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Clarke G, Kennedy PJ, Groeger JA, Quigley EM, Shanahan F, Cryan JF, Dinan TG. Impaired cognitive function in Crohn's disease: Relationship to disease activity. Brain Behav Immun Health 2020; 5:100093. [PMID: 34589862 PMCID: PMC8474502 DOI: 10.1016/j.bbih.2020.100093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 01/04/2023] Open
Abstract
Background & aims Impaired attention and response inhibition have been reported in patients with Crohn’s disease (CD) in clinical remission. Prospective studies are needed to determine whether this is a stable feature of CD and whether a similar impairment is evident in ulcerative colitis (UC). Thus, our aims were to examine whether patients with CD and UC exhibited a persistent impairment in attentional performance, and if this impairment was related to key biological indices of relevance to cognition. Methods A prospective observational study was conducted on fifteen patients with CD and 7 with UC in clinical remission recruited from a specialty clinic and 30 healthy matched control participants. A neuropsychological assessment was carried out at baseline (visit 1) and at a 6 month follow-up (visit 2). Plasma proinflammatory cytokines, the plasma kynurenine:tryptophan (Kyn:Trp) ratio and the salivary cortisol awakening response (CAR) were also determined at each visit. Results Across visits, patients with CD exhibited impaired attentional performance (p = 0.023). Plasma IL-6 (P = 0.001) and the Kyn:Trp ratio (P = 0.03) were consistently elevated and the CAR significantly blunted (P < 0.05) in patients with CD. No significant relationships were identified between any biochemical parameter and altered cognitive performance. Conclusions Impaired cognitive function is a stable feature of patients with CD. These data suggest that even where remission has been achieved, the functional impact of an organic gastrointestinal disorder on cognition is still evident. However, it is unclear at present if physiological changes due to disease activity play a role in cognitive impairment in CD. Crohn’s disease (CD) patients previously associated with impaired cognition. CD patients consistently exhibited impaired attentional performance at multiple visits. Functional impact of organic gastrointestinal disorder on cognition still evident in remission. Increased IL-6, kynurenine pathway activation and blunted cortisol awakening response in CD. Biochemical parameters not associated with altered cognitive performance.
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Key Words
- ACC, anterior cingulate cortex
- BMI, body mass index
- CANTAB®, Cambridge Neuropsychological Test Automated Battery
- CAR, cortisol awakening response
- CD, Crohn’s disease
- Cognition
- Crohn’s disease
- EM, Expectation-maximization
- Gut-brain axis
- HBI, Harvey Bradshaw Index
- HSD, Honestly Significant Difference
- IBD, Inflammatory bowel disease
- IED, Intra-Extradimensional Set Shift
- Immune system
- Inflammatory bowel disease
- MCAR, missing completely at random
- MRT, mean response time
- PAL, Paired Associates Learning
- PFC, prefrontal cortex
- SCCAI, Short Clinical Colitis Activity Index
- SWM, Spatial Working Memory
- Tryptophan
- UC, ulcerative colitis
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Affiliation(s)
- Gerard Clarke
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Paul J Kennedy
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - John A Groeger
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Eamonn Mm Quigley
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Fergus Shanahan
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
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Kornelsen J, Wilson A, Labus JS, Witges K, Mayer EA, Bernstein CN. Brain Resting-State Network Alterations Associated With Crohn's Disease. Front Neurol 2020; 11:48. [PMID: 32132964 PMCID: PMC7040490 DOI: 10.3389/fneur.2020.00048] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic disease that is associated with aspects of brain anatomy and activity. In this preliminary MRI study, we investigated differences in brain structure and in functional connectivity (FC) of brain regions in 35 participants with Crohn's disease (CD) and 21 healthy controls (HC). Voxel-based morphometry (VBM) analysis was performed to contrast CD and HC structural images. Region of interest (ROI) analyses were run to assess FC for resting-state network nodes. Independent component analysis (ICA) identified whole brain differences in FC associated with resting-state networks. Though no structural differences were found, ROI analyses showed increased FC between the frontoparietal (FP) network and salience network (SN), and decreased FC between nodes of the default mode network (DMN). ICA results revealed changes involving cerebellar (CER), visual (VIS), and SN components. Differences in FC associated with sex were observed for both ROI analysis and ICA. Taken together, these changes are consistent with an influence of CD on the brain and serve to direct future research hypotheses.
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Affiliation(s)
- Jennifer Kornelsen
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada.,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Alyssia Wilson
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer S Labus
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Kelcie Witges
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Emeran A Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Charles N Bernstein
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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Platero JL, Cuerda-Ballester M, Ibáñez V, Sancho D, Lopez-Rodríguez MM, Drehmer E, de la Rubia Ortí JE. The Impact of Coconut Oil and Epigallocatechin Gallate on the Levels of IL-6, Anxiety and Disability in Multiple Sclerosis Patients. Nutrients 2020; 12:nu12020305. [PMID: 31979305 PMCID: PMC7070654 DOI: 10.3390/nu12020305] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/15/2020] [Accepted: 01/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Due to the inflammatory nature of multiple sclerosis (MS), interleukin 6 (IL-6) is high in blood levels, and it also increases the levels of anxiety related to functional disability. Epigallocatechin gallate (EGCG) decreases IL-6, which could be enhanced by the anti-inflammatory effect of high ketone bodies after administering coconut oil (both of which are an anxiolytic). Therefore, the aim of this study was to assess the impact of coconut oil and EGCG on the levels of IL-6, anxiety and functional disability in patients with MS. Methods: A pilot study was conducted for four months with 51 MS patients who were randomly divided into an intervention group and a control group. The intervention group received 800 mg of EGCG and 60 mL of coconut oil, and the control group was prescribed a placebo. Both groups followed the same isocaloric Mediterranean diet. State and trait anxiety were determined before and after the study by means of the State-Trait Anxiety Inventory (STAI). In addition, IL-6 in serum was measured using the ELISA technique and functional capacity was determined with the Expanded Disability Status Scale (EDSS) and the body mass index (BMI). Results: State anxiety and functional capacity decreased in the intervention group and IL-6 decreased in both groups. Conclusions: EGCG and coconut oil improve state anxiety and functional capacity. In addition, a decrease in IL-6 is observed in patients with MS, possibly due to the antioxidant capacity of the Mediterranean diet and its impact on improving BMI.
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Affiliation(s)
- Jose Luis Platero
- Doctoral Degree School, Catholic University of Valencia San Vicente Martir, 46001 Valencia, Spain;
| | - María Cuerda-Ballester
- Department of Nursing, Catholic University of Valencia San Vicente Martir, 46001 Valencia, Spain; (M.C.-B.); (V.I.); (D.S.); (J.E.d.l.R.O.)
| | - Vanessa Ibáñez
- Department of Nursing, Catholic University of Valencia San Vicente Martir, 46001 Valencia, Spain; (M.C.-B.); (V.I.); (D.S.); (J.E.d.l.R.O.)
| | - David Sancho
- Department of Nursing, Catholic University of Valencia San Vicente Martir, 46001 Valencia, Spain; (M.C.-B.); (V.I.); (D.S.); (J.E.d.l.R.O.)
| | - María Mar Lopez-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain
- Correspondence: ; Tel.: +34-95-0015374
| | - Eraci Drehmer
- