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Yuan L, Yang L, Zhang S, Xu Z, Qin J, Shi Y, Yu P, Wang Y, Bao Z, Xia Y, Sun J, He W, Chen T, Chen X, Hu C, Zhang Y, Dong C, Zhao P, Wang Y, Jiang N, Lv B, Xue Y, Jiao B, Gao H, Chai K, Li J, Wang H, Wang X, Guan X, Liu X, Zhao G, Zheng Z, Yan J, Yu H, Chen L, Ye Z, You H, Bao Y, Cheng X, Zhao P, Wang L, Zeng W, Tian Y, Chen M, You Y, Yuan G, Ruan H, Gao X, Xu J, Xu H, Du L, Zhang S, Fu H, Cheng X. Development of a tongue image-based machine learning tool for the diagnosis of gastric cancer: a prospective multicentre clinical cohort study. EClinicalMedicine 2023; 57:101834. [PMID: 36825238 PMCID: PMC9941057 DOI: 10.1016/j.eclinm.2023.101834] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Tongue images (the colour, size and shape of the tongue and the colour, thickness and moisture content of the tongue coating), reflecting the health state of the whole body according to the theory of traditional Chinese medicine (TCM), have been widely used in China for thousands of years. Herein, we investigated the value of tongue images and the tongue coating microbiome in the diagnosis of gastric cancer (GC). METHODS From May 2020 to January 2021, we simultaneously collected tongue images and tongue coating samples from 328 patients with GC (all newly diagnosed with GC) and 304 non-gastric cancer (NGC) participants in China, and 16 S rDNA was used to characterize the microbiome of the tongue coating samples. Then, artificial intelligence (AI) deep learning models were established to evaluate the value of tongue images and the tongue coating microbiome in the diagnosis of GC. Considering that tongue imaging is more convenient and economical as a diagnostic tool, we further conducted a prospective multicentre clinical study from May 2020 to March 2022 in China and recruited 937 patients with GC and 1911 participants with NGC from 10 centres across China to further evaluate the role of tongue images in the diagnosis of GC. Moreover, we verified this approach in another independent external validation cohort that included 294 patients with GC and 521 participants with NGC from 7 centres. This study is registered at ClinicalTrials.gov, NCT01090362. FINDINGS For the first time, we found that both tongue images and the tongue coating microbiome can be used as tools for the diagnosis of GC, and the area under the curve (AUC) value of the tongue image-based diagnostic model was 0.89. The AUC values of the tongue coating microbiome-based model reached 0.94 using genus data and 0.95 using species data. The results of the prospective multicentre clinical study showed that the AUC values of the three tongue image-based models for GCs reached 0.88-0.92 in the internal verification and 0.83-0.88 in the independent external verification, which were significantly superior to the combination of eight blood biomarkers. INTERPRETATION Our results suggest that tongue images can be used as a stable method for GC diagnosis and are significantly superior to conventional blood biomarkers. The three kinds of tongue image-based AI deep learning diagnostic models that we developed can be used to adequately distinguish patients with GC from participants with NGC, even early GC and precancerous lesions, such as atrophic gastritis (AG). FUNDING The National Key R&D Program of China (2021YFA0910100), Program of Zhejiang Provincial TCM Sci-tech Plan (2018ZY006), Medical Science and Technology Project of Zhejiang Province (2022KY114, WKJ-ZJ-2104), Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer (JBZX-202006), Natural Science Foundation of Zhejiang Province (HDMY22H160008), Science and Technology Projects of Zhejiang Province (2019C03049), National Natural Science Foundation of China (82074245, 81973634, 82204828), and Chinese Postdoctoral Science Foundation (2022M713203).
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Key Words
- AFP, alpha fetoprotein
- AG, atrophic gastritis
- AI, artificial intelligence
- APINet, attentive pairwise interaction neural network
- AUC, area under the curve
- Artificial intelligence
- BC, breast cancer
- CA, carbohydrate antigen
- CEA, carcinoembryonic antigen
- CRC, colorectal cancer
- DT, decision tree learning
- EC, esophageal cancer
- GC, gastric cancer
- Gastric cancer
- HBPC, hepatobiliary pancreatic carcinoma
- HC, healthy control
- KNN, K-nearest neighbours
- LC, lung cancer
- NGC, non-gastric cancers
- PCoA, principal coordinates analysis
- SG, superficial gastritis
- SVM, support vector machine
- TCM, traditional Chinese medicine
- Tongue coating microbiome
- Tongue images
- Traditional Chinese medicine
- TransFG, transformer architecture for fine-grained recognition
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Affiliation(s)
- Li Yuan
- Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China
- Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Lin Yang
- Artificial Intelligence and Biomedical Images Analysis Lab, School of Engineering, Westlake University, China
| | - Shichuan Zhang
- Artificial Intelligence and Biomedical Images Analysis Lab, School of Engineering, Westlake University, China
| | - Zhiyuan Xu
- Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China
- Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Jiangjiang Qin
- Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China
- Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Yunfu Shi
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
- Oncology Department, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China
| | - Pengcheng Yu
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yi Wang
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Zhehan Bao
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yuhang Xia
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Jiancheng Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325099, China
| | - Weiyang He
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610042, China
| | - Tianhui Chen
- Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
| | - Xiaolei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325099, China
| | - Can Hu
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yunlong Zhang
- Artificial Intelligence and Biomedical Images Analysis Lab, School of Engineering, Westlake University, China
| | - Changwu Dong
- College of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, HeFei, 230038, China
| | - Ping Zhao
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610042, China
| | - Yanan Wang
- College of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, HeFei, 230038, China
| | - Nan Jiang
- College of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, HeFei, 230038, China
| | - Bin Lv
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yingwei Xue
- Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Baoping Jiao
- Department of General Surgery, Shanxi Cancer Hospital, Taiyuan, 030013, China
| | - Hongyu Gao
- Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Kequn Chai
- Oncology Department, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China
| | - Jun Li
- Department of General Surgery, Shanxi Cancer Hospital, Taiyuan, 030013, China
| | - Hao Wang
- Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Xibo Wang
- Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Xiaoqing Guan
- Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
| | - Xu Liu
- Department of Gastrointestinal Surgery, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Gang Zhao
- Department of Gastrointestinal Surgery, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Zhichao Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang, 110042, China
| | - Jie Yan
- Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang, 110042, China
| | - Haiyue Yu
- Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang, 110042, China
| | - Luchuan Chen
- Department of Gastrointestinal Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Zaisheng Ye
- Department of Gastrointestinal Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Huaqiang You
- Department of Gastroenterology, Yuhang District People's Hospital, Hangzhou, 311199, China
| | - Yu Bao
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610042, China
| | - Xi Cheng
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610042, China
| | - Peizheng Zhao
- Department of Health Management Center, Yueyang Central Hospital, Yueyang, 414000, China
| | - Liang Wang
- Department of Endoscopy Center, Kecheng District People's Hospital, Quzhou, 324000, China
| | - Wenting Zeng
- Department of General Surgery, Shanxi Cancer Hospital, Taiyuan, 030013, China
| | - Yanfei Tian
- Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang, 110042, China
| | - Ming Chen
- Department of Endoscopy Center, Shandong Cancer Hospital, Shandong, 250117, China
| | - You You
- Department of Health Management Center, Zigong Fourth People's Hospital, Zigong, 643099, China
| | - Guihong Yuan
- Department of Gastroenterology, Hainan Cancer Hospital, Hainan, 570312, China
| | - Hua Ruan
- Department of Chinese Surgery, Linping District Hospital of Traditional Chinese Medicine, Hangzhou, 311100, China
| | - Xiaole Gao
- The First Affiliated Hospital of Henan University of Science and Technology, Zhengzhou, 450062, China
| | - Jingli Xu
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Handong Xu
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Lingbin Du
- Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
| | - Shengjie Zhang
- Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
| | - Huanying Fu
- Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
| | - Xiangdong Cheng
- Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China
- Zhejiang Key Lab of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer, Zhejiang Cancer Hospital, Hangzhou, 310022, China
- Corresponding author. Department of Gastric surgery, Zhejiang Cancer Hospital, Banshan Road 1#, Hangzhou, Zhejiang, 310022, China.
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Kerbert AJC, Gupta S, Alabsawy E, Dobler I, Lønsmann I, Hall A, Nielsen SH, Nielsen MJ, Gronbaek H, Amoros À, Yeung D, Macnaughtan J, Mookerjee RP, Macdonald S, Andreola F, Moreau R, Arroyo V, Angeli P, Leeming DJ, Treem W, Karsdal MA, Jalan R. Biomarkers of extracellular matrix formation are associated with acute-on-chronic liver failure. JHEP Rep 2021; 3:100355. [PMID: 34805815 PMCID: PMC8581571 DOI: 10.1016/j.jhepr.2021.100355] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022]
Abstract
Background & Aims Acute-on-chronic liver failure (ACLF) is characterised by organ failure(s), high short-term mortality, and, pathophysiologically, deranged inflammatory responses. The extracellular matrix (ECM) is critically involved in regulating the inflammatory response. This study aimed to determine alterations in biomarkers of ECM turnover in ACLF and their association with inflammation, organ failures, and mortality. Methods We studied 283 patients with cirrhosis admitted for acute decompensation (AD) with or without ACLF, 64 patients with stable cirrhosis, and 30 healthy controls. A validation cohort (25 ACLF, 9 healthy controls) was included. Plasma PRO-C3, PRO-C4, PRO-C5, PRO-C6, and PRO-C8 (i.e. collagen type III–VI and VIII formation) and C4M and C6M (i.e. collagen type IV and VI degradation) were measured. Immunohistochemistry of PRO-C6 was performed on liver biopsies (AD [n = 7], ACLF [n = 5]). A competing-risk regression analysis was performed to explore the prognostic value of biomarkers of ECM turnover with 28- and 90-day mortality. Results PRO-C3 and PRO-C6 were increased in ACLF compared to AD (p = 0.089 and p <0.001, respectively), whereas collagen degradation markers C4M and C6M were similar. Both PRO-C3 and PRO-C6 were strongly associated with liver function and inflammatory markers. Only PRO-C6 was associated with extrahepatic organ failures and 28- and 90-day mortality (hazard ratio [HR; on log-scale] 6.168, 95% CI 2.366–16.080, p <0.001, and 3.495, 95% CI 1.509–8.093, p = 0.003, respectively). These findings were consistent in the validation cohort. High PRO-C6 expression was observed in liver biopsies of patients with ACLF. Conclusions This study shows, for the first time, evidence of severe net interstitial collagen deposition in ACLF and makes the novel observation of the association between PRO-C6 and (extrahepatic) organ failures and mortality. Further studies are needed to define the pathogenic significance of these observations. Lay summary This study describes a disrupted turnover of collagen type III and VI in Acute-on-chronic liver failure (ACLF). Plasma biomarkers of these collagens (PRO-C3 and PRO-C6) are associated with the severity of liver dysfunction and inflammation. PRO-C6, also known as the hormone endotrophin, has also been found to be associated with multi-organ failure and prognosis in acute decompensation and ACLF. Collagen type III and VI formation is increased in ACLF compared to AD. PRO-C3 and PRO-C6 correlate with the severity of liver dysfunction and inflammation in AD and ACLF. High PRO-C6 levels were found to be indicative for the presence of multi-organ failure and worse survival.
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Key Words
- ACLF, acute-on-chronic liver failure
- AD, acute decompensation
- CLIF-C ACLF, CLIF Consortium Acute-on-Chronic Liver
- CLIF-C AD, CLIF Consortium Acute Decompensation
- CLIF-C OF, CLIF Consortium Organ Failure
- CPE, concordance probability estimate
- Collagen
- DAMP, danger-associated molecular pattern
- ECM, extracellular matrix
- HC, healthy control
- HR, hazard ratio
- HSC, hepatic stellate cell
- IHC, immunohistochemistry
- INR, international normalised ratio
- K18, keratin 18
- Liver cirrhosis
- MELD, model for end-stage liver disease
- MMP, matrix metalloproteinase
- Multi-organ failure
- NGAL, neutrophil gelatinase-associated lipocalin
- NIS, noninterventional Study
- PAMP, pathogen-associated molecular pattern
- Prognosis
- ROC, receiver operating characteristic
- SC, stable cirrhosis
- TLR, toll-like receptor
- UCL, University College London
- UCLH, University College London Hospitals
- WCC, white cell count
- cK18, caspase-cleaved keratin 18
- α-SMA, alpha-smooth muscle actin
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Affiliation(s)
- Annarein J C Kerbert
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK
| | - Saurabh Gupta
- Translational and Biomarker Research, GI-DDU, Takeda Pharmaceuticals International Co., Cambridge, MA, USA
| | - Eman Alabsawy
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK.,Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iwona Dobler
- Statistical and Quantitative Sciences, Takeda Pharmaceuticals International Co., Cambridge, MA, USA
| | - Ida Lønsmann
- Biomarkers and Research, Nordic Bioscience, Herlev, Denmark
| | - Andrew Hall
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, London, UK
| | - Signe Holm Nielsen
- Biomarkers and Research, Nordic Bioscience, Herlev, Denmark.,Department of Biomedicine and Biotechnology, Technical University of Denmark, Lyngby, Denmark
| | | | - Henning Gronbaek
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Àlex Amoros
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Dave Yeung
- Translational and Biomarker Research, GI-DDU, Takeda Pharmaceuticals International Co., Cambridge, MA, USA
| | - Jane Macnaughtan
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK
| | - Rajeshwar P Mookerjee
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK.,Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Stewart Macdonald
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK
| | - Fausto Andreola
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK
| | - Richard Moreau
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain.,Inserm and Université de Paris, Centre de Recherche sur l'Inflammation (CRI), Paris, France.,Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, DIMED, University of Padova, Padua, Italy
| | | | - William Treem
- Clinical Science, GI-TAU, Takeda Pharmaceuticals International Co., Cambridge, MA, USA
| | | | - Rajiv Jalan
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, London, UK
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Riva A, Gray EH, Azarian S, Zamalloa A, McPhail MJ, Vincent RP, Williams R, Chokshi S, Patel VC, Edwards LA. Faecal cytokine profiling as a marker of intestinal inflammation in acutely decompensated cirrhosis. JHEP Rep 2020; 2:100151. [PMID: 32838247 PMCID: PMC7391986 DOI: 10.1016/j.jhepr.2020.100151] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/26/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS Gut dysbiosis and inflammation perpetuate loss of gut barrier integrity (GBI) and pathological bacterial translocation (BT) in cirrhosis, contributing to infection risk. Little is known about gut inflammation in cirrhosis and how this differs in acute decompensation (AD). We developed a novel approach to characterise intestinal immunopathology by quantifying faecal cytokines (FCs) and GBI markers. METHODS Faeces and plasma were obtained from patients with stable cirrhosis (SC; n = 16), AD (n = 47), and healthy controls (HCs; n = 31). A panel of 15 cytokines and GBI markers, including intestinal fatty-acid-binding protein-2 (FABP2), d-lactate, and faecal calprotectin (FCAL), were quantified by electrochemiluminescence/ELISA. Correlations between analytes and clinical metadata with univariate and multivariate analyses were performed. RESULTS Faecal (F) IL-1β, interferon gamma, tumour necrosis factor alpha, IL-21, IL-17A/F, and IL-22 were significantly elevated in AD vs. SC (q <0.01). F-IL-23 was significantly elevated in AD vs. HC (p = 0.0007). FABP2/d-lactate were significantly increased in faeces in AD vs. SC and AD vs. HC (p <0.0001) and in plasma (p = 0.0004; p = 0.011). F-FABP2 correlated most strongly with disease severity (Spearman's rho: Child-Pugh 0.466; p <0.0001; model for end-stage liver disease 0.488; p <0.0001). FCAL correlated with plasma IL-21, IL-1β, and IL-17F only and none of the faecal analytes. F-cytokines and F-GBI markers were more accurate than plasma in discriminating AD from SC. CONCLUSIONS FC profiling represents an innovative approach to investigating the localised intestinal cytokine micro-environment in cirrhosis. These data reveal that AD is associated with a highly inflamed and permeable gut barrier. FC profiles are very different from the classical innate-like features of systemic inflammation. There is non-specific upregulation of TH1/TH17 effector cytokines and those known to mediate intestinal barrier damage. This prevents mucosal healing in AD and further propagates BT and systemic inflammation. LAY SUMMARY The gut barrier is crucial in cirrhosis in preventing infection-causing bacteria that normally live in the gut from accessing the liver and other organs via the bloodstream. Herein, we characterised gut inflammation by measuring different markers in stool samples from patients at different stages of cirrhosis and comparing this to healthy people. These markers, when compared with equivalent markers usually measured in blood, were found to be very different in pattern and absolute levels, suggesting that there is significant gut inflammation in cirrhosis related to different immune system pathways to that seen outside of the gut. This provides new insights into gut-specific immune disturbances that predispose to complications of cirrhosis, and emphasises that a better understanding of the gut-liver axis is necessary to develop better targeted therapies.
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Key Words
- ACLF, acute-on-chronic liver failure
- AD, acute decompensation
- AUROC, area under the receiver operating characteristic
- BT, bacterial translocation
- Bacterial translocation
- CLIF-C AD, Chronic Liver Failure Consortium-acute decompensation
- Chronic liver disease
- Cytokines
- DS, discriminant score
- FABP2, fatty-acid-binding protein-2
- FCAL, faecal calprotectin
- FDR, false discovery rate
- FL, faecal lysate
- FWER, family-wise error rate
- GVB, gut vascular barrier
- Gut inflammation
- HC, healthy control
- IBD, inflammatory bowel disease
- IEC, intestinal epithelial cell
- Intestinal barrier function
- MELD, model for end-stage liver disease
- OPLS-DA, orthogonal projection to latent structures discriminant analysis
- PAMP, pathogen-associated molecular pattern
- PCA, principal component analysis
- ROC, receiver operating characteristic
- SC, stable cirrhosis
- UKELD, United Kingdom model for end-stage liver disease
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Affiliation(s)
- Antonio Riva
- Institute of Hepatology London, Foundation for Liver Research, London, UK
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Elizabeth H. Gray
- Institute of Hepatology London, Foundation for Liver Research, London, UK
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sarah Azarian
- Institute of Hepatology London, Foundation for Liver Research, London, UK
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Ane Zamalloa
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Mark J.W. McPhail
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Royce P. Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Roger Williams
- Institute of Hepatology London, Foundation for Liver Research, London, UK
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shilpa Chokshi
- Institute of Hepatology London, Foundation for Liver Research, London, UK
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Vishal C. Patel
- Institute of Hepatology London, Foundation for Liver Research, London, UK
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Lindsey A. Edwards
- Institute of Hepatology London, Foundation for Liver Research, London, UK
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Minegishi S, Kato S, Takase-Minegishi K, Horita N, Azushima K, Wakui H, Ishigami T, Kosuge M, Kimura K, Tamura K. Native T1 time and extracellular volume fraction in differentiation of normal myocardium from non-ischemic dilated and hypertrophic cardiomyopathy myocardium: A systematic review and meta-analysis. Int J Cardiol Heart Vasc 2019; 25:100422. [PMID: 31517037 PMCID: PMC6737306 DOI: 10.1016/j.ijcha.2019.100422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/02/2019] [Indexed: 11/02/2022]
Abstract
Background Both native T1 time and extracellular volume (ECV) fraction have been shown to be important measures for the detection of myocardial fibrosis. However, ECV determination requires the administration of an intravenous contrast agent, whereas native T1 mapping can be performed without a contrast agent. Methods Here, we conducted a meta-analysis of myocardial native T1 data obtained for non-ischemic cardiomyopathy (NIC) patients and controls. A literature review included studies that applied T1 mapping using modified Look-Locker inversion recovery to measure myocardial fibrosis, and the results were validated by comparing datasets for dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) patients and healthy controls (HCs). Results We identified 16 eligible studies. Pooled mean differences (MDs) and 95% confidence intervals (CIs) were estimated as follows. Native T1 at 1.5-T, DCM vs. HC: MD = 45.26 (95% CI: 30.92-59.59); HCM vs. HC: MD = 47.09 (95% CI: 32.42-61.76). Native T1 at 3.0-T, DCM vs. HC: MD = 82.52 (95% CI: 47.60-117.44); HCM vs. HC: MD = 115.87 (95% CI: 50.71-181.04). ECV at 1.5-T, DCM vs. HC: MD = 4.26 (95% CI: 3.06-5.46); HCM vs. HC: MD = 1.49 (95% CI: -1.45-4.43). ECV at 3.0-T, DCM vs. HC: MD = 8.40 (95% CI: 2.94-13.86); HCM vs. HC: MD = 8.02 (95% CI: 5.45-1-0.59). Conclusion In conclusion, native T1 values were significantly different between NIC patients and controls. Native T1 mapping may be a useful noninvasive method to detect diffuse myocardial fibrosis in NIC patients.
