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VanElzakker MB, Bues HF, Brusaferri L, Kim M, Saadi D, Ratai EM, Dougherty DD, Loggia ML. Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by [ 11C]PBR28 PET correlates with vascular disease measures. Brain Behav Immun 2024; 119:713-723. [PMID: 38642615 DOI: 10.1016/j.bbi.2024.04.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/28/2024] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
The COVID-19 pandemic caused by SARS-CoV-2 has triggered a consequential public health crisis of post-acute sequelae of COVID-19 (PASC), sometimes referred to as long COVID. The mechanisms of the heterogeneous persistent symptoms and signs that comprise PASC are under investigation, and several studies have pointed to the central nervous and vascular systems as being potential sites of dysfunction. In the current study, we recruited individuals with PASC with diverse symptoms, and examined the relationship between neuroinflammation and circulating markers of vascular dysfunction. We used [11C]PBR28 PET neuroimaging, a marker of neuroinflammation, to compare 12 PASC individuals versus 43 normative healthy controls. We found significantly increased neuroinflammation in PASC versus controls across a wide swath of brain regions including midcingulate and anterior cingulate cortex, corpus callosum, thalamus, basal ganglia, and at the boundaries of ventricles. We also collected and analyzed peripheral blood plasma from the PASC individuals and found significant positive correlations between neuroinflammation and several circulating analytes related to vascular dysfunction. These results suggest that an interaction between neuroinflammation and vascular health may contribute to common symptoms of PASC.
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Affiliation(s)
- Michael B VanElzakker
- Division of Neurotherapeutics, Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; PolyBio Research Foundation, Medford, MA, USA.
| | - Hannah F Bues
- Division of Neurotherapeutics, Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ludovica Brusaferri
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Computer Science And Informatics, School of Engineering, London South Bank University, London, UK
| | - Minhae Kim
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deena Saadi
- Division of Neurotherapeutics, Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eva-Maria Ratai
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Darin D Dougherty
- Division of Neurotherapeutics, Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Schiller D, Yu ANC, Alia-Klein N, Becker S, Cromwell HC, Dolcos F, Eslinger PJ, Frewen P, Kemp AH, Pace-Schott EF, Raber J, Silton RL, Stefanova E, Williams JHG, Abe N, Aghajani M, Albrecht F, Alexander R, Anders S, Aragón OR, Arias JA, Arzy S, Aue T, Baez S, Balconi M, Ballarini T, Bannister S, Banta MC, Barrett KC, Belzung C, Bensafi M, Booij L, Bookwala J, Boulanger-Bertolus J, Boutros SW, Bräscher AK, Bruno A, Busatto G, Bylsma LM, Caldwell-Harris C, Chan RCK, Cherbuin N, Chiarella J, Cipresso P, Critchley H, Croote DE, Demaree HA, Denson TF, Depue B, Derntl B, Dickson JM, Dolcos S, Drach-Zahavy A, Dubljević O, Eerola T, Ellingsen DM, Fairfield B, Ferdenzi C, Friedman BH, Fu CHY, Gatt JM, de Gelder B, Gendolla GHE, Gilam G, Goldblatt H, Gooding AEK, Gosseries O, Hamm AO, Hanson JL, Hendler T, Herbert C, Hofmann SG, Ibanez A, Joffily M, Jovanovic T, Kahrilas IJ, Kangas M, Katsumi Y, Kensinger E, Kirby LAJ, Koncz R, Koster EHW, Kozlowska K, Krach S, Kret ME, Krippl M, Kusi-Mensah K, Ladouceur CD, Laureys S, Lawrence A, Li CSR, Liddell BJ, Lidhar NK, Lowry CA, Magee K, Marin MF, Mariotti V, Martin LJ, Marusak HA, Mayer AV, Merner AR, Minnier J, Moll J, Morrison RG, Moore M, Mouly AM, Mueller SC, Mühlberger A, Murphy NA, Muscatello MRA, Musser ED, Newton TL, Noll-Hussong M, Norrholm SD, Northoff G, Nusslock R, Okon-Singer H, Olino TM, Ortner C, Owolabi M, Padulo C, Palermo R, Palumbo R, Palumbo S, Papadelis C, Pegna AJ, Pellegrini S, Peltonen K, Penninx BWJH, Pietrini P, Pinna G, Lobo RP, Polnaszek KL, Polyakova M, Rabinak C, Helene Richter S, Richter T, Riva G, Rizzo A, Robinson JL, Rosa P, Sachdev PS, Sato W, Schroeter ML, Schweizer S, Shiban Y, Siddharthan A, Siedlecka E, Smith RC, Soreq H, Spangler DP, Stern ER, Styliadis C, Sullivan GB, Swain JE, Urben S, Van den Stock J, Vander Kooij MA, van Overveld M, Van Rheenen TE, VanElzakker MB, Ventura-Bort C, Verona E, Volk T, Wang Y, Weingast LT, Weymar M, Williams C, Willis ML, Yamashita P, Zahn R, Zupan B, Lowe L. The Human Affectome. Neurosci Biobehav Rev 2024; 158:105450. [PMID: 37925091 PMCID: PMC11003721 DOI: 10.1016/j.neubiorev.2023.105450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 06/11/2022] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
Over the last decades, theoretical perspectives in the interdisciplinary field of the affective sciences have proliferated rather than converged due to differing assumptions about what human affective phenomena are and how they work. These metaphysical and mechanistic assumptions, shaped by academic context and values, have dictated affective constructs and operationalizations. However, an assumption about the purpose of affective phenomena can guide us to a common set of metaphysical and mechanistic assumptions. In this capstone paper, we home in on a nested teleological principle for human affective phenomena in order to synthesize metaphysical and mechanistic assumptions. Under this framework, human affective phenomena can collectively be considered algorithms that either adjust based on the human comfort zone (affective concerns) or monitor those adaptive processes (affective features). This teleologically-grounded framework offers a principled agenda and launchpad for both organizing existing perspectives and generating new ones. Ultimately, we hope the Human Affectome brings us a step closer to not only an integrated understanding of human affective phenomena, but an integrated field for affective research.
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Affiliation(s)
- Daniela Schiller
- Department of Psychiatry, the Nash Family Department of Neuroscience, and the Friedman Brain Institute, at the Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Alessandra N C Yu
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Nelly Alia-Klein
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany; Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, Balgrist Campus, Lengghalde 5, 8008 Zurich, Switzerland
| | - Howard C Cromwell
- J.P. Scott Center for Neuroscience, Mind and Behavior, Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, United States
| | - Florin Dolcos
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Paul J Eslinger
- Departments of Neurology, Neural & Behavioral Science, Radiology, and Public Health Sciences, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, United States
| | - Paul Frewen
- Departments of Psychiatry, Psychology and Neuroscience at the University of Western Ontario, London, Ontario, Canada
| | - Andrew H Kemp
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, United Kingdom
| | - Edward F Pace-Schott
- Harvard Medical School and Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, United States; Departments of Neurology, Radiation Medicine, Psychiatry, and Division of Neuroscience, ONPRC, Oregon Health & Science University, Portland, OR, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Elka Stefanova
- Faculty of Medicine, University of Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Serbia
| | - Justin H G Williams
- Griffith University, Gold Coast Campus, 1 Parklands Dr, Southport, QLD 4215, Australia
| | - Nobuhito Abe
- Institute for the Future of Human Society, Kyoto University, 46 Shimoadachi-cho, Yoshida Sakyo-ku, Kyoto, Japan
| | - Moji Aghajani
- Institute of Education & Child Studies, Section Forensic Family & Youth Care, Leiden University, the Netherlands; Department of Psychiatry, Amsterdam UMC, Location VUMC, GGZ InGeest Research & Innovation, Amsterdam Neuroscience, the Netherlands
| | - Franziska Albrecht
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Stockholm, Sweden
| | - Rebecca Alexander
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia; Australian National University, Canberra, ACT, Australia
| | - Silke Anders
- Department of Neurology, University of Lübeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Oriana R Aragón
- Yale University, 2 Hillhouse Ave, New Haven, CT, United States; Cincinnati University, Marketing Department, 2906 Woodside Drive, Cincinnati, OH 45221-0145, United States
| | - Juan A Arias
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, United Kingdom; Department of Statistics, Mathematical Analysis, and Operational Research, Universidade de Santiago de Compostela, Spain; The Galician Center for Mathematical Research and Technology (CITMAga), 15782 Santiago de Compostela, Spain
| | - Shahar Arzy
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel
| | - Tatjana Aue
- Institute of Psychology, University of Bern, Fabrikstr. 8, 3012 Bern, Switzerland
| | | | - Michela Balconi
- International Research Center for Cognitive Applied Neuroscience, Catholic University of Milan, Milan, Italy
| | - Tommaso Ballarini
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Scott Bannister
- Durham University, Palace Green, DH1 RL3 Durham, United Kingdom
| | | | - Karen Caplovitz Barrett
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO, United States; Department of Community & Behavioral Health, Colorado School of Public Health, Denver, CO, United States
| | | | - Moustafa Bensafi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France
| | - Linda Booij
- Department of Psychology, Concordia University, Montreal, Canada; CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Jamila Bookwala
- Department of Psychology, Lafayette College, Easton, PA, United States
| | - Julie Boulanger-Bertolus
- Department of Anesthesiology and Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
| | - Sydney Weber Boutros
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, United States
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Wallstr. 3, 55122 Mainz, Germany; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Antonio Bruno
- Department of Biomedical, Dental Sciences and Morpho-Functional Imaging - University of Messina, Italy
| | - Geraldo Busatto
- Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lauren M Bylsma
- Departments of Psychiatry and Psychology; and the Center for Neural Basis of Cognition, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health, and Wellbeing, Australian National University, Canberra, ACT, Australia
| | - Julian Chiarella
- Department of Psychology, Concordia University, Montreal, Canada; CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano (IRCCS), Milan, Italy; Department of Psychology, University of Turin, Turin, Italy
| | - Hugo Critchley
- Psychiatry, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Sussex, United Kingdom
| | - Denise E Croote
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai and Friedman Brain Institute, New York, NY 10029, United States; Hospital Universitário Gaffrée e Guinle, Universidade do Rio de Janeiro, Brazil
| | - Heath A Demaree
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Thomas F Denson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Brendan Depue
- Departments of Psychological and Brain Sciences and Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, United States
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Joanne M Dickson
- Edith Cowan University, Psychology Discipline, School of Arts and Humanities, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Sanda Dolcos
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Anat Drach-Zahavy
- The Faculty of Health and Welfare Sciences, University of Haifa, Haifa, Israel
| | - Olga Dubljević
- Neurology Clinic, Clinical Center of Serbia, Serbia; Institute for Biological Research "Siniša Stanković", National Institute of Republic of Serbia, Belgrade, Serbia
| | - Tuomas Eerola
- Durham University, Palace Green, DH1 RL3 Durham, United Kingdom
| | - Dan-Mikael Ellingsen
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Beth Fairfield
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy; UniCamillus, International Medical University, Rome, Italy
| | - Camille Ferdenzi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France
| | - Bruce H Friedman
- Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Cynthia H Y Fu
- School of Psychology, University of East London, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Justine M Gatt
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia; School of Psychology, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - Beatrice de Gelder
- Department of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Guido H E Gendolla
- Geneva Motivation Lab, University of Geneva, FPSE, Section of Psychology, CH-1211 Geneva 4, Switzerland
| | - Gadi Gilam
- The Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, CA, United States
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | | | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liege, Liege, Belgium
| | - Alfons O Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Jamie L Hanson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15206, United States
| | - Talma Hendler
- Tel Aviv Center for Brain Function, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Cornelia Herbert
- Department of Applied Emotion and Motivation Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps University Marburg, Germany
| | - Agustin Ibanez
- Universidad de San Andres, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), United States and Trinity Collegue Dublin (TCD), Ireland
| | - Mateus Joffily
- Groupe d'Analyse et de Théorie Economique (GATE), 93 Chemin des Mouilles, 69130 Écully, France
| | - Tanja Jovanovic
- Department of Psychiatry and Behavaioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Ian J Kahrilas
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Maria Kangas
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Yuta Katsumi
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Elizabeth Kensinger
- Department of Psychology and Neuroscience, Boston College, Boston, MA, United States
| | - Lauren A J Kirby
- Department of Psychology and Counseling, University of Texas at Tyler, Tyler, TX, United States
| | - Rebecca Koncz
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia; Specialty of Psychiatry, The University of Sydney, Concord, New South Wales, Australia
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Sören Krach
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Mariska E Kret
- Leiden University, Cognitive Psychology, Pieter de la Court, Waassenaarseweg 52, Leiden 2333 AK, the Netherlands
| | - Martin Krippl
