluorophosphate (DFP), a sarin surrogate and irreversible AChE inhibitor. Methods C57BL/6J mice were exposed to CORT for 4 days, and exposed to DFP on day 5, before sacrifice 6 h later. The transcriptome was examined using RNA-seq, and the epigenome was examined using reduced representation bisulfite sequencing and H3K27ac ChIP-seq. Results We show transcriptional, histone modification (H3K27ac) and DNA methylation changes in genes related to the immune and neuronal system, potentially relevant to neuroinflammatory and cognitive symptoms of GWI. Further evidence suggests altered proportions of myelinating oligodendrocytes in the frontal cortex, perhaps connected to white matter deficits seen in GWI sufferers. Conclusions Our findings may reflect the early changes which occurred in GWI veterans, and we observe alterations in several pathways altered in GWI sufferers. These close links to changes seen in veterans with GWI indicates that this model reflects the environmental exposures related to GWI and may provide a model for biomarker development and testing future treatments. Electronic supplementary material The online version of this article (10.1186/s12974-018-1113-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David G Ashbrook
- Department of Biological Sciences and Center for Environmental Epigenetics and Development and Department of Cell and Systems Biology, University of Toronto, Scarborough campus, Toronto, ON, Canada.,Present address: Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, TN, 38103, USA
| | - Benjamin Hing
- Department of Biological Sciences and Center for Environmental Epigenetics and Development and Department of Cell and Systems Biology, University of Toronto, Scarborough campus, Toronto, ON, Canada.,Present address: Department of Psychiatry, Medical Laboratories, The University of Iowa, Iowa City, Iowa, 52246, USA
| | | | | | - Julie V Miller
- CDC-NIOSH, 1095 Willowdale Road, Morgantown, WV, 26505, USA
| | - Wilfred C de Vega
- Department of Biological Sciences and Center for Environmental Epigenetics and Development and Department of Cell and Systems Biology, University of Toronto, Scarborough campus, Toronto, ON, Canada
| | - Diane B Miller
- CDC-NIOSH, 1095 Willowdale Road, Morgantown, WV, 26505, USA
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital Research Institute, Rochester, NY, USA
| | | | - Patrick O McGowan
- Department of Biological Sciences and Center for Environmental Epigenetics and Development and Department of Cell and Systems Biology, University of Toronto, Scarborough campus, Toronto, ON, Canada. .,Department of Psychology, University of Toronto, Toronto, ON, Canada. .,Department of Physiology, University of Toronto, Toronto, ON, Canada.
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Schommer E, Pathak R, McNulty Z, Shah R, Broderick G. 207 Single Center Experience Using Doppler Assessment for Erectile Dysfunction (ED) Complaint in More Than 500 Patients. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fletcher MA, Barnes Z, Broderick G, Klimas NG. Psychoneuroimmunology and Natural Killer Cells: The Chromium-Release Whole-Blood Assay. Methods Mol Biol 2018; 1781:209-220. [PMID: 29705850 DOI: 10.1007/978-1-4939-7828-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Natural killer (NK) cells are an essential component of innate immunity. These lymphocytes are also sensitive barometers of the effects of endogenous and exogenous stressors on the immune system. This chapter describes a chromium (51Cr)-release bioassay designed to measure to the target cell killing capacity of NK cells (NKCC). Key features of the cytotoxicity assay are that it is done with whole blood and that numbers of effector cells are determined for each sample by flow cytometry and lymphocyte count. Effector cells are defined as CD3-CD56+ lymphocytes. Target cells are the K562 erythroleukemia cell line. Killing capacity is defined as number of target cells killed per effector cell, at an effector cell/target cell ratio of 1:1 during a 4-h in vitro assay.
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Affiliation(s)
- Mary Ann Fletcher
- Department of Medicine, University of Miami, Miami, FL, USA.
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA.
| | - Zachary Barnes
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital Research Institute, Rochester, NY, USA
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
- Miami Veterans Affairs Medical Center, Miami, FL, USA
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Tory Toole J, Rice MA, Cargill J, Craddock TJA, Nierenberg B, Klimas NG, Fletcher MA, Morris M, Zysman J, Broderick G. Increasing Resilience to Traumatic Stress: Understanding the Protective Role of Well-Being. Methods Mol Biol 2018; 1781:87-100. [PMID: 29705844 DOI: 10.1007/978-1-4939-7828-1_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The brain maintains homeostasis in part through a network of feedback and feed-forward mechanisms, where neurochemicals and immune markers act as mediators. Using a previously constructed model of biobehavioral feedback, we found that in addition to healthy equilibrium another stable regulatory program supported chronic depression and anxiety. Exploring mechanisms that might underlie the contributions of subjective well-being to improved therapeutic outcomes in depression, we iteratively screened 288 candidate feedback patterns linking well-being to molecular signaling networks for those that maintained the original homeostatic regimes. Simulating stressful trigger events on each candidate network while maintaining high levels of subjective well-being isolated a specific feedback network where well-being was promoted by dopamine and acetylcholine, and itself promoted norepinephrine while inhibiting cortisol expression. This biobehavioral feedback mechanism was especially effective in reproducing well-being's clinically documented ability to promote resilience and protect against onset of depression and anxiety.
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Affiliation(s)
- J Tory Toole
- College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Mark A Rice
- College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA.,Center for Clinical Systems Biology, Rochester General Hospital Research Institute, Rochester, NY, USA
| | - Jordan Cargill
- College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Travis J A Craddock
- College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA.,Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Barry Nierenberg
- College of Psychology, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA.,Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Mary Ann Fletcher
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA.,Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Mariana Morris
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA.,Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Joel Zysman
- Center for Computational Science, University of Miami, Miami, FL, USA
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital Research Institute, Rochester, NY, USA. .,Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA.
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Cook DB, Light AR, Light KC, Broderick G, Shields MR, Dougherty RJ, Meyer JD, VanRiper S, Stegner AJ, Ellingson LD, Vernon SD. Neural consequences of post-exertion malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Brain Behav Immun 2017; 62:87-99. [PMID: 28216087 DOI: 10.1016/j.bbi.2017.02.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/01/2017] [Accepted: 02/13/2017] [Indexed: 12/21/2022] Open
Abstract
Post exertion malaise is one of the most debilitating aspects of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, yet the neurobiological consequences are largely unexplored. The objective of the study was to determine the neural consequences of acute exercise using functional brain imaging. Fifteen female Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients and 15 healthy female controls completed 30min of submaximal exercise (70% of peak heart rate) on a cycle ergometer. Symptom assessments (e.g. fatigue, pain, mood) and brain imaging data were collected one week prior to and 24h following exercise. Functional brain images were obtained during performance of: 1) a fatiguing cognitive task - the Paced Auditory Serial Addition Task, 2) a non-fatiguing cognitive task - simple number recognition, and 3) a non-fatiguing motor task - finger tapping. Symptom and exercise data were analyzed using independent samples t-tests. Cognitive performance data were analyzed using mixed-model analysis of variance with repeated measures. Brain responses to fatiguing and non-fatiguing tasks were analyzed using linear mixed effects with cluster-wise (101-voxels) alpha of 0.05. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients reported large symptom changes compared to controls (effect size ≥0.8, p<0.05). Patients and controls had similar physiological responses to exercise (p>0.05). However, patients exercised at significantly lower Watts and reported greater exertion and leg muscle pain (p<0.05). For cognitive performance, a significant Group by Time interaction (p<0.05), demonstrated pre- to post-exercise improvements for controls and worsening for patients. Brain responses to finger tapping did not differ between groups at either time point. During number recognition, controls exhibited greater brain activity (p<0.05) in the posterior cingulate cortex, but only for the pre-exercise scan. For the Paced Serial Auditory Addition Task, there was a significant Group by Time interaction (p<0.05) with patients exhibiting increased brain activity from pre- to post-exercise compared to controls bilaterally for inferior and superior parietal and cingulate cortices. Changes in brain activity were significantly related to symptoms for patients (p<0.05). Acute exercise exacerbated symptoms, impaired cognitive performance and affected brain function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients. These converging results, linking symptom exacerbation with brain function, provide objective evidence of the detrimental neurophysiological effects of post-exertion malaise.
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Affiliation(s)
- Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States; University of Wisconsin - Madison, Madison, WI, United States.
| | - Alan R Light
- University of Utah, Salt Lake City, UT, United States
| | | | - Gordon Broderick
- Nova Southeastern University, Fort Lauderdale, FL, United States
| | | | | | - Jacob D Meyer
- University of Wisconsin - Madison, Madison, WI, United States
| | | | - Aaron J Stegner
- University of Wisconsin - Madison, Madison, WI, United States
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Barker T, Russo SA, Barker G, Rice MA, Jeffrey MG, Broderick G, Craddock TJA. A case matched study examining the reliability of using ImPACT to assess effects of multiple concussions. BMC Psychol 2017; 5:14. [PMID: 28454588 PMCID: PMC5410025 DOI: 10.1186/s40359-017-0184-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 3.8 million sport and recreational concussions occur per year, creating a need for accurate diagnosis and management of concussions. Researchers and clinicians are exploring the potential dose-response cumulative effects of concussive injuries using computerized neuropsychological exams, however, results have been mixed and/or contradictory. This study starts with a large adolescent population and applies strict inclusion criteria to examine how previous mild traumatic brain injuries affect symptom reports and neurocognitive performance on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) computerized tool. METHODS After applying exclusion criteria and case matching, 204 male and 99 female participants remained. These participants were grouped according to sex and the number of previous self-reported concussions and examined for overall differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. In an effort to further reduce confounding factors due to the varying group sizes, participants were then case matched on age, sex, and body mass index and analyzed for differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. RESULTS Case matched analysis demonstrated males with concussions experience significantly higher rates of dizziness (p = .027, η2 = .035), fogginess (p = .038, η2 = .032), memory problems (p = .003, η2 = .055), and concentration problems (p = .009, η2 = .046) than males with no reported previous concussions. No significant effects were found for females, although females reporting two concussions demonstrated a slight trend for experiencing higher numbers of symptoms than females reporting no previous concussions. CONCLUSIONS The results suggest that male adolescent athletes reporting multiple concussions have lingering concussive symptoms well after the last concussive event; however, these symptoms were found to be conflicting and better explained by complainer versus complacent attitudes in the population examined. Our results conflict with a significant portion of the current literature that uses relatively lenient inclusion and exclusion criteria, providing evidence of the importance of strict inclusion and exclusion criteria and examination of confounding factors when assessing the effects of concussions.
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Affiliation(s)
- Trevor Barker
- Department of Psychology & Neuroscience, Nova Southeastern University, Ft. Lauderdale, 33314, FL, USA
| | - Stephen A Russo
- Department of Neurology, Thomas Jefferson University, Philadelphia, 19107, PA, USA.,Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, 19107, PA, USA
| | - Gaytri Barker
- Department of Psychology & Neuroscience, Nova Southeastern University, Ft. Lauderdale, 33314, FL, USA
| | - Mark A Rice
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, 33314, FL, USA
| | - Mary G Jeffrey
- Department of Psychology & Neuroscience, Nova Southeastern University, Ft. Lauderdale, 33314, FL, USA
| | - Gordon Broderick
- Department of Psychology & Neuroscience, Nova Southeastern University, Ft. Lauderdale, 33314, FL, USA.,Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, 33314, FL, USA.,Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, 33314, USA
| | - Travis J A Craddock
- Department of Psychology & Neuroscience, Nova Southeastern University, Ft. Lauderdale, 33314, FL, USA. .,Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale, 33314, FL, USA. .,Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, 33314, USA. .,Department of Computer Science, Nova Southeastern University, Ft. Lauderdale, 33314, FL, USA.
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Harvey JM, Broderick G, Bowie A, Barnes ZM, Katz BZ, O'Gorman MRG, Vernon SD, Fletcher MA, Klimas NG, Taylor R. Tracking post-infectious fatigue in clinic using routine Lab tests. BMC Pediatr 2016; 16:54. [PMID: 27118537 PMCID: PMC4847210 DOI: 10.1186/s12887-016-0596-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 04/21/2016] [Indexed: 12/25/2022] Open
Abstract
Background While biomarkers for chronic fatigue syndrome (CFS) are beginning to emerge they typically require a highly specialized clinical laboratory. We hypothesized that subsets of commonly measured laboratory markers used in combination could support the diagnosis of post-infectious CFS (PI-CFS) in adolescents following infectious mononucleosis (IM) and help determine who might develop persistence of symptoms. Methods Routine clinical laboratory markers were collected prospectively in 301 mono-spot positive adolescents, 4 % of whom developed CFS (n = 13). At 6, 12, and 24 months post-diagnosis with IM, 59 standard tests were performed including metabolic profiling, liver enzyme panel, hormone profiles, complete blood count (CBC), differential white blood count (WBC), salivary cortisol, and urinalysis. Classification models separating PI-CFS from controls were constructed at each time point using stepwise subset selection. Results Lower ACTH levels at 6 months post-IM diagnosis were highly predictive of CFS (AUC p = 0.02). ACTH levels in CFS overlapped with healthy controls at 12 months, but again showed a trend towards a deficiency at 24 months. Conversely, estradiol levels depart significantly from normal at 12 months only to recover at 24 months (AUC p = 0.02). Finally, relative neutrophil count showed a significant departure from normal at 24 months in CFS (AUC p = 0.01). Expression of these markers evolved differently over time between groups. Conclusions Preliminary results suggest that serial assessment of stress and sex hormones as well as the relative proportion of innate immune cells measured using standard clinical laboratory tests may support the diagnosis of PI-CFS in adolescents with IM. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0596-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Gordon Broderick
- Department of Medicine, University of Miami, Miami, FL, USA. .,Institute for Neuro Immune Medicine, Nova Southeastern University, University Park Plaza, 3440 South University, Fort Lauderdale, 33328, FL, USA. .,University of Alberta, Edmonton, AB, Canada.
| | | | | | - Ben Z Katz
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | | | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Nova Southeastern University, University Park Plaza, 3440 South University, Fort Lauderdale, 33328, FL, USA
| | - Nancy G Klimas
- Institute for Neuro Immune Medicine, Nova Southeastern University, University Park Plaza, 3440 South University, Fort Lauderdale, 33328, FL, USA
| | - Renee Taylor
- University of Illinois at Chicago, Chicago, IL, USA
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Russell L, Broderick G, Taylor R, Fernandes H, Harvey J, Barnes Z, Smylie A, Collado F, Balbin EG, Katz BZ, Klimas NG, Fletcher MA. Illness progression in chronic fatigue syndrome: a shifting immune baseline. BMC Immunol 2016; 17:3. [PMID: 26965484 PMCID: PMC4785654 DOI: 10.1186/s12865-016-0142-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/29/2016] [Indexed: 01/04/2023] Open
Abstract
Background Validation of biomarkers for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) across data sets has proven disappointing. As immune signature may be affected by many factors, our objective was to explore the shift in discriminatory cytokines across ME/CFS subjects separated by duration of illness. Methods Cytokine expression collected at rest across multiple studies for female ME/CFS subjects (i) 18 years or younger, ill for 2 years or less (n = 18), (ii) 18–50 years of age, ill for 7 years (n = 22), and (iii) age 50 years or older (n = 28), ill for 11 years on average. Control subjects were matched for age and body mass index (BMI). Data describing the levels of 16 cytokines using a chemiluminescent assay was used to support the identification of separate linear classification models for each subgroup. In order to isolate the effects of duration of illness alone, cytokines that changed significantly with age in the healthy control subjects were excluded a priori. Results Optimal selection of cytokines in each group resulted in subsets of IL-1α, 6, 8, 15 and TNFα. Common to any 2 of 3 groups were IL-1α, 6 and 8. Setting these 3 