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Key Words
- CI, confidence interval
- CMR, cardiac magnetic resonance
- DCM, dilated cardiomyopathy
- Dilated cardiomyopathy
- ECV, extracellular volume
- Extracellular volume fraction
- HC, healthy control
- HCM, hypertrophic cardiomyopathy
- Hypertrophic cardiomyopathy
- LGE-MRI, late gadolinium-enhanced magnetic resonance imaging
- MD, mean difference
- MINORS, Methodological Index for Non-Randomized Studies
- MOLLI, modified Look-Locker inversion recovery
- Meta-analysis
- NIC, non-ischemic cardiomyopathy
- Native T1 mapping
- SCD, sudden cardiac death
- SD, standard deviation
- Systematic review
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Affiliation(s)
- Shintaro Minegishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shingo Kato
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kaoru Takase-Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kengo Azushima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomoaki Ishigami
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masami Kosuge
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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McDermott K, Ren P, Lin F. The mediating role of hippocampal networks on stress regulation in amnestic mild cognitive impairment. Neurobiol Stress 2019; 10:100162. [PMID: 31193516 PMCID: PMC6535625 DOI: 10.1016/j.ynstr.2019.100162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/30/2018] [Revised: 01/18/2019] [Accepted: 04/03/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives To examine the role of the hippocampus in stress regulation in older adults with amnestic mild cognitive impairment (aMCI). Methods This study combined resting-state functional MRI, structural MRI, self-reported chronic stress exposure, and an electrocardiography-based acute stress protocol to compare aMCI group (n = 17) to their cognitively healthy counterparts (HC, n = 22). Results For the entire sample, there was a positive correlation between chronic stress exposure and acute stress regulation. The aMCI group showed significantly smaller volumes in the right hippocampus than HC. The two groups did not differ in chronic stress exposure or acute stress regulation. In the HC group, the left hippocampal connectivity with inferior parietal lobe was significantly correlated with both the chronic stress and acute stress. In the aMCI group, the left hippocampal connectivity with both the right insula and the left precentral gyrus was significantly correlated to chronic stress exposure and acute stress regulation. Additionally, the left hippocampal connectivity with right insula significantly mediated the relationship between chronic stress exposure and acute stress regulation in aMCI group. Conclusions Extra hippocampal networks may be recruited as compensation to attend the maintenance of relatively normal stress regulation in aMCI by alleviating the detrimental effects of chronic stress exposure on acute stress regulation.
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Key Words
- AD, Alzheimer's Disease
- ANS, Autonomic Nervous System
- Acute stress regulation
- Chronic stress exposure
- FC, functional connectivity
- GDS, Geriatric Depression Scale
- GLM, General Linear Model
- HC, healthy control
- HF-HRV, high frequency heart rate variability
- HPA, Hypothalamic Pituitary Adrenal
- Hippocampus
- LHIP, left hippocampus
- LIPL, left inferior parietal lobe
- LPG, left precentral gyrus
- MOCA, Montreal Cognitive Assessment
- Mild cognitive impairment
- PSS, Perceived stress scale
- RAVLT, Rey's Auditory Verbal Learning Test
- RHIP, right hippocampus
- Resting-state functional connectivity
- Rinsula, right insula
- aMCI, amnestic Mild Cognitive Impairment
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Affiliation(s)
- Kelsey McDermott
- School of Nursing, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Ping Ren
- School of Nursing, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Feng Lin
- School of Nursing, University of Rochester Medical Center, Rochester, NY, 14642, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, 14642, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, 14642, USA
- Department of Brain and Cognitive Science, University of Rochester, Rochester, NY, 14627, USA
- Corresponding author. 601 Elmwood Ave, Rochester, NY, 14642
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Ma R, Liu C, Lu M, Yuan X, Cheng G, Kong F, Lu J, Strååt K, Björkholm M, Ma L, Xu D. The TERT locus genotypes of rs2736100-CC/CA and rs2736098-AA predict shorter survival in renal cell carcinoma. Urol Oncol 2019; 37:301.e1-301.e10. [PMID: 30738744 DOI: 10.1016/j.urolonc.2019.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The single nucleotide polymorphisms (SNPs) at the TERT rs2736100 and rs2736098 are associated with multicancer susceptibility, however, published findings regarding renal cell carcinoma (RCC) risk are conflicting. In addition, the potential of these SNPs to predict outcomes in RCC remains unclear. The present study is designed to address these questions. PATIENTS AND METHODS We recruited 343 patients with RCC and ethnic-/sex-matched healthy controls. TERT rs2736100 and rs2736098 SNPs were analyzed, and their relationships with relapse/survival were evaluated using univariate or multivariate Cox regression. RESULTS The genotype distribution did not significantly differ between RCC patients and healthy controls. RCC patients carrying the rs2736100-CC/CA variants had significantly shorter progression-free and overall survival (PFS and OS) than did those AA-carriers (P = 0.009 and 0.032, respectively), while the rs2736098-AA variant was associated with shorter PFS and OS (P = 0.008 and 0.017, respectively). Multivariate analyses showed that rs2736100-CC/CA and rs2736098-AA predicted shorter PFS and OS independently of other established prognostic variables in RCCs. Furthermore, patients carrying both rs2736100-CC/CA and rs2736098-AA had shortest PFS and OS (P = 0.003 and 0.013, respectively) and the hazard ratio of relapse was 7.2 (95% confidence interval: 2.0-26.1). CONCLUSIONS There is no significant association between rs2736100/rs2736098 SNPs and RCC risk. rs2736100-CC/CA and rs2736098-AA variants serve as independent predictors of a poor prognosis in RCC. Given that blood or even urinary DNA can be used to genotype these germline variants before treatment, these 2 SNPs may serve as a potential marker for risk stratification.
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Affiliation(s)
- Runzhuo Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, PR China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, PR China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Beijing 100191, PR China
| | - Xiaotian Yuan
- Department of Medicine and Center for Molecular Medicine (CMM), Karolinska Institutet and Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden.
| | - Guanghui Cheng
- Central Research Laboratory, the Second Hospital of Shandong University, Jinan 250033, PR China
| | - Feng Kong
- Central Research Laboratory, the Second Hospital of Shandong University, Jinan 250033, PR China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing 100191, PR China
| | - Klas Strååt
- Department of Medicine and Center for Molecular Medicine (CMM), Karolinska Institutet and Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden
| | - Magnus Björkholm
- Department of Medicine and Center for Molecular Medicine (CMM), Karolinska Institutet and Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, PR China.
| | - Dawei Xu
- Department of Medicine and Center for Molecular Medicine (CMM), Karolinska Institutet and Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden
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Berman BD, Honce JM, Shelton E, Sillau SH, Nagae LM. Isolated focal dystonia phenotypes are associated with distinct patterns of altered microstructure. Neuroimage Clin 2018; 19:805-12. [PMID: 30013924 DOI: 10.1016/j.nicl.2018.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/17/2018] [Accepted: 06/03/2018] [Indexed: 01/21/2023]
Abstract
Objective Isolated adult-onset focal dystonia is considered a network disorder with disturbances to the motor basal ganglia and cerebellar circuits playing a pathophysiological role, but why specific body regions become affected remains unknown. We aimed to use diffusion tensor imaging to determine if the two most common phenotypes of focal dystonia are associated with distinguishing microstructural changes affecting the motor network. Methods Fifteen blepharospasm patients, 20 cervical dystonia patients, and 30 age- and sex-matched healthy controls were recruited. Maps of fractional anisotropy and mean diffusivity were analyzed using a voxel-based approach and an automated region-of-interest technique to evaluate deep gray matter nuclei. Correlations between diffusion measures and dystonia severity were tested, and post hoc discriminant analyses were conducted. Results Voxel-based analyses revealed significantly reduced fractional anisotropy in the right cerebellum and increased mean diffusivity in the left caudate of cervical dystonia patients compared to controls, as well as lower fractional anisotropy in the right cerebellum in cervical dystonia patients relative to blepharospasm patients. In addition to reduced fractional anisotropy in the bilateral caudate nucleus of cervical dystonia patients relative to controls and blepharospasm patients, region-of-interest analyses revealed significantly reduced fractional anisotropy in the right globus pallidus internus and left red nucleus of blepharospasm patients compared to both controls and cervical dystonia patients. Diffusivity measures in the red nucleus of blepharospasm patients correlated with disease severity. In a three-group discriminant analysis, participants were correctly classified with only modest reliability (67-75%), but in a two-group discriminant analysis, patients could be distinguished from each other with high reliability (83-100%). Conclusions Different focal dystonia phenotypes are associated with distinct patterns of altered microstructure within constituent regions of basal ganglia and cerebellar circuits.
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Key Words
- BSP, blepharospasm
- Basal ganglia
- Blepharospasm
- CD, cervical dystonia
- Cerebellum
- Cervical dystonia
- DTI, diffusion tensor imaging
- Diffusion tensor imaging
- FA, fractional anisotropy
- HC, healthy control
- JRS, Jankovic Rating Scale
- MD, mean diffusivity
- MNI, Montreal Neurological Institute
- ROI, region of interest
- TWSTRS, Toronto Western Spasmodic Torticollis Rating Scale
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Chung JW, Burciu RG, Ofori E, Coombes SA, Christou EA, Okun MS, Hess CW, Vaillancourt DE. Beta-band oscillations in the supplementary motor cortex are modulated by levodopa and associated with functional activity in the basal ganglia. Neuroimage Clin 2018; 19:559-571. [PMID: 29984164 PMCID: PMC6029579 DOI: 10.1016/j.nicl.2018.05.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 12/15/2022]
Abstract
We investigated the effect of acute levodopa administration on movement-related cortical oscillations and movement velocity in Parkinson's disease (PD). Patients with PD on and off medication and age- and sex-matched healthy controls performed a ballistic upper limb flexion movement as fast and accurately as possible while cortical oscillations were recorded with high-density electroencephalography. Patients off medication were also studied using task-based functional magnetic resonance imaging (fMRI) using a force control paradigm. Percent signal change of functional activity during the force control task was calculated for the putamen and subthalamic nucleus (STN) contralateral to the hand tested. We found that patients with PD off medication had an exaggerated movement-related beta-band (13–30 Hz) desynchronization in the supplementary motor area (SMA) compared to controls. In PD, spectral power in the beta-band was correlated with movement velocity. Following an acute dose of levodopa, we observed that the beta-band desynchronization in the SMA was reduced in PD, and was associated with increased movement velocity and increased voltage of agonist muscle activity. Further, using fMRI we found that the functional activity in the putamen and STN in the off medication state, was related to how responsive that cortical oscillations in the SMA of PD were to levodopa. Collectively, these findings provide the first direct evaluation of how movement-related cortical oscillations relate to movement velocity during the ballistic phase of movement in PD and demonstrate that functional brain activity in the basal ganglia pathways relate to the effects of dopaminergic medication on cortical neuronal oscillations during movement. Acute levodopa decreased beta-band desynchronization in the SMA, while improving movement velocity and muscle activity. Beta-band cortical activity during movement is positively correlated with upper limb movement velocity. fMRI in basal ganglia predicted the response of beta-band cortical activity to levodopa.