- Faculty of Natural Sciences, Department of Psychology, Otto von Guericke University Magdeburg, Universitätsplatz 2, Magdeburg, Germany
| | - Kwabena Kusi-Mensah
- Department of Psychiatry, Komfo Anokye Teaching Hospital, P. O. Box 1934, Kumasi, Ghana; Department of Psychiatry, University of Cambridge, Darwin College, Silver Street, CB3 9EU Cambridge, United Kingdom; Behavioural Sciences Department, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Cecile D Ladouceur
- Departments of Psychiatry and Psychology and the Center for Neural Basis of Cognition (CNBC), University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liege, Liege, Belgium
| | - Alistair Lawrence
- Scotland's Rural College, King's Buildings, Edinburgh, Scotland; The Roslin Institute, University of Edinburgh, Easter Bush, Scotland
| | - Chiang-Shan R Li
- Connecticut Mental Health Centre, Yale University, New Haven, CT, United States
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - Navdeep K Lidhar
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Christopher A Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Kelsey Magee
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada; Research Center, Institut universitaire en santé mentale de Montréal, Montreal, Canada
| | - Veronica Mariotti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Loren J Martin
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Hilary A Marusak
- Department of Psychiatry and Behavaioral Neurosciences, Wayne State University, Detroit, MI, United States; Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, United States
| | - Annalina V Mayer
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Amanda R Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Jessica Minnier
- School of Public Health, Oregon Health & Science University, Portland, OR, United States
| | - Jorge Moll
- Cognitive Neuroscience and Neuroinformatics Unit, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Robert G Morrison
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Matthew Moore
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States; War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Anne-Marie Mouly
- Lyon Neuroscience Research Center, CNRS-UMR 5292, INSERM U1028, Universite Lyon, Lyon, France
| | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Andreas Mühlberger
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany
| | - Nora A Murphy
- Department of Psychology, Loyola Marymount University, Los Angeles, CA, United States
| | | | - Erica D Musser
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, United States
| | - Tamara L Newton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States
| | - Michael Noll-Hussong
- Psychosomatic Medicine and Psychotherapy, TU Muenchen, Langerstrasse 3, D-81675 Muenchen, Germany
| | - Seth Davin Norrholm
- Department of Psychiatry and Behavaioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, University of Ottawa Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Canada
| | - Robin Nusslock
- Department of Psychology and Institute for Policy Research, Northwestern University, 2029 Sheridan Road, Evanston, IL, United States
| | - Hadas Okon-Singer
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Thomas M Olino
- Department of Psychology, Temple University, 1701N. 13th St, Philadelphia, PA, United States
| | - Catherine Ortner
- Thompson Rivers University, Department of Psychology, 805 TRU Way, Kamloops, BC, Canada
| | - Mayowa Owolabi
- Department of Medicine and Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan; University College Hospital, Ibadan, Oyo State, Nigeria; Blossom Specialist Medical Center Ibadan, Oyo State, Nigeria
| | - Caterina Padulo
- Department of Psychological, Health and Territorial Sciences, University of Chieti, Chieti, Italy
| | - Romina Palermo
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Rocco Palumbo
- Department of Psychological, Health and Territorial Sciences, University of Chieti, Chieti, Italy
| | - Sara Palumbo
- Department of Surgical, Medical and Molecular Pathology and of Critical Care, University of Pisa, Pisa, Italy
| | - Christos Papadelis
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
| | - Alan J Pegna
- School of Psychology, University of Queensland, Saint Lucia, Queensland, Australia
| | - Silvia Pellegrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Kirsi Peltonen
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland; INVEST Research Flagship, University of Turku, Turku, Finland
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Location VUMC, GGZ InGeest Research & Innovation, Amsterdam Neuroscience, the Netherlands
| | | | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Rosario Pintos Lobo
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, United States
| | - Kelly L Polnaszek
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Maryna Polyakova
- Neurology Department, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Christine Rabinak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, United States
| | - S Helene Richter
- Department of Behavioural Biology, University of Münster, Badestraße 13, Münster, Germany
| | - Thalia Richter
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano (IRCCS), Milan, Italy; Humane Technology Lab., Università Cattolica del Sacro Cuore, Milan, Italy
| | - Amelia Rizzo
- Department of Biomedical, Dental Sciences and Morpho-Functional Imaging - University of Messina, Italy
| | | | - Pedro Rosa
- Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia
| | - Wataru Sato
- Psychological Process Research Team, Guardian Robot Project, RIKEN, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto, Japan
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Schweizer
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom; School of Psychology, University of New South Wales, Sydney, Australia
| | - Youssef Shiban
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany; Department of Psychology (Clinical Psychology and Psychotherapy Research), PFH - Private University of Applied Sciences, Gottingen, Germany
| | - Advaith Siddharthan
- Knowledge Media Institute, The Open University, Milton Keynes MK7 6AA, United Kingdom
| | - Ewa Siedlecka
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Robert C Smith
- Departments of Medicine and Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Hermona Soreq
- Department of Biological Chemistry, Edmond and Lily Safra Center of Brain Science and The Institute of Life Sciences, Hebrew University, Jerusalem, Israel
| | - Derek P Spangler
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, United States
| | - Emily R Stern
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States; New York University School of Medicine, New York, NY, United States
| | - Charis Styliadis
- Neuroscience of Cognition and Affection group, Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - James E Swain
- Departments of Psychiatry & Behavioral Health, Psychology, Obstetrics, Gynecology & Reproductive Medicine, and Program in Public Health, Renaissance School of Medicine at Stony Brook University, New York, United States
| | - Sébastien Urben
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jan Van den Stock
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Michael A Vander Kooij
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, Universitatsmedizin der Johannes Guttenberg University Medical Center, Mainz, Germany
| | | | - Tamsyn E Van Rheenen
- University of Melbourne, Melbourne Neuropsychiatry Centre, Department of Psychiatry, 161 Barry Street, Carlton, VIC, Australia
| | - Michael B VanElzakker
- Division of Neurotherapeutics, Massachusetts General Hospital, Boston, MA, United States
| | - Carlos Ventura-Bort
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Edelyn Verona
- Department of Psychology, University of South Florida, Tampa, FL, United States
| | - Tyler Volk
- Professor Emeritus of Biology and Environmental Studies, New York University, New York, NY, United States
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Leah T Weingast
- Department of Social Work and Human Services and the Department of Psychological Sciences, Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany; Faculty of Health Sciences Brandenburg, University of Potsdam, Germany
| | - Claire Williams
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, United Kingdom; Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, United Kingdom
| | - Megan L Willis
- School of Behavioural and Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Paula Yamashita
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Roland Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Barbra Zupan
- Central Queensland University, School of Health, Medical and Applied Sciences, Bruce Highway, Rockhampton, QLD, Australia
| | - Leroy Lowe
- Neuroqualia (NGO), Truro, Nova Scotia, Canada.