markers as a triple screen and adjusting their contribution according to illness duration sub-groups produced ME/CFS classification accuracies of 75–88 %. The contribution of IL-1α, higher in recently ill adolescent ME/CFS subjects was progressively less important with duration. While high levels of IL-8 screened positive for ME/CFS in the recently afflicted, the opposite was true for subjects ill for more than 2 years. Similarly, while low levels of IL-6 suggested early ME/CFS, the reverse was true in subjects over 18 years of age ill for more than 2 years. Conclusions These preliminary results suggest that IL-1α, 6 and 8 adjusted for illness duration may serve as robust biomarkers, independent of age, in screening for ME/CFS. Electronic supplementary material The online version of this article (doi:10.1186/s12865-016-0142-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lindsey Russell
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gordon Broderick
- Department of Medicine, University of Alberta, Edmonton, AB, Canada. .,Miami Veterans Affairs Medical Center, Miami, FL, USA. .,Institute for Neuro-immune Medicine, Nova Southeastern University, Suite 3440 University Park Plaza, 3424 South University Drive, Fort Lauderdale, FL, 33328, USA.
| | - Renee Taylor
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Jeanna Harvey
- Department of Medicine, University of Miami, Miami, FL, USA.,Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Zachary Barnes
- Department of Medicine, University of Miami, Miami, FL, USA.,Miami Veterans Affairs Medical Center, Miami, FL, USA.,Institute for Neuro-immune Medicine, Nova Southeastern University, Suite 3440 University Park Plaza, 3424 South University Drive, Fort Lauderdale, FL, 33328, USA
| | - AnneLiese Smylie
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Fanny Collado
- Miami Veterans Affairs Medical Center, Miami, FL, USA
| | | | - Ben Z Katz
- Division of Infectious Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nancy G Klimas
- Miami Veterans Affairs Medical Center, Miami, FL, USA.,Institute for Neuro-immune Medicine, Nova Southeastern University, Suite 3440 University Park Plaza, 3424 South University Drive, Fort Lauderdale, FL, 33328, USA
| | - Mary Ann Fletcher
- Miami Veterans Affairs Medical Center, Miami, FL, USA.,Institute for Neuro-immune Medicine, Nova Southeastern University, Suite 3440 University Park Plaza, 3424 South University Drive, Fort Lauderdale, FL, 33328, USA
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Craddock TJA, Del Rosario RR, Rice M, Zysman JP, Fletcher MA, Klimas NG, Broderick G. Achieving Remission in Gulf War Illness: A Simulation-Based Approach to Treatment Design. PLoS One 2015; 10:e0132774. [PMID: 26192591 PMCID: PMC4508058 DOI: 10.1371/journal.pone.0132774] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/19/2015] [Indexed: 12/26/2022] Open
Abstract
Gulf War Illness (GWI) is a chronic multi-symptom disorder affecting up to one-third of the 700,000 returning veterans of the 1991 Persian Gulf War and for which there is no known cure. GWI symptoms span several of the body’s principal regulatory systems and include debilitating fatigue, severe musculoskeletal pain, cognitive and neurological problems. Using computational models, our group reported previously that GWI might be perpetuated at least in part by natural homeostatic regulation of the neuroendocrine-immune network. In this work, we attempt to harness these regulatory dynamics to identify treatment courses that might produce lasting remission. Towards this we apply a combinatorial optimization scheme to the Monte Carlo simulation of a discrete ternary logic model that represents combined hypothalamic-pituitary-adrenal (HPA), gonadal (HPG), and immune system regulation in males. In this work we found that no single intervention target allowed a robust return to normal homeostatic control. All combined interventions leading to a predicted remission involved an initial inhibition of Th1 inflammatory cytokines (Th1Cyt) followed by a subsequent inhibition of glucocorticoid receptor function (GR). These first two intervention events alone ended in stable and lasting return to the normal regulatory control in 40% of the simulated cases. Applying a second cycle of this combined treatment improved this predicted remission rate to 2 out of 3 simulated subjects (63%). These results suggest that in a complex illness such as GWI, a multi-tiered intervention strategy that formally accounts for regulatory dynamics may be required to reset neuroendocrine-immune homeostasis and support extended remission.