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Key Words
- BOLD, blood oxygen level dependent
- Ballistic movements
- DBS, deep brain stimulation
- ECoG, electrocorticography
- EEG
- EEG, electroencephalography
- EMG, electromyography
- ERSP, event-related power spectral perturbation
- FDR, false discovery rate
- HC, healthy control
- ICA, independent component analysis
- LFP, local field potential
- Levodopa
- M1, primary motor cortex
- MDS-UPDRS, Movement Disorder Society Unified Parkinson's Disease Rating Scale
- MEG, magnetoencephalography
- MPA, measure projection analysis
- MVC, maximum voluntary contraction
- MoCA, Montreal Cognitive Assessment
- PD, Parkinson's disease
- PD-OFF, off medication (levodopa) day
- PD-ON, on medication (levodopa) day
- PET, positron emission tomography
- Parkinson's disease
- ROI, regions of interest
- S1, primary somatosensory cortex
- SMA, supplementary motor area
- SNc, substantia nigra pars compacta
- STN, subthalamic nucleus
- Supplementary motor area
- fMRI
- fMRI, functional magnetic resonance imaging
- iEMG, integrated electromyography
- rCBF, regional cerebral blood flow
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Affiliation(s)
- Jae Woo Chung
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Roxana G Burciu
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Edward Ofori
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Stephen A Coombes
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - Christopher W Hess
- Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
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Consonni M, Contarino VE, Catricalà E, Dalla Bella E, Pensato V, Gellera C, Lauria G, Cappa SF. Cortical markers of cognitive syndromes in amyotrophic lateral sclerosis. Neuroimage Clin 2018; 19:675-682. [PMID: 30023173 PMCID: PMC6046611 DOI: 10.1016/j.nicl.2018.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) can be associated with a spectrum of cognitive and behavioural symptoms, but the related patterns of focal cortical atrophy in non-demented ALS patients remain largely unknown. We enrolled 48 non-demented ALS patients and 26 healthy controls for a comprehensive neuropsychological assessment and a magnetic resonance exam. Behavioural and cognitive impairment was defined on the basis of a data-driven multi-domain approach in 21 ALS patients. Averaged cortical thickness of 74 bilateral brain regions was used as a measure of cortical atrophy. Cortical thinning in a fronto-parietal network, suggesting a disease-specific pattern of neurodegeneration, was present in all patients, independent of cognitive and behavioural status. Between-group and correlational analyses revealed that inferior frontal, temporal, cingular and insular thinning are markers for cognitive and behavioural deficits, with language impairment mainly related to left temporal pole and insular involvement. These specific correlates support the concept of a spectrum of deficits, with an overlap between the ALS cognitive phenotypes and the syndromes of frontotemporal dementia. Language, social cognition and executive dysfunctions are frequent symptoms in ALS. Fronto-parietal cortical thinning is present in non-demented ALS patients. Temporal, cingular and insular thinning are markers for cognitive impairment in ALS. Left temporal pole and insular thinning is linked to language impairment in ALS.
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Key Words
- ALS, amyotrophic lateral sclerosis
- ALSbi, ALS with mild behavioural impairment
- ALSci, ALS with mild cognitive impairment
- ALScn, cognitively-normal ALS
- ALSimp, ALS with cognitive and/or behavioural impairment
- Amyotrophic lateral sclerosis
- C9+ ALS, ALS harbouring C9orf72 repeat expansion
- C9– ALS, ALS without C9orf repeat expansion
- CT, cortical thickness
- Cognitive impairment
- Cognitive profiles
- Cortical thickness
- FTD, frontotemporal dementia
- GM, grey matter
- HC, healthy control
- MD, multi-domain
- Temporal lobe
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Affiliation(s)
- Monica Consonni
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria 11, 20133 Milan, Italy.
| | - Valeria E Contarino
- Neuroradiology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria 11, 20133 Milan, Italy
| | - Eleonora Catricalà
- Institute for Advanced Study-IUSS Pavia, Palazzo del Broletto e Piazza Vittoria 15, 27100 Pavia, Italy
| | - Eleonora Dalla Bella
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria 11, 20133 Milan, Italy
| | - Viviana Pensato
- Genetics of Neurodegenerative and Metabolic Diseases Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation 'Carlo Besta' Neurological Institute, Via Celoria 11, 20133 Milan, Italy
| | - Cinzia Gellera
- Genetics of Neurodegenerative and Metabolic Diseases Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation 'Carlo Besta' Neurological Institute, Via Celoria 11, 20133 Milan, Italy
| | - Giuseppe Lauria
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria 11, 20133 Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
| | - Stefano F Cappa
- Institute for Advanced Study-IUSS Pavia, Palazzo del Broletto e Piazza Vittoria 15, 27100 Pavia, Italy; IRCCS S. Giovanni di Dio Fatebenefratelli, via Pilastroni 4, 25125 Brescia, Italy
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Hagemeier J, Ramanathan M, Schweser F, Dwyer MG, Lin F, Bergsland N, Weinstock-Guttman B, Zivadinov R. Iron-related gene variants and brain iron in multiple sclerosis and healthy individuals. Neuroimage Clin 2017; 17:530-540. [PMID: 29201641 PMCID: PMC5699896 DOI: 10.1016/j.nicl.2017.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022]
Abstract
Brain iron homeostasis is known to be disturbed in multiple sclerosis (MS), yet little is known about the association of common gene variants linked to iron regulation and pathological tissue changes in the brain. In this study, we investigated the association of genetic determinants linked to iron regulation with deep gray matter (GM) magnetic susceptibility in both healthy controls (HC) and MS patients. Four hundred (400) patients with MS and 150 age- and sex-matched HCs were enrolled and obtained 3 T MRI examination. Three (3) single nucleotide polymorphisms (SNPs) associated with iron regulation were genotyped: two SNPs in the human hereditary hemochromatosis protein gene HFE: rs1800562 (C282Y mutation) and rs1799945 (H63D mutation), as well as the rs1049296 SNP in the transferrin gene (C2 mutation). The effects of disease and genetic status were studied using quantitative susceptibility mapping (QSM) voxel-based analysis (VBA) and region-of-interest (ROI) analysis of the deep GM. The general linear model framework was used to compare groups. Analyses were corrected for age and sex, and adjusted for false discovery rate. We found moderate increases in susceptibility in the right putamen of participants with the C282Y (+ 6.1 ppb) and H63D (+ 6.9 ppb) gene variants vs. non-carriers, as well as a decrease in thalamic susceptibility of progressive MS patients with the C282Y mutation (left: − 5.3 ppb, right: − 6.7 ppb, p < 0.05). Female MS patients had lower susceptibility in the caudate (− 6.0 ppb) and putamen (left: − 3.9 ppb, right: − 4.6 ppb) than men, but only when they had a wild-type allele (p < 0.05). Iron-gene linked increases in putamen susceptibility (in HC and relapsing remitting MS) and decreases in thalamus susceptibility (in progressive MS), coupled with apparent sex interactions, indicate that brain iron in healthy and disease states may be influenced by genetic factors. Magnetic susceptibility and common gene variants linked to iron were investigated. The C282Y and H63D alleles were associated with putamen and thalamus susceptibility changes. Dependent on allele status, men and women differed in deep GM susceptibility in MS.
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Key Words
- EDSS, Expanded Disability Status Scale
- FDR, false discovery rate
- FWE, family-wise error rate
- GLM, general linear model
- GM, gray matter
- GRE, gradient recalled echo
- HC, healthy control
- HFE, human hemochromatosis gene
- Iron
- Iron related genes
- MS, multiple sclerosis
- MSSS, multiple sclerosis severity scale
- Multiple sclerosis
- QSM
- QSM, quantitative susceptibility mapping
- Quantitative susceptibility mapping
- ROI, region of interest
- RRMS, relapsing-remitting multiple sclerosis
- SNP, single nucleotide polymorphism
- T1w, T1-weighted
- TF, transferrin
- TFCE, threshold-free cluster enhancement
- VBA, voxel-based analysis
- ppb, parts per billion
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Affiliation(s)
- Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging, Clinical and Translational Science Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Fuchun Lin
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging, Clinical and Translational Science Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Ng B, Varoquaux G, Poline JB, Thirion B, Greicius MD, Poston KL. Distinct alterations in Parkinson's medication-state and disease-state connectivity. Neuroimage Clin 2017; 16:575-585. [PMID: 28971008 PMCID: PMC5608603 DOI: 10.1016/j.nicl.2017.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/30/2017] [Accepted: 09/05/2017] [Indexed: 01/05/2023]
Abstract
Altered brain connectivity has been described in people with Parkinson's disease and in response to dopaminergic medications. However, it is unclear whether dopaminergic medications primarily 'normalize' disease related connectivity changes or if they induce unique alterations in brain connectivity. Further, it is unclear how these disease- and medication-associated changes in brain connectivity relate differently to specific motor manifestations of disease, such as bradykinesia/rigidity and tremor. In this study, we applied a novel covariance projection approach in combination with a bootstrapped permutation test to resting state functional MRI data from 57 Parkinson's disease and 20 healthy control participants to determine the Parkinson's medication-state and disease-state connectivity changes associated with different motor manifestations of disease. First, we identified brain connections that best classified Parkinson's disease ON versus OFF dopamine and Parkinson's disease versus healthy controls, achieving 96.9 ± 5.9% and 72.7 ± 12.4% classification accuracy, respectively. Second, we investigated the connections that significantly contribute to the classifications. We found that the connections greater in Parkinson's disease OFF compared to ON dopamine are primarily between motor (cerebellum and putamen) and posterior cortical regions, such as the posterior cingulate cortex. By contrast, connections that are greater in ON compared to OFF dopamine are between the right and left medial prefrontal cortex. We also identified the connections that are greater in healthy control compared to Parkinson's disease and found the most significant connections are associated with primary motor regions, such as the striatum and the supplementary motor area. Notably, these are different connections than those identified in Parkinson's disease OFF compared to ON. Third, we determined which of the Parkinson's medication-state and disease-state connections are associated with the severity of different motor symptoms. We found two connections correlate with both bradykinesia/rigidity severity and tremor severity, whereas four connections correlate with only bradykinesia/rigidity severity, and five connections correlate with only tremor severity. Connections that correlate with only tremor severity are anchored by the cerebellum and the supplemental motor area, but only those connections that include the supplemental motor area predict dopaminergic improvement in tremor. Our results suggest that dopaminergic medications do not simply 'normalize' abnormal brain connectivity associated with Parkinson's disease, but rather dopamine drives distinct connectivity changes, only some of which are associated with improved motor symptoms. In addition, the dissociation between of connections related to severity of bradykinesia/rigidity versus tremor highlights the distinct abnormalities in brain circuitry underlying these specific motor symptoms.