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3
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VanElzakker MB, Tillman EM, Yonker LM, Ratai EM, Georgiopoulos AM. Neuropsychiatric adverse effects from CFTR modulators deserve a serious research effort. Curr Opin Pulm Med 2023; 29:603-609. [PMID: 37655981 PMCID: PMC10552811 DOI: 10.1097/mcp.0000000000001014] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
PURPOSE OF REVIEW This review highlights the problem of neuropsychiatric adverse effects (AEs) associated with elexacaftor/tezacaftor/ivacaftor (ETI), current suboptimal mitigation approaches, a novel testable mechanistic hypothesis, and potential solutions requiring further research. RECENT FINDINGS Studies show that a minority of persons with cystic fibrosis (PwCF) initiating cystic fibrosis transmembrane conductance regulator (CFTR) modulators experience neuropsychiatric AEs including worsening mood, cognition, anxiety, sleep, and suicidality. The GABA-A receptor is a ligand-gated chloride channel, and magnetic resonance spectroscopy neuroimaging studies have shown that reduced GABA expression in rostral anterior cingulate cortex is associated with anxiety and depression. Recent research details the impact of peripheral inflammation and the gut-brain axis on central neuroinflammation. Plasma ETI concentrations and sweat chloride have been evaluated in small studies of neuropsychiatric AEs but not validated to guide dose titration or correlated with pharmacogenomic variants or safety/efficacy. SUMMARY Although ETI is well tolerated by most PwCF, some experience debilitating neuropsychiatric AEs. In some cases, these AEs may be driven by modulation of CFTR and chloride transport within the brain. Understanding biological mechanisms is a critical next step in identifying which PwCF are likely to experience AEs, and in developing evidence-based strategies to mitigate them, while retaining modulator efficacy.
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4
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VanElzakker MB, Bues HF, Brusaferri L, Kim M, Saadi D, Ratai EM, Dougherty DD, Loggia ML. Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by [ 11C]PBR28 PET correlates with vascular disease measures. bioRxiv 2023:2023.10.19.563117. [PMID: 37905031 PMCID: PMC10614970 DOI: 10.1101/2023.10.19.563117] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
The COVID-19 pandemic caused by SARS-CoV-2 has triggered a consequential public health crisis of post-acute sequelae of COVID-19 (PASC), sometimes referred to as long COVID. The mechanisms of the heterogeneous persistent symptoms and signs that comprise PASC are under investigation, and several studies have pointed to the central nervous and vascular systems as being potential sites of dysfunction. In the current study, we recruited individuals with PASC with diverse symptoms, and examined the relationship between neuroinflammation and circulating markers of vascular dysfunction. We used [11C]PBR28 PET neuroimaging, a marker of neuroinflammation, to compare 12 PASC individuals versus 43 normative healthy controls. We found significantly increased neuroinflammation in PASC versus controls across a wide swath of brain regions including midcingulate and anterior cingulate cortex, corpus callosum, thalamus, basal ganglia, and at the boundaries of ventricles. We also collected and analyzed peripheral blood plasma from the PASC individuals and found significant positive correlations between neuroinflammation and several circulating analytes related to vascular dysfunction. These results suggest that an interaction between neuroinflammation and vascular health may contribute to common symptoms of PASC.
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Affiliation(s)
- Michael B VanElzakker
- Division of Neurotherapeutics, Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- PolyBio Research Foundation, Medford, MA, USA
| | - Hannah F Bues
- Division of Neurotherapeutics, Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ludovica Brusaferri
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Computer Science And Informatics, School of Engineering, London South Bank University, London, UK
| | - Minhae Kim
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deena Saadi
- Division of Neurotherapeutics, Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eva-Maria Ratai
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Darin D Dougherty
- Division of Neurotherapeutics, Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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5
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Proal AD, VanElzakker MB, Aleman S, Bach K, Boribong BP, Buggert M, Cherry S, Chertow DS, Davies HE, Dupont CL, Deeks SG, Eimer W, Ely EW, Fasano A, Freire M, Geng LN, Griffin DE, Henrich TJ, Iwasaki A, Izquierdo-Garcia D, Locci M, Mehandru S, Painter MM, Peluso MJ, Pretorius E, Price DA, Putrino D, Scheuermann RH, Tan GS, Tanzi RE, VanBrocklin HF, Yonker LM, Wherry EJ. Author Correction: SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC). Nat Immunol 2023; 24:1778. [PMID: 37723351 DOI: 10.1038/s41590-023-01646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Amy D Proal
- PolyBio Research Foundation, Medford, MA, USA.
| | - Michael B VanElzakker
- PolyBio Research Foundation, Medford, MA, USA
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soo Aleman
- Dept of Infectious Diseases and Unit of Post-Covid Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Katie Bach
- PolyBio Research Foundation, Medford, MA, USA
- Nonresident Senior Fellow, Brookings Institution, Washington, DC, USA
| | - Brittany P Boribong
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcus Buggert
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Huddinge, Sweden
| | - Sara Cherry
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, UPENN, Philadelphia, PA, USA
| | - Daniel S Chertow
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Helen E Davies
- Department of Respiratory Medicine, University Hospital Llandough, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | | | - Steven G Deeks
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - William Eimer
- Harvard Medical School, Boston, MA, USA
- Genetics and Aging Research Unit, Mass General Institute for Neurodegenerative Disease, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - E Wesley Ely
- The Critical Illness, Brain Dysfunction, Survivorship (CIBS) Center at Vanderbilt University Medical Center and the Veteran's Affairs Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA
| | - Alessio Fasano
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcelo Freire
- J. Craig Venter Institute Department of Infectious Diseases, University of California, San Diego, La Jolla, CA, USA
| | - Linda N Geng
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Diane E Griffin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy J Henrich
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
- Center for Infection and Immunity, Yale University School of Medicine, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - David Izquierdo-Garcia
- Department of Radiology, Harvard Medical School, Charlestown, MA, USA
- Department of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michela Locci
- Institute for Immunology and Immune Health, and Department of Microbiology, University of Pennsylvania Perelman School Medicine, Philadelphia, PA, USA
| | - Saurabh Mehandru
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark M Painter
- Institute for Immunology and Immune Health, and Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School Medicine, Philadelphia, PA, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
- Systems Immunity Research Institute, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - David Putrino
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard H Scheuermann
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA, USA
- Department of Pathology, University of California, San Diego, San Diego, CA, USA
- La Jolla Institute for Immunology, San Diego, CA, USA
| | - Gene S Tan
- J. Craig Venter Institute, La Jolla, CA, USA
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rudolph E Tanzi
- Harvard Medical School, Boston, MA, USA
- Genetics and Aging Research Unit, Mass General Institute for Neurodegenerative Disease, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Lael M Yonker
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - E John Wherry
- Institute for Immunology and Immune Health, and Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School Medicine, Philadelphia, PA, USA
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6
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Proal AD, VanElzakker MB, Aleman S, Bach K, Boribong BP, Buggert M, Cherry S, Chertow DS, Davies HE, Dupont CL, Deeks SG, Eimer W, Ely EW, Fasano A, Freire M, Geng LN, Griffin DE, Henrich TJ, Iwasaki A, Izquierdo-Garcia D, Locci M, Mehandru S, Painter MM, Peluso MJ, Pretorius E, Price DA, Putrino D, Scheuermann RH, Tan GS, Tanzi RE, VanBrocklin HF, Yonker LM, Wherry EJ. SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC). Nat Immunol 2023; 24:1616-1627. [PMID: 37667052 DOI: 10.1038/s41590-023-01601-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/18/2023] [Indexed: 09/06/2023]
Abstract
Millions of people are suffering from Long COVID or post-acute sequelae of COVID-19 (PASC). Several biological factors have emerged as potential drivers of PASC pathology. Some individuals with PASC may not fully clear the coronavirus SARS-CoV-2 after acute infection. Instead, replicating virus and/or viral RNA-potentially capable of being translated to produce viral proteins-persist in tissue as a 'reservoir'. This reservoir could modulate host immune responses or release viral proteins into the circulation. Here we review studies that have identified SARS-CoV-2 RNA/protein or immune responses indicative of a SARS-CoV-2 reservoir in PASC samples. Mechanisms by which a SARS-CoV-2 reservoir may contribute to PASC pathology, including coagulation, microbiome and neuroimmune abnormalities, are delineated. We identify research priorities to guide the further study of a SARS-CoV-2 reservoir in PASC, with the goal that clinical trials of antivirals or other therapeutics with potential to clear a SARS-CoV-2 reservoir are accelerated.
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Affiliation(s)
- Amy D Proal
- PolyBio Research Foundation, Medford, MA, USA.
| | - Michael B VanElzakker
- PolyBio Research Foundation, Medford, MA, USA
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soo Aleman
- Dept of Infectious Diseases and Unit of Post-Covid Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Katie Bach
- PolyBio Research Foundation, Medford, MA, USA
- Nonresident Senior Fellow, Brookings Institution, Washington, DC, USA
| | - Brittany P Boribong
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcus Buggert
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Huddinge, Sweden
| | - Sara Cherry
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, UPENN, Philadelphia, PA, USA
| | - Daniel S Chertow
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Helen E Davies
- Department of Respiratory Medicine, University Hospital Llandough, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | | | - Steven G Deeks
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - William Eimer
- Harvard Medical School, Boston, MA, USA
- Genetics and Aging Research Unit, Mass General Institute for Neurodegenerative Disease, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - E Wesley Ely
- The Critical Illness, Brain Dysfunction, Survivorship (CIBS) Center at Vanderbilt University Medical Center and the Veteran's Affairs Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA
| | - Alessio Fasano
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcelo Freire
- J. Craig Venter Institute Department of Infectious Diseases, University of California, San Diego, La Jolla, CA, USA
| | - Linda N Geng
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Diane E Griffin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy J Henrich
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
- Center for Infection and Immunity, Yale University School of Medicine, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - David Izquierdo-Garcia
- Department of Radiology, Harvard Medical School, Charlestown, MA, USA
- Department of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michela Locci
- Institute for Immunology and Immune Health, and Department of Microbiology, University of Pennsylvania Perelman School Medicine, Philadelphia, PA, USA
| | - Saurabh Mehandru
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark M Painter
- Institute for Immunology and Immune Health, and Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School Medicine, Philadelphia, PA, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
- Systems Immunity Research Institute, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - David Putrino
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard H Scheuermann
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA, USA
- Department of Pathology, University of California, San Diego, San Diego, CA, USA
- La Jolla Institute for Immunology, San Diego, CA, USA
| | - Gene S Tan
- J. Craig Venter Institute, La Jolla, CA, USA
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rudolph E Tanzi
- Harvard Medical School, Boston, MA, USA
- Genetics and Aging Research Unit, Mass General Institute for Neurodegenerative Disease, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Lael M Yonker
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - E John Wherry
- Institute for Immunology and Immune Health, and Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School Medicine, Philadelphia, PA, USA
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7
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Hinojosa CA, VanElzakker MB, Kaur N, Felicione JM, Charney ME, Bui E, Marques L, Summergrad P, Rauch SL, Simon NM, Shin LM. Pre-treatment amygdala activation and habituation predict symptom change in post-traumatic stress disorder. Front Behav Neurosci 2023; 17:1198244. [PMID: 37492481 PMCID: PMC10363634 DOI: 10.3389/fnbeh.2023.1198244] [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] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
Trauma-focused psychotherapy approaches are the first-line treatment option for post-traumatic stress disorder (PTSD); however, up to a third of patients remain symptomatic even after completion of the treatment. Predicting which patients will respond to a given treatment option would support personalized treatments and improve the efficiency of healthcare systems. Although previous neuroimaging studies have examined possible pre-treatment predictors of response to treatment, the findings have been somewhat inconsistent, and no other study has examined habituation to stimuli as a predictor. In this study, 16 treatment-seeking adults (MAge = 43.63, n = 10 women) with a primary diagnosis of PTSD passively viewed pictures of emotional facial expressions during functional magnetic resonance imaging (fMRI). After scanning, participants rated facial expressions on both valence and arousal. Participants then completed eight weekly sessions of prolonged exposure (PE) therapy. PTSD symptom severity was measured before and after treatment. Overall, participants showed symptomatic improvement with PE. Consistent with hypotheses, lesser activation in the amygdala and greater activation in the ventromedial prefrontal cortex during the presentation of fearful vs. happy facial expressions, as well as a greater decline in amygdala activation across blocks of fearful facial expressions at baseline, were associated with greater reduction of PTSD symptoms. Given that the repeated presentation of emotional material underlies PE, changes in brain responses with repeated stimulus presentations warrant further studies as potential predictors of response to exposure therapies.
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Affiliation(s)
- Cecilia A. Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael B. VanElzakker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Navneet Kaur
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Julia M. Felicione
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
| | - Meredith E. Charney
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Eric Bui
- Normandie Univ, University of Caen Normandy (UNICAEN), L'Institut national de la santé et de la recherche médicale (INSERM), U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France
- Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Center for Anxiety and Traumatic Stress Disorders, Boston, MA, United States
| | - Paul Summergrad
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, United States
| | - Scott L. Rauch
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Naomi M. Simon
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Lisa M. Shin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychology, Tufts University, Medford, MA, United States
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8
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Hinojosa CA, VanElzakker MB, Hughes KC, Offringa R, Sangermano LM, Spaulding IG, Staples-Bradley LK, Whitman ET, Lasko NB, Rauch SL, Orr SP, Pitman RK, Shin LM. Exaggerated amygdala activation to ambiguous facial expressions is a familial vulnerability factor for posttraumatic stress disorder. J Psychiatr Res 2022; 156:451-459. [PMID: 36332360 PMCID: PMC9742331 DOI: 10.1016/j.jpsychires.2022.10.049] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous research has reported hyperresponsivity in the amygdala and hyporesponsivity in ventral portions of the medial prefrontal cortex to threat-related stimuli in posttraumatic stress disorder (PTSD). Whether such findings generalize to more ambiguous stimuli and whether such brain activation abnormalities reflect familial vulnerabilities, trauma-exposure, or acquired characteristics of PTSD remain unclear. In this study, we measured brain responses to emotionally ambiguous stimuli (i.e., surprised facial expressions) in identical twin pairs discordant for trauma exposure to elucidate the origin of brain activation abnormalities. METHODS Participants with PTSD (n = 12) and their trauma-unexposed identical cotwins (n = 12), as well as trauma-exposed participants without PTSD (n = 15) and their trauma-unexposed identical cotwins (n = 15), passively viewed surprised and neutral facial expressions during functional magnetic resonance imaging (fMRI). Afterward, participants labeled and rated each facial expression on valence and arousal. RESULTS Amygdala activation to Surprised and Neutral facial expressions (versus Fixation) was greater in the participants with PTSD and their trauma-unexposed identical cotwins without PTSD, compared to the control twin pairs. In contrast, medial frontal gyrus (MFG) activation to Surprised facial expressions (versus Fixation) was diminished in the PTSD group relative to the other three groups. CONCLUSIONS Amygdala hyperresponsivity to emotionally ambiguous facial expressions may be a familial vulnerability factor that increases the likelihood of developing PTSD after experiencing a traumatic event. In contrast, MFG hyporesponsivity may be an acquired characteristic of the disorder.
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Affiliation(s)
- Cecilia A Hinojosa
- Department of Psychology, Tufts University, Medford, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Michael B VanElzakker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Katherine C Hughes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Reid Offringa
- Department of Psychology, Tufts University, Medford, MA, USA
| | - Lisa M Sangermano
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Isabella G Spaulding
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Lindsay K Staples-Bradley
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Ethan T Whitman
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Natasha B Lasko
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Lisa M Shin
- Department of Psychology, Tufts University, Medford, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
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Proal AD, VanElzakker MB. Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms. Front Microbiol 2021; 12:698169. [PMID: 34248921 PMCID: PMC8260991 DOI: 10.3389/fmicb.2021.698169] [Citation(s) in RCA: 404] [Impact Index Per Article: 134.7] [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: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 12/23/2022] Open
Abstract
The novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic of coronavirus disease 2019 (COVID-19). Across the globe, a subset of patients who sustain an acute SARS-CoV-2 infection are developing a wide range of persistent symptoms that do not resolve over the course of many months. These patients are being given the diagnosis Long COVID or Post-acute sequelae of COVID-19 (PASC). It is likely that individual patients with a PASC diagnosis have different underlying biological factors driving their symptoms, none of which are mutually exclusive. This paper details mechanisms by which RNA viruses beyond just SARS-CoV-2 have be connected to long-term health consequences. It also reviews literature on acute COVID-19 and other virus-initiated chronic syndromes such as post-Ebola syndrome or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to discuss different scenarios for PASC symptom development. Potential contributors to PASC symptoms include consequences from acute SARS-CoV-2 injury to one or multiple organs, persistent reservoirs of SARS-CoV-2 in certain tissues, re-activation of neurotrophic pathogens such as herpesviruses under conditions of COVID-19 immune dysregulation, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation issues, dysfunctional brainstem/vagus nerve signaling, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins. The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage care for specific patients with the diagnosis.
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Affiliation(s)
- Amy D. Proal
- PolyBio Research Foundation, Kenmore, WA, United States
| | - Michael B. VanElzakker
- PolyBio Research Foundation, Kenmore, WA, United States
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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VanElzakker MB, Brumfield SA, Lara Mejia PS. Corrigendum: Neuroinflammation and Cytokines in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Critical Review of Research Methods. Front Neurol 2020; 11:863. [PMID: 33041960 PMCID: PMC7527589 DOI: 10.3389/fneur.2020.00863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/07/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Michael B VanElzakker
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sydney A Brumfield
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Paula S Lara Mejia
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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11
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Pace-Schott EF, Amole MC, Aue T, Balconi M, Bylsma LM, Critchley H, Demaree HA, Friedman BH, Gooding AEK, Gosseries O, Jovanovic T, Kirby LA, Kozlowska K, Laureys S, Lowe L, Magee K, Marin MF, Merner AR, Robinson JL, Smith RC, Spangler DP, Van Overveld M, VanElzakker MB. Physiological feelings. Neurosci Biobehav Rev 2019; 103:267-304. [DOI: 10.1016/j.neubiorev.2019.05.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/27/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
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12
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VanElzakker MB, Brumfield SA, Lara Mejia PS. Corrigendum: Neuroinflammation and Cytokines in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Critical Review of Research Methods. Front Neurol 2019; 10:316. [PMID: 31001197 PMCID: PMC6454267 DOI: 10.3389/fneur.2019.00316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Michael B VanElzakker
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sydney A Brumfield
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Paula S Lara Mejia
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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13
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VanElzakker MB, Brumfield SA, Lara Mejia PS. Neuroinflammation and Cytokines in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Critical Review of Research Methods. Front Neurol 2019; 9:1033. [PMID: 30687207 PMCID: PMC6335565 DOI: 10.3389/fneur.2018.01033] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [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: 08/26/2018] [Accepted: 11/16/2018] [Indexed: 01/18/2023] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is the label given to a syndrome that can include long-term flu-like symptoms, profound fatigue, trouble concentrating, and autonomic problems, all of which worsen after exertion. It is unclear how many individuals with this diagnosis are suffering from the same condition or have the same underlying pathophysiology, and the discovery of biomarkers would be clarifying. The name "myalgic encephalomyelitis" essentially means "muscle pain related to central nervous system inflammation" and many efforts to find diagnostic biomarkers have focused on one or more aspects of neuroinflammation, from periphery to brain. As the field uncovers the relationship between the symptoms of this condition and neuroinflammation, attention must be paid to the biological mechanisms of neuroinflammation and issues with its potential measurement. The current review focuses on three methods used to study putative neuroinflammation in ME/CFS: (1) positron emission tomography (PET) neuroimaging using translocator protein (TSPO) binding radioligand (2) magnetic resonance spectroscopy (MRS) neuroimaging and (3) assays of cytokines circulating in blood and cerebrospinal fluid. PET scanning using TSPO-binding radioligand is a promising option for studies of neuroinflammation. However, methodological difficulties that exist both in this particular technique and across the ME/CFS neuroimaging literature must be addressed for any results to be interpretable. We argue that the vast majority of ME/CFS neuroimaging has failed to use optimal techniques for studying brainstem, despite its probable centrality to any neuroinflammatory causes or autonomic effects. MRS is discussed as a less informative but more widely available, less invasive, and less expensive option for imaging neuroinflammation, and existing studies using MRS neuroimaging are reviewed. Studies seeking to find a peripheral circulating cytokine "profile" for ME/CFS are reviewed, with attention paid to the biological and methodological reasons for lack of replication among these studies. We argue that both the biological mechanisms of cytokines and the innumerable sources of potential variance in their measurement make it unlikely that a consistent and replicable diagnostic cytokine profile will ever be discovered.