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Affiliation(s)
- Travis J. A. Craddock
- Institute for Neuro Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- Graduate School for Computer and Information Sciences, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- * E-mail:
| | - Ryan R. Del Rosario
- Institute for Neuro Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
| | - Mark Rice
- Institute for Neuro Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
| | - Joel P. Zysman
- Center for Computational Science, University of Miami, Miami, FL, USA
| | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
| | - Nancy G. Klimas
- Institute for Neuro Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- Veterans Affairs Medical Center, Miami, FL, United States of America
| | - Gordon Broderick
- Institute for Neuro Immune Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
- College of Pharmacy, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
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Craddock TJA, Harvey JM, Nathanson L, Barnes ZM, Klimas NG, Fletcher MA, Broderick G. Using gene expression signatures to identify novel treatment strategies in gulf war illness. BMC Med Genomics 2015; 8:36. [PMID: 26156520 PMCID: PMC4495687 DOI: 10.1186/s12920-015-0111-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/26/2015] [Indexed: 12/12/2022] Open
Abstract
Background Gulf War Illness (GWI) is a complex multi-symptom disorder that affects up to one in three veterans of this 1991 conflict and for which no effective treatment has been found. Discovering novel treatment strategies for such a complex chronic illness is extremely expensive, carries a high probability of failure and a lengthy cycle time. Repurposing Food and Drug Administration approved drugs offers a cost-effective solution with a significantly abbreviated timeline. Methods Here, we explore drug re-purposing opportunities in GWI by combining systems biology and bioinformatics techniques with pharmacogenomic information to find overlapping elements in gene expression linking GWI to successfully treated diseases. Gene modules were defined based on cellular function and their activation estimated from the differential expression of each module’s constituent genes. These gene modules were then cross-referenced with drug atlas and pharmacogenomic databases to identify agents currently used successfully for treatment in other diseases. To explore the clinical use of these drugs in illnesses similar to GWI we compared gene expression patterns in modules that were significantly expressed in GWI with expression patterns in those same modules in other illnesses. Results We found 19 functional modules with significantly altered gene expression patterns in GWI. Within these modules, 45 genes were documented drug targets. Illnesses with highly correlated gene expression patterns overlapping considerably with GWI were found in 18 of the disease conditions studied. Brain, muscular and autoimmune disorders composed the bulk of these. Conclusion Of the associated drugs, immunosuppressants currently used in treating rheumatoid arthritis, and hormone based therapies were identified as the best available candidates for treating GWI symptoms. Electronic supplementary material The online version of this article (doi:10.1186/s12920-015-0111-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Travis J A Craddock
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA. .,Graduate School of Computer and Information Sciences, Nova Southeastern University, Fort Lauderdale, USA. .,Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA. .,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA. .,Department of Medicine, University of Alberta, Edmonton, Canada.