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Affiliation(s)
- Bernard Ng
- Mostafavi Lab, Department of Statistics, University of British Columbia, Vancouver, BC, Canada.,Parietal team, INRIA Saclay, Gif-sur-Yvette, France.,Functional Imaging in Neuropsychiatric Disorders (FIND) Lab, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | | | | | | | - Michael D Greicius
- Functional Imaging in Neuropsychiatric Disorders (FIND) Lab, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Kathleen L Poston
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
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Lee SE, Sias AC, Mandelli ML, Brown JA, Brown AB, Khazenzon AM, Vidovszky AA, Zanto TP, Karydas AM, Pribadi M, Dokuru D, Coppola G, Geschwind DH, Rademakers R, Gorno-Tempini ML, Rosen HJ, Miller BL, Seeley WW. Network degeneration and dysfunction in presymptomatic C9ORF72 expansion carriers. Neuroimage Clin 2016; 14:286-297. [PMID: 28337409 PMCID: PMC5349617 DOI: 10.1016/j.nicl.2016.12.006] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 12/12/2022]
Abstract
Hexanucleotide repeat expansions in C9ORF72 are the most common known genetic cause of familial and sporadic frontotemporal dementia and amyotrophic lateral sclerosis. Previous work has shown that patients with behavioral variant frontotemporal dementia due to C9ORF72 show salience and sensorimotor network disruptions comparable to those seen in sporadic behavioral variant frontotemporal dementia, but it remains unknown how early in the lifespan these and other changes in brain structure and function arise. To gain insights into this question, we compared 15 presymptomatic carriers (age 43.7 ± 10.2 years, nine females) to matched healthy controls. We used voxel-based morphometry to assess gray matter, diffusion tensor imaging to interrogate white matter tracts, and task-free functional MRI to probe the salience, sensorimotor, default mode, and medial pulvinar thalamus-seeded networks. We further used a retrospective chart review to ascertain psychiatric histories in carriers and their non-carrier family members. Carriers showed normal cognition and behavior despite gray matter volume and brain connectivity deficits that were apparent as early as the fourth decade of life. Gray matter volume deficits were topographically similar though less severe than those in patients with behavioral variant frontotemporal dementia due to C9ORF72, with major foci in cingulate, insula, thalamus, and striatum. Reduced white matter integrity was found in the corpus callosum, cingulum bundles, corticospinal tracts, uncinate fasciculi and inferior longitudinal fasciculi. Intrinsic connectivity deficits were detected in all four networks but most prominent in salience and medial pulvinar thalamus-seeded networks. Carrier and control groups showed comparable relationships between imaging metrics and age, suggesting that deficits emerge during early adulthood. Carriers and non-carrier family members had comparable lifetime histories of psychiatric symptoms. Taken together, the findings suggest that presymptomatic C9ORF72 expansion carriers exhibit functionally compensated brain volume and connectivity deficits that are similar, though less severe, to those reported during the symptomatic phase. The early adulthood emergence of these deficits suggests that they represent aberrant network patterning during development, an early neurodegeneration prodrome, or both. Presymptomatic C9ORF72 expansion carriers have brain connectivity deficits. These deficits may be a developmental lesion rather than early neurodegeneration. Non-carriers and presymptomatic carriers share psychiatric symptomatology.
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Key Words
- ALS, amyotrophic lateral sclerosis
- Amyotrophic lateral sclerosis
- CDR, Clinical Dementia Rating scale
- DMN, default mode network
- Diffusion tensor imaging
- FA, fractional anisotropy
- FTD, frontotemporal dementia
- FWE, familywise error
- Frontotemporal dementia
- Functional MRI
- Genetics
- HC, healthy control
- ICN, intrinsic connectivity network
- IRI, Interpersonal Reactivity Index
- MMSE, Mini-Mental State Exam
- MND, motor neuron disease
- NPI, Neuropsychiatric Inventory
- ROI, region of interest
- SMN, sensorimotor network
- TIV, total intracranial volume
- VBM, voxel-based morphometry
- bvFTD, behavioral variant frontotemporal dementia
- fMRI, functional MRI
- preSxC9, presymptomatic C9ORF72 expansion carriers
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Affiliation(s)
- Suzee E. Lee
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
- Corresponding author.
| | - Ana C. Sias
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
| | - Maria Luisa Mandelli
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
| | - Jesse A. Brown
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
| | - Alainna B. Brown
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
| | - Anna M. Khazenzon
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
- Stanford University, Department of Psychology, Jordan Hall, 450 Serra Mall, Stanford, CA 94305, USA
| | - Anna A. Vidovszky
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
| | - Theodore P. Zanto
- University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, MC: 0444, San Francisco, CA 94158, USA
| | - Anna M. Karydas
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
| | - Mochtar Pribadi
- Department of Neurology and Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza Los Angeles, CA 90024, USA
| | - Deepika Dokuru
- Department of Neurology and Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza Los Angeles, CA 90024, USA
| | - Giovanni Coppola
- Department of Neurology and Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza Los Angeles, CA 90024, USA
| | - Dan H. Geschwind
- Department of Neurology and Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza Los Angeles, CA 90024, USA
| | - Rosa Rademakers
- Mayo Clinic, Department of Neuroscience, Birdsall Research Building 207, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Maria Luisa Gorno-Tempini
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
| | - Howard J. Rosen
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
| | - Bruce L. Miller
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
| | - William W. Seeley
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, 675 Nelson Rising Lane, MC:1207, San Francisco, CA 94158, USA
- University of California, San Francisco, Department of Pathology, 675 Nelson Rising Lane, Suite 140, MC:1207, San Francisco, CA 94158, USA
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Kopitzki K, Oldag A, Sweeney-Reed CM, Machts J, Veit M, Kaufmann J, Hinrichs H, Heinze HJ, Kollewe K, Petri S, Mohammadi B, Dengler R, Kupsch AR, Vielhaber S. Interhemispheric connectivity in amyotrophic lateral sclerosis: A near-infrared spectroscopy and diffusion tensor imaging study. Neuroimage Clin 2016; 12:666-72. [PMID: 27761397 DOI: 10.1016/j.nicl.2016.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Aim of the present study was to investigate potential impairment of non-motor areas in amyotrophic lateral sclerosis (ALS) using near-infrared spectroscopy (NIRS) and diffusion tensor imaging (DTI). In particular, we evaluated whether homotopic resting-state functional connectivity (rs-FC) of non-motor associated cortical areas correlates with clinical parameters and disease-specific degeneration of the corpus callosum (CC) in ALS. MATERIAL AND METHODS Interhemispheric homotopic rs-FC was assessed in 31 patients and 30 healthy controls (HCs) for 8 cortical sites, from prefrontal to occipital cortex, using NIRS. DTI was performed in a subgroup of 21 patients. All patients were evaluated for cognitive dysfunction in the executive, memory, and visuospatial domains. RESULTS ALS patients displayed an altered spatial pattern of correlation between homotopic rs-FC values when compared to HCs (p = 0.000013). In patients without executive dysfunction a strong correlation existed between the rate of motor decline and homotopic rs-FC of the anterior temporal lobes (ATLs) (ρ = - 0.85, p = 0.0004). Furthermore, antero-temporal homotopic rs-FC correlated with fractional anisotropy in the central corpus callosum (CC), corticospinal tracts (CSTs), and forceps minor as determined by DTI (p < 0.05). CONCLUSIONS The present study further supports involvement of non-motor areas in ALS. Our results render homotopic rs-FC as assessed by NIRS a potential clinical marker for disease progression rate in ALS patients without executive dysfunction and a potential anatomical marker for ALS-specific degeneration of the CC and CSTs.
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Key Words
- AC, anterior commissure
- ALS, amyotrophic lateral sclerosis
- ALS-EX, ALS with executive impairment
- ALS-NECI, ALS with non-executive cognitive impairment
- ALSFRS-R, revised ALS functional rating scale
- ATL, anterior temporal lobe
- Amyotrophic lateral sclerosis
- CC, corpus callosum
- CST, corticospinal tract
- Corpus callosum
- DD, disease duration
- DPR, disease progression rate
- DTI, diffusion tensor imaging
- Diffusion tensor imaging
- FA, fractional anisotropy
- FTD, frontotemporal dementia
- HC, healthy control
- Hb, hemoglobin
- Interhemispheric connectivity
- NIRS, near-infrared spectroscopy
- Near-infrared spectroscopy
- TBSS, tract based spatial statistics
- WM, white matter
- fMRI, functional magnetic resonance imaging
- pALS, pure ALS no cognitive impairment
- rs-FC, resting-state functional connectivity
- rs-fNIRS, resting-state functional NIRS
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Zhou F, Huang S, Zhuang Y, Gao L, Gong H. Frequency-dependent changes in local intrinsic oscillations in chronic primary insomnia: A study of the amplitude of low-frequency fluctuations in the resting state. Neuroimage Clin 2016. [PMID: 28649490 PMCID: PMC5470569 DOI: 10.1016/j.nicl.2016.05.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
New neuroimaging techniques have led to significant advancements in our understanding of cerebral mechanisms of primary insomnia. However, the neuronal low-frequency oscillation remains largely uncharacterized in chronic primary insomnia (CPI). In this study, the amplitude of low-frequency fluctuation (ALFF), a data-driven method based on resting-state functional MRI, was used to examine local intrinsic activity in 27 patients with CPI and 27 age-, sex-, and education-matched healthy controls. We examined neural activity in two frequency bands, slow-4 (between 0.027 and 0.073 Hz) and slow-5 (0.010–0.027 Hz), because blood-oxygen level dependent (BOLD) fluctuations in different low-frequency bands may present different neurophysiological manifestations that pertain to a spatiotemporal organization. The ALFF associated with the primary disease effect was widely distributed in the cerebellum posterior lobe (CPL), dorsal and ventral prefrontal cortex, anterior cingulate cortex, precuneus, somatosensory cortex, and several default-mode sub-regions. Several brain regions (i.e., the right cerebellum, anterior lobe, and left putamen) exhibited an interaction between the frequency band and patient group. In the slow-5 band, increased ALFF of the right postcentral gyrus/inferior parietal lobule (PoCG/IPL) was enhanced in association with the sleep quality (ρ = 0.414, P = 0.044) and anxiety index (ρ = 0.406, P = 0.049) of the CPI patients. These findings suggest that during chronic insomnia, the intrinsic functional plasticity primarily responds to the hyperarousal state, which is the loss of inhibition in sensory-informational processing. Our findings regarding an abnormal sensory input and intrinsic processing mechanism might provide novel insight into the pathophysiology of CPI. Furthermore, the frequency factor should be taken into consideration when exploring ALFF-related clinical manifestations. Primary disease effect was widely distributed in several cerebral areas in patients with chronic primary insomnia (CPI). Several brain regions (i.e., right cerebellum, anterior lobe, and left putamen) exhibited interactions between the frequency band and patient group. In the slow-5 band, increased ALFF associated with the sleep quality or the anxiety index in the CPI patients. Our findings regarding an abnormal sensory input and intrinsic processing mechanism might provide novel insight into the pathophysiology of CPI. Furthermore, the frequency factor should be taken into consideration when exploring ALFF-related clinical manifestations.
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Key Words
- ACC, anterior cingulate cortex
- ALFF, amplitude of low-frequency fluctuation
- ANOVA, analysis of variance
- Amplitude of low-frequency fluctuations
- CPI, chronic primary insomnia
- CPL, cerebellum posterior lobe
- Chronic primary insomnia
- FC, functional connectivity
- Functional magnetic resonance imaging, resting state
- Functional plasticity
- Fus/CAL, fusiform gyrus/cerebellum anterior lobe
- HC, healthy control
- MFG/SFG, middle/superior frontal gyrus
- MOG, middle occipital gyrus
- MRI, magnetic resonance imaging
- PCC, posterior cingulate cortex
- PCUN, precuneus
- PSQI, Pittsburgh Sleep Quality Index
- PoCG/IPL, postcentral gyrus/inferior parietal lobule
- SPECT, single-photon emission computed tomography
- SPM, statistical parametric mapping
- STAI-s, State Trait Anxiety Inventory-state
- STAI-t, State Trait Anxiety Inventory-trait
- STG, superior temporal gyrus
- fMRI, functional MRI
- fO/AI, frontal operculum/anterior insula
- mPFC, medial prefrontal gyrus
- mTL, medial temporal lobe
- rs-fMRI, resting-state fMRI
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Affiliation(s)
- Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China; Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006, China.
| | - Suhua Huang
- Department of Radiology, Jiangxi Province Children's Hospital, Nanchang 330006, China
| | - Ying Zhuang
- Department of Oncology, The Second Hospital of Nanchang, Nanchang 330003, China
| | - Lei Gao
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang 330006, China; Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006, China.
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Kraguljac NV, White DM, Hadley JA, Visscher K, Knight D, ver Hoef L, Falola B, Lahti AC. Abnormalities in large scale functional networks in unmedicated patients with schizophrenia and effects of risperidone. Neuroimage Clin 2015; 10:146-58. [PMID: 26793436 PMCID: PMC4683457 DOI: 10.1016/j.nicl.2015.11.015] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/30/2015] [Accepted: 11/20/2015] [Indexed: 12/25/2022]
Abstract
Objective To describe abnormalities in large scale functional networks in unmedicated patients with schizophrenia and to examine effects of risperidone on networks. Material and methods 34 unmedicated patients with schizophrenia and 34 matched healthy controls were enrolled in this longitudinal study. We collected resting state functional MRI data with a 3T scanner at baseline and six weeks after they were started on risperidone. In addition, a group of 19 healthy controls were scanned twice six weeks apart. Four large scale networks, the dorsal attention network, executive control network, salience network, and default mode network were identified with seed based functional connectivity analyses. Group differences in connectivity, as well as changes in connectivity over time, were assessed on the group's participant level functional connectivity maps. Results In unmedicated patients with schizophrenia we found resting state connectivity to be increased in the dorsal attention network, executive control network, and salience network relative to control participants, but not the default mode network. Dysconnectivity was attenuated after six weeks of treatment only in the dorsal attention network. Baseline connectivity in this network was also related to clinical response at six weeks of treatment with risperidone. Conclusions Our results demonstrate abnormalities in large scale functional networks in patients with schizophrenia that are modulated by risperidone only to a certain extent, underscoring the dire need for development of novel antipsychotic medications that have the ability to alleviate symptoms through attenuation of dysconnectivity. We found widespread functional dysconnectivity in unmedicated patients with schizophrenia. Large scale functional networks appear differentially affected in the disorder. Attenuation of dysconnectivity with risperidone is seen only to a limited extent.
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Key Words
- ALFF, amplitude of low frequency fluctuations
- Antipsychotic medication
- BOLD, blood oxygen level dependent signal
- BPRS, Brief Psychiatric Rating Scale
- DAN, dorsal attention network
- DARTEL, diffeomorphic anatomical registration using exponentiated lie algebra algorithm
- DMN, default mode network
- Default mode network
- Dorsal attention network
- ECN, executive control network
- Executive control network
- FD, framewise displacement
- FDR, false discovery rate
- HC, healthy control
- KE, cluster extent
- MNI, Montreal Neurological Institute
- RBANS, Repeatable Battery for the Assessment of Neuropsychological Status
- SZ, patient with schizophrenia
- Salience network
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Affiliation(s)
- Nina Vanessa Kraguljac
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - David Matthew White
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Jennifer Ann Hadley
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Kristina Visscher
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - David Knight
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lawrence ver Hoef
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Blessing Falola
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Adrienne Carol Lahti
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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Lim KP, Chun NAL, Gan CP, Teo SH, Rahman ZAA, Abraham MT, Zain RB, Ponniah S, Cheong SC. Identification of immunogenic MAGED4B peptides for vaccine development in oral cancer immunotherapy. Hum Vaccin Immunother 2015; 10:3214-23. [PMID: 25483651 DOI: 10.4161/hv.29226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The ever-increasing number of tumor-associated antigens has provided a major stimulus for the development of therapeutic peptides vaccines. Tumor-associated peptides can induce high immune response rates and have been developed as vaccines for several types of solid tumors, and many are at various stages of clinical testing. MAGED4B, a melanoma antigen, is overexpressed in oral squamous cell carcinoma (OSCC) and this expression promotes proliferation and cell migration. In this study, we have identified 9 short peptides derived from MAGED4B protein that are restricted in binding to the HLA subtypes common in the Asian population (HLA-A2, A11, and A24). The peptides had good binding affinity with the MHC-Class I molecules and stimulated ex-vivo IFN-gamma and Granzyme-B production in blood samples from OSCC patients, suggesting that they are immunogenic. Further, T cells stimulated with peptide-pulsed dendritic cells showed enhanced T-cell cytotoxic activity against MAGED4B-overexpressing OSCC cell lines. In summary, we have identified MAGED4B peptides that induce anti-tumor immune responses advocating that they could be further developed as vaccine candidates for the treatment of OSCC.
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Affiliation(s)
- Kue Peng Lim
- a Oral Cancer Research Team; Cancer Research Initiatives Foundation (CARIF) ; Subang Jaya , Selangor , Malaysia
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Wen J, Yablonskiy DA, Luo J, Lancia S, Hildebolt C, Cross AH. Detection and quantification of regional cortical gray matter damage in multiple sclerosis utilizing gradient echo MRI. Neuroimage Clin 2015; 9:164-75. [PMID: 27330979 DOI: 10.1016/j.nicl.2015.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/29/2022]
Abstract
Cortical gray matter (GM) damage is now widely recognized in multiple sclerosis (MS). The standard MRI does not reliably detect cortical GM lesions, although cortical volume loss can be measured. In this study, we demonstrate that the gradient echo MRI can reliably and quantitatively assess cortical GM damage in MS patients using standard clinical scanners. High resolution multi-gradient echo MRI was used for regional mapping of tissue-specific MRI signal transverse relaxation rate values (R2(*)) in 10 each relapsing-remitting, primary-progressive and secondary-progressive MS subjects. A voxel spread function method was used to correct artifacts induced by background field gradients. R2(*) values from healthy controls (HCs) of varying ages were obtained to establish baseline data and calculate ΔR2(*) values - age-adjusted differences between MS patients and HC. Thickness of cortical regions was also measured in all subjects. In cortical regions, ΔR2(*) values of MS patients were also adjusted for changes in cortical thickness. Symbol digit modalities (SDMT) and paced auditory serial addition (PASAT) neurocognitive tests, as well as Expanded Disability Status Score, 25-foot timed walk and nine-hole peg test results were also obtained on all MS subjects. We found that ΔR2(*) values were lower in multiple cortical GM and normal appearing white matter (NAWM) regions in MS compared with HC. ΔR2(*) values of global cortical GM and several specific cortical regions showed significant (p < 0.05) correlations with SDMT and PASAT scores, and showed better correlations than volumetric measures of the same regions. Neurological tests not focused on cognition (Expanded Disability Status Score, 25-foot timed walk and nine-hole peg tests) showed no correlation with cortical GM ΔR2(*) values. The technique presented here is robust and reproducible. It requires less than 10 min and can be implemented on any MRI scanner. Our results show that quantitative tissue-specific R2(*) values can serve as biomarkers of tissue injury due to MS in the brain, including the cerebral cortex, an area that has been difficult to evaluate using standard MRI.
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Key Words
- 25FTW, 25-foot timed walk
- 9HPT, Nine-hole peg test
- Cognitive disability
- Cortical gray matter
- EDSS, expanded disability status scale
- GEPCI, gradient echo plural contrast imaging
- GM, gray matter
- HC, healthy control
- MPRAGE, magnetization prepared rapid gradient echo
- MS, multiple sclerosis
- Multiple sclerosis
- NAWM, normal appearing white matter
- NCGMV, normalized cortical gray matter volume
- PASAT, paced auditory serial addition test
- PPMS, primary-progressive multiple sclerosis
- Quantitative
- R2*
- ROI, region of interest
- RRMS, relapsing–remitting multiple sclerosis
- SDMT, symbol digit modalities test
- SPMS, secondary-progressive multiple sclerosis
- WM, white matter
- WMLL, white matter lesion load
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Chang EH, Volpe BT, Mackay M, Aranow C, Watson P, Kowal C, Storbeck J, Mattis P, Berlin R, Chen H, Mader S, Huerta TS, Huerta PT, Diamond B. Selective Impairment of Spatial Cognition Caused by Autoantibodies to the N-Methyl-D-Aspartate Receptor. EBioMedicine 2015; 2:755-64. [PMID: 26286205 PMCID: PMC4534689 DOI: 10.1016/j.ebiom.2015.05.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [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: 04/08/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 12/13/2022] Open
Abstract
Patients with systemic lupus erythematosus (SLE) experience cognitive abnormalities in multiple domains including processing speed, executive function, and memory. Here we show that SLE patients carrying antibodies that bind DNA and the GluN2A and GluN2B subunits of the N-methyl-d-aspartate receptor (NMDAR), termed DNRAbs, displayed a selective impairment in spatial recall. Neural recordings in a mouse model of SLE, in which circulating DNRAbs penetrate the hippocampus, revealed that CA1 place cells exhibited a significant expansion in place field size. Structural analysis showed that hippocampal pyramidal cells had substantial reductions in their dendritic processes and spines. Strikingly, these abnormalities became evident at a time when DNRAbs were no longer detectable in the hippocampus. These results suggest that antibody-mediated neurocognitive impairments may be highly specific, and that spatial cognition may be particularly vulnerable to DNRAb-mediated structural and functional injury to hippocampal cells that evolves after the triggering insult is no longer present.