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Affiliation(s)
- Michael B. VanElzakker
- Division of Neurotherapeutics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Hinojosa CA, Kaur N, VanElzakker MB, Shin LM. Cingulate subregions in posttraumatic stress disorder, chronic stress, and treatment. Cingulate Cortex 2019; 166:355-370. [DOI: 10.1016/b978-0-444-64196-0.00020-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Dahlgren MK, Laifer LM, VanElzakker MB, Offringa R, Hughes KC, Staples-Bradley LK, Dubois SJ, Lasko NB, Hinojosa CA, Orr SP, Pitman RK, Shin LM. Diminished medial prefrontal cortex activation during the recollection of stressful events is an acquired characteristic of PTSD. Psychol Med 2018; 48:1128-1138. [PMID: 28893331 PMCID: PMC5847462 DOI: 10.1017/s003329171700263x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous research has shown relatively diminished medial prefrontal cortex activation and heightened psychophysiological responses during the recollection of personal events in post-traumatic stress disorder (PTSD), but the origin of these abnormalities is unknown. Twin studies provide the opportunity to determine whether such abnormalities reflect familial vulnerabilities, result from trauma exposure, or are acquired characteristics of PTSD. METHODS In this case-control twin study, 26 male identical twin pairs (12 PTSD; 14 non-PTSD) discordant for PTSD and combat exposure recalled and imagined trauma-unrelated stressful and neutral life events using a standard script-driven imagery paradigm during functional magnetic resonance imaging and concurrent skin conductance measurement. RESULTS Diminished activation in the medial prefrontal cortex during Stressful v. Neutral script-driven imagery was observed in the individuals with PTSD, relative to other groups. CONCLUSIONS Diminished medial prefrontal cortex activation during Stressful v. Neutral script-driven imagery may be an acquired characteristic of PTSD. If replicated, this finding could be used prospectively to inform diagnosis and the assessment of treatment response.
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Affiliation(s)
- M. Kathryn Dahlgren
- Department of Psychology, Tufts University, Medford, MA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Michael B. VanElzakker
- Department of Psychology, Tufts University, Medford, MA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Reid Offringa
- Department of Psychology, Tufts University, Medford, MA
| | - Katherine C. Hughes
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | | | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Cecilia A. Hinojosa
- Department of Psychology, Tufts University, Medford, MA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Lisa M. Shin
- Department of Psychology, Tufts University, Medford, MA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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16
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Kutlu MG, Marin MF, Tumolo JM, Kaur N, VanElzakker MB, Shin LM, Gould TJ. Nicotine exposure leads to deficits in differential cued fear conditioning in mice and humans: A potential role of the anterior cingulate cortex. Neurosci Lett 2018. [PMID: 29518543 DOI: 10.1016/j.neulet.2018.03.002] [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: 12/18/2022]
Abstract
Stress and anxiety disorders such as posttraumatic stress disorder (PTSD) are characterized by disrupted safety learning. Tobacco smoking has been strongly implicated in stress and anxiety disorder symptomatology, both as a contributing factor and as a vulnerability factor. Rodent studies from our lab have recently shown that acute and chronic nicotine exposure disrupts safety learning. However, it is unknown if these effects of nicotine translate to humans. The present studies addressed this gap by administering a translational differential cued fear conditioning paradigm to both mice and humans. In mice, we found that chronic nicotine exposure reduced discrimination between a conditioned stimulus (CS) that signals for danger (CS+) and another CS that signals for safety (CS-) during both acquisition and testing. We then employed a similar differential cued fear conditioning paradigm in human smokers and non-smokers undergoing functional magnetic resonance imaging (fMRI). Smokers showed reduced CS+/CS- discrimination during fear conditioning compared to non-smokers. Furthermore, using fMRI, we found that subgenual and dorsal anterior cingulate cortex activations were lower in smokers than in non-smokers during differential cued fear conditioning. These results suggest a potential biological mechanism underlying a dysregulated ability to discriminate between danger and safety cues. Our results indicate a clear parallel between the effects of nicotine exposure on safety learning in mice and humans and therefore suggest that smoking might represent a risk factor for inability to process information related to danger and safety related cues.
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Affiliation(s)
- Munir Gunes Kutlu
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA.
| | - Marie-France Marin
- Research Center of the Montreal Mental Health University Institute, Department of Psychiatry, University of Montreal, Montreal, QC, Canada
| | - Jessica M Tumolo
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Navneet Kaur
- Department of Psychology, Tufts University, Medford, MA, USA
| | - Michael B VanElzakker
- Department of Psychology, Tufts University, Medford, MA, USA; Department of Psychiatry, Massachusetts General Hospital; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lisa M Shin
- Department of Psychology, Tufts University, Medford, MA, USA; Department of Psychiatry, Massachusetts General Hospital; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Thomas J Gould
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
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17
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Marin MF, Song H, VanElzakker MB, Staples-Bradley LK, Linnman C, Pace-Schott EF, Lasko NB, Shin LM, Milad MR. Association of Resting Metabolism in the Fear Neural Network With Extinction Recall Activations and Clinical Measures in Trauma-Exposed Individuals. Am J Psychiatry 2016; 173:930-8. [PMID: 26917165 DOI: 10.1176/appi.ajp.2015.14111460] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 11/30/2022]
Abstract
OBJECTIVE Exposure-based therapy, an effective treatment for posttraumatic stress disorder (PTSD), relies on extinction learning principles. In PTSD patients, dysfunctional patterns in the neural circuitry underlying fear extinction have been observed using resting-state or functional activation measures. It remains undetermined whether resting activity predicts activations during extinction recall or PTSD symptom severity. Moreover, it remains unclear whether trauma exposure per se affects resting activity in this circuitry. The authors employed a multimodal approach to examine the relationships among resting metabolism, clinical symptoms, and activations during extinction recall. METHOD Three cohorts were recruited: PTSD patients (N=24), trauma-exposed individuals with no PTSD (TENP) (N=20), and trauma-unexposed healthy comparison subjects (N=21). Participants underwent a resting positron emission tomography scan 4 days before a functional MRI fear conditioning and extinction paradigm. RESULTS Amygdala resting metabolism negatively correlated with clinical functioning (as measured by the Global Assessment of Functioning Scale) in the TENP group, and hippocampal resting metabolism negatively correlated with clinical functioning in the PTSD group. In the PTSD group, dorsal anterior cingulate cortex (dACC) resting metabolism positively correlated with PTSD symptom severity, and it predicted increased dACC activations but decreased hippocampal and ventromedial prefrontal cortex activations during extinction recall. The TENP group had lower amygdala resting metabolism compared with the PTSD and healthy comparison groups, and it exhibited lower hippocampus resting metabolism relative to the healthy comparison group. CONCLUSIONS Resting metabolism in the fear circuitry correlated with functioning, PTSD symptoms, and extinction recall activations, further supporting the relevance of this network to the pathophysiology of PTSD. The study findings also highlight the fact that chronic dysfunction in the amygdala and hippocampus is demonstrable in PTSD and other trauma-exposed individuals, even without exposure to an evocative stimulus.