| | | | - Lubov Nathanson
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Zachary M Barnes
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Miller School of Medicine, University of Miami, Miami, USA.,Miami Veterans Affairs Medical Center, Miami, USA.,Diabetes Research Institute, University of Miami, Miami, USA
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Miller School of Medicine, University of Miami, Miami, USA.,Miami Veterans Affairs Medical Center, Miami, USA
| | - Mary Ann Fletcher
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Miller School of Medicine, University of Miami, Miami, USA
| | - Gordon Broderick
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA.,Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Department of Medicine, University of Alberta, Edmonton, Canada
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Fritsch P, Craddock TJA, del Rosario RM, Rice MA, Smylie A, Folcik VA, de Vries G, Fletcher MA, Klimas NG, Broderick G. Succumbing to the laws of attraction. ACTA ACUST UNITED AC 2014. [DOI: 10.4161/sysb.28948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Craddock TJA, Fritsch P, Rice MA, del Rosario RM, Miller DB, Fletcher MA, Klimas NG, Broderick G. A role for homeostatic drive in the perpetuation of complex chronic illness: Gulf War Illness and chronic fatigue syndrome. PLoS One 2014; 9:e84839. [PMID: 24416298 PMCID: PMC3885655 DOI: 10.1371/journal.pone.0084839] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/19/2013] [Indexed: 12/15/2022] Open
Abstract
A key component in the body's stress response, the hypothalamic-pituitary-adrenal (HPA) axis orchestrates changes across a broad range of major biological systems. Its dysfunction has been associated with numerous chronic diseases including Gulf War Illness (GWI) and chronic fatigue syndrome (CFS). Though tightly coupled with other components of endocrine and immune function, few models of HPA function account for these interactions. Here we extend conventional models of HPA function by including feed-forward and feedback interaction with sex hormone regulation and immune response. We use this multi-axis model to explore the role of homeostatic regulation in perpetuating chronic conditions, specifically GWI and CFS. An important obstacle in building these models across regulatory systems remains the scarcity of detailed human in vivo kinetic data as its collection can present significant health risks to subjects. We circumvented this using a discrete logic representation based solely on literature of physiological and biochemical connectivity to provide a qualitative description of system behavior. This connectivity model linked molecular variables across the HPA axis, hypothalamic-pituitary-gonadal (HPG) axis in men and women, as well as a simple immune network. Inclusion of these interactions produced multiple alternate homeostatic states and sexually dimorphic responses. Experimental data for endocrine-immune markers measured in male GWI subjects showed the greatest alignment with predictions of a naturally occurring alternate steady state presenting with hypercortisolism, low testosterone and a shift towards a Th1 immune response. In female CFS subjects, expression of these markers aligned with an alternate homeostatic state displaying hypocortisolism, high estradiol, and a shift towards an anti-inflammatory Th2 activation. These results support a role for homeostatic drive in perpetuating dysfunctional cortisol levels through persistent interaction with the immune system and HPG axis. Though coarse, these models may nonetheless support the design of robust treatments that might exploit these regulatory regimes.
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Affiliation(s)
- Travis J. A. Craddock
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- Graduate School for Computer and Information Sciences, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- * E-mail:
| | - Paul Fritsch
- Department of Medicine, Faculty of Dentistry and Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark A. Rice
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Ryan M. del Rosario
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Diane B. Miller
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Mary Ann Fletcher
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Nancy G. Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Gordon Broderick
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- Department of Medicine, Faculty of Dentistry and Medicine, University of Alberta, Edmonton, Alberta, Canada
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
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Broderick G, Craddock TJA. Systems biology of complex symptom profiles: capturing interactivity across behavior, brain and immune regulation. Brain Behav Immun 2013; 29:1-8. [PMID: 23022717 PMCID: PMC3554865 DOI: 10.1016/j.bbi.2012.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 09/13/2012] [Accepted: 09/14/2012] [Indexed: 12/15/2022] Open
Abstract
As our thinking about the basic principles of biology and medicine continue to evolve, the importance of context and regulatory interaction is becoming increasingly obvious. Biochemical and physiological components do not exist in isolation but instead are part of a tightly integrated network of interacting elements that ensure robustness and support the emergence of complex behavior. This integration permeates all levels of biology from gene regulation, to immune cell signaling, to coordinated patterns of neuronal activity and the resulting psychosocial interaction. Systems biology is an emerging branch of science that sits as a translational catalyst at the interface of the life and computational sciences. While there is no universally accepted definition of systems biology, we attempt to provide an overview of some the basic unifying concepts and current efforts in the field as they apply to illnesses where brain and subsequent behavior are a chief component, for example autism, schizophrenia, depression, and others. Methods in this field currently constitute a broad mosaic that stretches across multiple scales of biology and physiological compartments. While this work by no means constitutes an exhaustive list of all these methods, this work highlights the principal sub-disciplines presently driving the field as well as future directions of progress.