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Key Words
- AP, alkaline phosphatase
- BBB, blood–brain barrier
- BDI, Beck depression index
- C3, C4, complements 3 and 4, respectively
- CA1 place cell
- CA1, cornus ammonis area 1 of the hippocampus
- CNS, central nervous system
- CSF, cerebrospinal fluid
- DMARD, disease-modifying drugs
- DNRAb, anti-DNA antibody reactive to the GluN2A and GluN2B subunits of the NMDAR
- DWEYS, amino acid consensus sequence (D/E, W, D/E, Y, S/G) for DNRAb binding
- FA, Freund's adjuvant
- HC, healthy control
- HEK-293T, human embryonic kidney 293 T cell
- Hippocampus
- IgG, immunoglobulin G
- LPS, lipopolysaccharide
- Lupus
- MAP, multi-antigenic polylysine backbone
- Mouse lupus model
- NMDAR, N-methyl-d-aspartate receptor
- NOR, novel object recognition
- NPSLE, neuropsychiatric lupus
- Neuropsychiatric lupus
- OPM, object place memory
- SELENA, safety of estrogens in lupus erythematosus national assessment
- SLE, systemic lupus erythematosus
- SLEDAI, systemic lupus erythematosus disease activity index
- SLICCDI, systemic lupus international collaborating clinics damage index
- dsDNA, double stranded DNA
- i.p, intraperitoneally
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Affiliation(s)
- Eric H Chang
- Laboratory of Immune & Neural Networks, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA
| | - Bruce T Volpe
- Laboratory of Functional Neuroanatomy, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA ; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY 11030, USA
| | - Meggan Mackay
- Autoimmune & Musculoskeletal Disease Center, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA
| | - Cynthia Aranow
- Autoimmune & Musculoskeletal Disease Center, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA
| | - Philip Watson
- Department of Psychology, Queens College, Flushing, NY 11367, USA
| | - Czeslawa Kowal
- Autoimmune & Musculoskeletal Disease Center, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA
| | - Justin Storbeck
- Department of Psychology, Queens College, Flushing, NY 11367, USA
| | - Paul Mattis
- Susan and Leonard Feinstein Center for Neurosciences, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA
| | - RoseAnn Berlin
- Laboratory of Functional Neuroanatomy, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA
| | - Huiyi Chen
- School of Biological Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 637551, Singapore
| | - Simone Mader
- Autoimmune & Musculoskeletal Disease Center, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA
| | - Tomás S Huerta
- Laboratory of Immune & Neural Networks, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA
| | - Patricio T Huerta
- Laboratory of Immune & Neural Networks, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA ; Autoimmune & Musculoskeletal Disease Center, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA ; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY 11030, USA
| | - Betty Diamond
- Autoimmune & Musculoskeletal Disease Center, Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY 11030, USA ; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY 11030, USA
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de Goeje PL, Bezemer K, Heuvers ME, Dingemans AMC, Groen HJ, Smit EF, Hoogsteden HC, Hendriks RW, Aerts JG, Hegmans JP. Immunoglobulin-like transcript 3 is expressed by myeloid-derived suppressor cells and correlates with survival in patients with non-small cell lung cancer. Oncoimmunology 2015; 4:e1014242. [PMID: 26140237 DOI: 10.1080/2162402x.2015.1014242] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 12/31/2022] Open
Abstract
Myeloid-derived suppressor cells (MDSCs) play an important role in immune suppression and accumulate under pathologic conditions such as cancer and chronic inflammation. They comprise a heterogeneous population of immature myeloid cells that exert their immunosuppressive function via a variety of mechanisms. Immunoglobulin-like transcript 3 (ILT3) is a receptor containing immunoreceptor tyrosine-based inhibition motifs (ITIMs) that can be expressed on antigen-presenting cells and is an important regulator of dendritic cell tolerance. ILT3 exists in a membrane-bound and a soluble form and can interact with a yet unidentified ligand on T cells and thereby induce T-cell anergy, regulatory T cells, or T suppressor cells. In this study, we analyzed freshly isolated peripheral blood mononuclear cells (PBMCs) of 105 patients with non-small cell lung cancer and 20 healthy controls and demonstrated for the first time that ILT3 is expressed on MDSCs. We show that increased levels of circulating MDSCs correlate with reduced survival. On the basis of ILT3 cell surface expression, an ILT3low and ILT3high population of polymorphonuclear (PMN)-MDSCs could be distinguished. Interestingly, in line with the immunosuppressive function of ILT3 on dendritic cells, patients with an increased proportion of PMN-MDSCs and an increased fraction of the ILT3high subset had a shorter median survival than patients with elevated PMN-MDSC and a smaller ILT3high fraction. No correlation between the ILT3high subset and other immune variables was found. ILT3 expressed on MDSCs might reflect a previously unknown mechanism by which this cell population induces immune suppression and could therefore be an attractive target for immune intervention.
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Key Words
- APC, antigen-presenting cell
- CD85k
- DC, dendritic cell
- ELISA, enzyme-linked immunosorbent assay
- HC, healthy control
- ILT3, immunoglobulin-like transcript 3
- LILRB4
- LIR-5
- MDSC, myeloid-derived suppressor cell
- MFI, mean fluorescence intensity
- MO-MDSC, monocytic MDSC
- NFκB, nuclear factor κB
- NSCLC, non-small cell lung carcinoma
- PBMC, peripheral blood mononuclear cell
- PMN-MDSC, polymorphonuclear MDSC
- Treg, regulatory T cell
- Ts, T suppressor cell
- immune suppression
- immunoglobulin-like transcript 3
- myeloid-derived suppressor cells
- non-small cell lung cancer
- overall survival
- sILT3, soluble ILT3
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Affiliation(s)
- Pauline L de Goeje
- Erasmus MC Cancer Institute; Department of Pulmonary Medicine ; Rotterdam, The Netherlands
| | - Koen Bezemer
- Erasmus MC Cancer Institute; Department of Pulmonary Medicine ; Rotterdam, The Netherlands
| | - Marlies E Heuvers
- Erasmus MC Cancer Institute; Department of Pulmonary Medicine ; Rotterdam, The Netherlands
| | - Anne-Marie C Dingemans
- Maastricht University Medical Center; Department of Pulmonary Medicine ; Maastricht, The Netherlands
| | - Harry Jm Groen
- University of Groningen and University Medical Center Groningen; Department of Pulmonary Medicine ; Groningen, The Netherlands
| | - Egbert F Smit
- VU University Medical Center; Department of Pulmonary Medicine ; Amsterdam, The Netherlands ; Current address: Netherlands Cancer Institute; Department of Thoracic Oncology; Amsterdam, The Netherlands
| | - Henk C Hoogsteden
- Erasmus MC Cancer Institute; Department of Pulmonary Medicine ; Rotterdam, The Netherlands
| | - Rudi W Hendriks
- Erasmus MC Cancer Institute; Department of Pulmonary Medicine ; Rotterdam, The Netherlands
| | - Joachim Gjv Aerts
- Erasmus MC Cancer Institute; Department of Pulmonary Medicine ; Rotterdam, The Netherlands ; Amphia Hospital; Department of Pulmonary Medicine ; Breda, The Netherlands
| | - Joost Pjj Hegmans
- Erasmus MC Cancer Institute; Department of Pulmonary Medicine ; Rotterdam, The Netherlands
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Gupta A, Mayer EA, Sanmiguel CP, Van Horn JD, Woodworth D, Ellingson BM, Fling C, Love A, Tillisch K, Labus JS. Patterns of brain structural connectivity differentiate normal weight from overweight subjects. Neuroimage Clin 2015; 7:506-17. [PMID: 25737959 PMCID: PMC4338207 DOI: 10.1016/j.nicl.2015.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Alterations in the hedonic component of ingestive behaviors have been implicated as a possible risk factor in the pathophysiology of overweight and obese individuals. Neuroimaging evidence from individuals with increasing body mass index suggests structural, functional, and neurochemical alterations in the extended reward network and associated networks. Aim To apply a multivariate pattern analysis to distinguish normal weight and overweight subjects based on gray and white-matter measurements. Methods Structural images (N = 120, overweight N = 63) and diffusion tensor images (DTI) (N = 60, overweight N = 30) were obtained from healthy control subjects. For the total sample the mean age for the overweight group (females = 32, males = 31) was 28.77 years (SD = 9.76) and for the normal weight group (females = 32, males = 25) was 27.13 years (SD = 9.62). Regional segmentation and parcellation of the brain images was performed using Freesurfer. Deterministic tractography was performed to measure the normalized fiber density between regions. A multivariate pattern analysis approach was used to examine whether brain measures can distinguish overweight from normal weight individuals. Results 1. White-matter classification: The classification algorithm, based on 2 signatures with 17 regional connections, achieved 97% accuracy in discriminating overweight individuals from normal weight individuals. For both brain signatures, greater connectivity as indexed by increased fiber density was observed in overweight compared to normal weight between the reward network regions and regions of the executive control, emotional arousal, and somatosensory networks. In contrast, the opposite pattern (decreased fiber density) was found between ventromedial prefrontal cortex and the anterior insula, and between thalamus and executive control network regions. 2. Gray-matter classification: The classification algorithm, based on 2 signatures with 42 morphological features, achieved 69% accuracy in discriminating overweight from normal weight. In both brain signatures regions of the reward, salience, executive control and emotional arousal networks were associated with lower morphological values in overweight individuals compared to normal weight individuals, while the opposite pattern was seen for regions of the somatosensory network. Conclusions 1. An increased BMI (i.e., overweight subjects) is associated with distinct changes in gray-matter and fiber density of the brain. 2. Classification algorithms based on white-matter connectivity involving regions of the reward and associated networks can identify specific targets for mechanistic studies and future drug development aimed at abnormal ingestive behavior and in overweight/obesity. Multivariate analysis can be used to classify overweight from normal weight individuals. Anatomical connectivity achieved 97% accuracy in the classification algorithm. Greater connectivity was observed in extended reward and somatosensory regions. Morphological gray-matter achieved 69% accuracy in the classification algorithm. Lower morphological values were observed in regions of the extended reward network.