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Affiliation(s)
- Marie-France Marin
- From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; the Department of Psychology, Tufts University, Medford, Mass.; and the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston
| | - Huijin Song
- From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; the Department of Psychology, Tufts University, Medford, Mass.; and the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston
| | - Michael B VanElzakker
- From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; the Department of Psychology, Tufts University, Medford, Mass.; and the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston
| | - Lindsay K Staples-Bradley
- From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; the Department of Psychology, Tufts University, Medford, Mass.; and the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston
| | - Clas Linnman
- From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; the Department of Psychology, Tufts University, Medford, Mass.; and the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston
| | - Edward F Pace-Schott
- From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; the Department of Psychology, Tufts University, Medford, Mass.; and the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston
| | - Natasha B Lasko
- From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; the Department of Psychology, Tufts University, Medford, Mass.; and the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston
| | - Lisa M Shin
- From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; the Department of Psychology, Tufts University, Medford, Mass.; and the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston
| | - Mohammed R Milad
- From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; the Department of Psychology, Tufts University, Medford, Mass.; and the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston
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VanElzakker MB, Dahlgren MK, Davis FC, Dubois S, Shin LM. From Pavlov to PTSD: the extinction of conditioned fear in rodents, humans, and anxiety disorders. Neurobiol Learn Mem 2014; 113:3-18. [PMID: 24321650 PMCID: PMC4156287 DOI: 10.1016/j.nlm.2013.11.014] [Citation(s) in RCA: 299] [Impact Index Per Article: 29.9] [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] [Received: 08/01/2013] [Revised: 10/31/2013] [Accepted: 11/24/2013] [Indexed: 01/08/2023]
Abstract
Nearly 100 years ago, Ivan Pavlov demonstrated that dogs could learn to use a neutral cue to predict a biologically relevant event: after repeated predictive pairings, Pavlov's dogs were conditioned to anticipate food at the sound of a bell, which caused them to salivate. Like sustenance, danger is biologically relevant, and neutral cues can take on great salience when they predict a threat to survival. In anxiety disorders such as posttraumatic stress disorder (PTSD), this type of conditioned fear fails to extinguish, and reminders of traumatic events can cause pathological conditioned fear responses for decades after danger has passed. In this review, we use fear conditioning and extinction studies to draw a direct line from Pavlov to PTSD and other anxiety disorders. We explain how rodent studies have informed neuroimaging studies of healthy humans and humans with PTSD. We describe several genes that have been linked to both PTSD and fear conditioning and extinction and explain how abnormalities in fear conditioning or extinction may reflect a general biomarker of anxiety disorders. Finally, we explore drug and neuromodulation treatments that may enhance therapeutic extinction in anxiety disorders.
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Affiliation(s)
- Michael B VanElzakker
- Tufts University Psychology, 490 Boston Avenue, Medford, MA 02155, USA; Massachusetts General Hospital Psychiatry, 149 Thirteenth Street, Charlestown, MA 02129, USA.
| | - M Kathryn Dahlgren
- Tufts University Psychology, 490 Boston Avenue, Medford, MA 02155, USA; Massachusetts General Hospital Psychiatry, 149 Thirteenth Street, Charlestown, MA 02129, USA
| | - F Caroline Davis
- Massachusetts General Hospital Psychiatry, 149 Thirteenth Street, Charlestown, MA 02129, USA
| | - Stacey Dubois
- Tufts University Psychology, 490 Boston Avenue, Medford, MA 02155, USA
| | - Lisa M Shin
- Tufts University Psychology, 490 Boston Avenue, Medford, MA 02155, USA; Massachusetts General Hospital Psychiatry, 149 Thirteenth Street, Charlestown, MA 02129, USA
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VanElzakker MB. Chronic fatigue syndrome from vagus nerve infection: A psychoneuroimmunological hypothesis. Med Hypotheses 2013; 81:414-23. [DOI: 10.1016/j.mehy.2013.05.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 05/15/2013] [Accepted: 05/23/2013] [Indexed: 12/20/2022]
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Hayes JP, VanElzakker MB, Shin LM. Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies. Front Integr Neurosci 2012; 6:89. [PMID: 23087624 PMCID: PMC3466464 DOI: 10.3389/fnint.2012.00089] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [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: 05/16/2012] [Accepted: 09/18/2012] [Indexed: 12/14/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a psychiatric syndrome that develops after exposure to terrifying and life-threatening events including warfare, motor-vehicle accidents, and physical and sexual assault. The emotional experience of psychological trauma can have long-term cognitive effects. The hallmark symptoms of PTSD involve alterations to cognitive processes such as memory, attention, planning, and problem solving, underscoring the detrimental impact that negative emotionality has on cognitive functioning. As such, an important challenge for PTSD researchers and treatment providers is to understand the dynamic interplay between emotion and cognition. Contemporary cognitive models of PTSD theorize that a preponderance of information processing resources are allocated toward threat detection and interpretation of innocuous stimuli as threatening, narrowing one's attentional focus at the expense of other cognitive operations. Decades of research have shown support for these cognitive models of PTSD using a variety of tasks and methodological approaches. The primary goal of this review is to summarize the latest neurocognitive and neuroimaging research of emotion-cognition interactions in PTSD. To directly assess the influence of emotion on cognition and vice versa, the studies reviewed employed challenge tasks that included both cognitive and emotional components. The findings provide evidence for memory and attention deficits in PTSD that are often associated with changes in functional brain activity. The results are reviewed to provide future directions for research that may direct better and more effective treatments for PTSD.
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Affiliation(s)
- Jasmeet P. Hayes
- National Center for PTSD, VA Boston Healthcare SystemBoston, MA, USA
- Department of Psychiatry, Boston University School of MedicineBoston, MA, USA
| | - Michael B. VanElzakker
- Department of Psychology, Tufts UniversityMedford, MA, USA
- Department of Psychiatry, The Massachusetts General HospitalBoston, MA, USA
| | - Lisa M. Shin
- Department of Psychology, Tufts UniversityMedford, MA, USA
- Department of Psychiatry, The Massachusetts General HospitalBoston, MA, USA
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