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Affiliation(s)
- Gordon Broderick
- Department of Medicine, University of Alberta, Edmonton, Canada.
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Broderick G, Ben-Hamo R, Vashishtha S, Efroni S, Nathanson L, Barnes Z, Fletcher MA, Klimas N. Altered immune pathway activity under exercise challenge in Gulf War Illness: an exploratory analysis. Brain Behav Immun 2013. [PMID: 23201588 DOI: 10.1016/j.bbi.2012.11.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Though potentially linked to the basic physiology of stress response we still have no clear understanding of Gulf War Illness (GWI), a debilitating illness presenting with a complex constellation of immune, endocrine and neurological symptoms. Here we compared male GWI (n=20) with healthy veterans (n=22) and subjects with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) (n=7). Blood was drawn during a Graded eXercise Test (GXT) prior to exercise, at peak effort (VO2 max) and 4-h post exercise. Affymetrix HG U133 plus 2.0 microarray gene expression profiling in peripheral blood mononuclear cells (PBMCs) was used to estimate activation of over 500 documented pathways. This was cast against ELISA-based measurement of 16 cytokines in plasma and flow cytometric assessment of lymphocyte populations and cytotoxicity. A 2-way ANOVA corrected for multiple comparisons (q statistic <0.05) indicated significant increases in neuroendocrine-immune signaling and inflammatory activity in GWI, with decreased apoptotic signaling. Conversely, cell cycle progression and immune signaling were broadly subdued in CFS. Partial correlation networks linking pathways with symptom severity via changes in immune cell abundance, function and signaling were constructed. Central to these were changes in IL-10 and CD2+ cell abundance and their link to two pathway clusters. The first consisted of pathways supporting neuronal development and migration whereas the second was related to androgen-mediated activation of NF-κB. These exploratory results suggest an over-expression of known exercise response mechanisms as well as illness-specific changes that may involve an overlapping stress-potentiated neuro-inflammatory response.
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Affiliation(s)
- Gordon Broderick
- Department of Medicine, University of Alberta, Edmonton, Canada.
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Abstract
Fatigue that persists for 6 months or more is termed chronic fatigue. Chronic fatigue (CF) in combination with a minimum of 4 of 8 symptoms and the absence of diseases that could explain these symptoms, constitute the case definition for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Inflammation, immune system activation, autonomic dysfunction, impaired functioning in the hypothalamic-pituitary-adrenal axis, and neuroendocrine dysregulation have all been suggested as root causes of fatigue. The identification of objective markers consistently associated with CFS/ME is an important goal in relation to diagnosis and treatment, as the current case definitions are based entirely on physical signs and symptoms. This review is focused on the recent literature related to biomarkers for fatigue associated with CFS/ME and, for comparison, those associated with other diseases. These markers are distributed across several of the body's core regulatory systems. A complex construct of symptoms emerges from alterations and/or dysfunctions in the nervous, endocrine and immune systems. We propose that new insight will depend on our ability to develop and deploy an integrative profiling of CFS/ME pathogenesis at the molecular level. Until such a molecular signature is obtained efforts to develop effective treatments will continue to be severely limited.
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Affiliation(s)
- Nancy G. Klimas
- Miami Veterans Affairs Medical Center, Miami, FL, USA Ph: 305-575-; ,Nova Southeastern University, Institute for Neuro-Immune Medicine, Davie, FL
| | - Gordon Broderick
- Department of Medicine, University of Alberta, Edmonton, AB, Canada Ph: 780-492-1633;
| | - Mary Ann Fletcher
- Miami Veterans Affairs Medical Center, Miami, FL, USA Ph: 305-575-; ,Department of Medicine, University of Miami, Miami, FL, USA Ph: 305-243-6288;
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