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Key Words
- ACC, anterior cingulate cortex
- ANOVA, analysis of variance
- Anatomical white-matter connectivity
- BMI, body mass index
- CT, cortical thickness
- Classification algorithm
- DTI, diffusion tensor imaging
- DWI, diffusion-weighted MRIs
- FA, flip angle
- FACT, fiber assignment by continuous tracking
- FDR, false-discovery rate
- FOV, field of view
- GLM, general linear model
- GMV, gray matter volume
- HAD, hospital anxiety and Depression Scale
- HC, healthy control
- MC, mean curvature
- Morphological gray-matter
- Multivariate analysis
- NPV, negative predictive value
- OFG, orbitofrontal gyrus
- Obesity
- Overweight
- PPC, posterior parietal cortex
- PPV, positive predictive value
- Reward network
- SA, surface area
- SPSS, statistical package for the social sciences
- TE, echo time
- TR, repetition time
- VIP, variable importance in projection
- VTA, ventral tegmental area
- aMCC, anterior mid cingulate cortex
- dlPFC, dorsolateral prefrontal cortex
- sPLS-DA, sparse partial least squares for discrimination Analysis
- sgACC, subgenual anterior cingulate cortex
- vmPFC, ventromedial prefrontal cortex
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Affiliation(s)
- Arpana Gupta
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Ingestive Behavior and Obesity Program (IBOP), UCLA, Los Angeles, CA, USA ; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA ; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
| | - Emeran A Mayer
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Ingestive Behavior and Obesity Program (IBOP), UCLA, Los Angeles, CA, USA ; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA ; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA ; Ahmanson-Lovelace Brain Mapping Center, UCLA, Los Angeles, CA, USA
| | - Claudia P Sanmiguel
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Ingestive Behavior and Obesity Program (IBOP), UCLA, Los Angeles, CA, USA ; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA ; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
| | - John D Van Horn
- The Institute for Neuroimaging and Informatics, Keck School of Medicine, USC, Los Angeles, CA, USA
| | - Davis Woodworth
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Ingestive Behavior and Obesity Program (IBOP), UCLA, Los Angeles, CA, USA ; Radiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Benjamin M Ellingson
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Ingestive Behavior and Obesity Program (IBOP), UCLA, Los Angeles, CA, USA ; Radiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Connor Fling
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Ingestive Behavior and Obesity Program (IBOP), UCLA, Los Angeles, CA, USA
| | - Aubrey Love
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Ingestive Behavior and Obesity Program (IBOP), UCLA, Los Angeles, CA, USA
| | - Kirsten Tillisch
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Ingestive Behavior and Obesity Program (IBOP), UCLA, Los Angeles, CA, USA ; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA ; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA ; Integrative Medicine, GLA VHA, UCLA, Los Angeles, CA, USA
| | - Jennifer S Labus
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, Ingestive Behavior and Obesity Program (IBOP), UCLA, Los Angeles, CA, USA ; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA ; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
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Kerbler GM, Fripp J, Rowe CC, Villemagne VL, Salvado O, Rose S, Coulson EJ. Basal forebrain atrophy correlates with amyloid β burden in Alzheimer's disease. Neuroimage Clin 2014; 7:105-13. [PMID: 25610772 PMCID: PMC4299972 DOI: 10.1016/j.nicl.2014.11.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 06/11/2014] [Accepted: 11/18/2014] [Indexed: 12/11/2022]
Abstract
The brains of patients suffering from Alzheimer's disease (AD) have three classical pathological hallmarks: amyloid-beta (Aβ) plaques, tau tangles, and neurodegeneration, including that of cholinergic neurons of the basal forebrain. However the relationship between Aβ burden and basal forebrain degeneration has not been extensively studied. To investigate this association, basal forebrain volumes were determined from magnetic resonance images of controls, subjects with amnestic mild cognitive impairment (aMCI) and AD patients enrolled in the longitudinal Alzheimer's Disease Neuroimaging Initiative (ADNI) and Australian Imaging, Biomarkers and Lifestyle (AIBL) studies. In the AIBL cohort, these volumes were correlated within groups to neocortical gray matter retention of Pittsburgh compound B (PiB) from positron emission tomography images as a measure of Aβ load. The basal forebrain volumes of AD and aMCI subjects were significantly reduced compared to those of control subjects. Anterior basal forebrain volume was significantly correlated to neocortical PiB retention in AD subjects and aMCI subjects with high Aβ burden, whereas posterior basal forebrain volume was significantly correlated to neocortical PiB retention in control subjects with high Aβ burden. Therefore this study provides new evidence for a correlation between neocortical Aβ accumulation and basal forebrain degeneration. In addition, cluster analysis showed that subjects with a whole basal forebrain volume below a determined cut-off value had a 7 times higher risk of having a worse diagnosis within ~18 months. The link between amyloid (Aβ) and basal forebrain degeneration in AD is unclear. We find that basal forebrain volumes are correlated with neocortical Aβ burden. Basal forebrain volume correlates with Aβ burden in at-risk control subjects. Basal forebrain atrophy delineates subjects at increased risk of progressing to AD.
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Key Words
- 3D, 3-dimensional
- AD, Alzheimer's disease
- ADNI, Alzheimer's Disease Neuroimaging Initiative
- AIBL, Australian Imaging, Biomarkers and Lifestyle Flagship Study of Aging
- Alzheimer's disease
- Amyloid
- Aβ, amyloid-beta
- Basal forebrain
- CSF, cerebrospinal fluid
- GM, gray matter
- HC, healthy control
- MCI, mild cognitive impairment
- MNI, Montreal Neurological Institute
- MPM, maximum probability maps
- MPRAGE, magnetization prepared rapid gradient echo
- MRI, magnetic resonance imaging
- Magnetic resonance imaging
- OR, odds ratio
- PET
- PET, positron emission tomography
- PiB, Pittsburgh compound B
- SPSS, statistics software package for the social sciences
- SUVR, standard uptake value ratio
- SyN, symmetric normalization
- T1W, T1-weighted
- TG-ROC, two-graph receiver operating characteristic
- WM, white matter
- aMCI, amnestic mild cognitive impairment
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Affiliation(s)
- Georg M Kerbler
- Queensland Brain Institute, Clem Jones Centre for Ageing Dementia Research, The University of Queensland, Brisbane, Qld 4072, Australia
| | - Jürgen Fripp
- Commonwealth Scientific and Industrial Research Organisation, Computational Informatics, Brisbane, Qld 4029, Australia
| | - Christopher C Rowe
- Department of Nuclear Medicine and Centre for PET, Austin Health, Melbourne, Vic. 3084, Australia
| | - Victor L Villemagne
- Department of Nuclear Medicine and Centre for PET, Austin Health, Melbourne, Vic. 3084, Australia ; Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Vic. 3084, Australia
| | - Olivier Salvado
- Commonwealth Scientific and Industrial Research Organisation, Computational Informatics, Brisbane, Qld 4029, Australia
| | - Stephen Rose
- Commonwealth Scientific and Industrial Research Organisation, Computational Informatics, Brisbane, Qld 4029, Australia
| | - Elizabeth J Coulson
- Queensland Brain Institute, Clem Jones Centre for Ageing Dementia Research, The University of Queensland, Brisbane, Qld 4072, Australia
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Riwkes S, Goldstein A, Gilboa-Schechtman E. The temporal unfolding of face processing in social anxiety disorder--a MEG study. Neuroimage Clin 2014; 7:678-87. [PMID: 25844308 PMCID: PMC4377840 DOI: 10.1016/j.nicl.2014.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/10/2014] [Accepted: 11/01/2014] [Indexed: 11/04/2022]
Abstract
The current study is the first to use magnetoencephalography (MEG) to examine how individuals with social anxiety disorder (SAD) process emotional facial expressions (EFEs). We expected that, compared to healthy controls (HCs), participants with SAD will show an early (<200 ms post-stimulus) over-activation in the insula and the fusiform gyrus (FG, associated with the N170/M170 component), and later (>200 ms post-stimulus) over-activation in the dorsolateral prefrontal cortex (DLPFC). Individuals with SAD (n = 12) and healthy controls (HCs, n = 12) were presented with photographs of facial displays during MEG recording. As compared to the HC group, the SAD group showed a reduced M170 (right FG under-activation around 130–200 ms); early reduced activation in the right insula, and lower insular sensitivity to the type of EFE displayed. In addition, the SAD group showed a late over-activation in the right DLPFC. This unique EFE processing pattern in SAD suggests an early under-activation of cortical areas, possibly related to reduced emphasis on high spatial frequency information and greater early emphasis on low spatial frequency information. The late DLPFC over-activation in the SAD group may correlate to failures of cognitive control in this disorder. The importance of a temporal perspective for the understanding of facial processing in psychopathology is underlined. This study is the first to use MEG to study social anxiety disorder (SAD). SADs and controls viewed emotional facial expressions during MEG. Compared to controls, SADs showed reduced M170 (early fusiform gyrus activity). SADs presented a late over-activation in the right dorsolateral prefrontal cortex. The late frontal over-activity may correlate to failures of cognitive control in SAD.
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Key Words
- AFNI, analysis of functional neuroimages
- BDI, Beck Depression Inventory
- Cognitive control
- DLPFC, dorsolateral prefrontal cortex
- EEG, electroencephalography
- EFE, emotional facial expressions
- FG, fusiform gyrus
- FMRI, functional magnetic resonance imaging
- FNE, fear of negative evaluation
- Facial processing
- HC, healthy control
- HSF, high spatial frequency
- LSAS, Liebowitz Social Anxiety Scale
- LSF, low spatial frequency
- MEG, magnetoencephalography
- Magnetoenchephalography
- Regulation
- SA, social anxiety
- SAD, social anxiety disorder
- SAM, synthetic aperture modeling
- Social anxiety
- TMS, transcranial magnetic stimulation
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Affiliation(s)
- Sharon Riwkes
- Department of Psychology, Bar Ilan University, Ramat Gan 52900, Israel
| | - Abraham Goldstein
- Department of Psychology, Bar Ilan University, Ramat Gan 52900, Israel
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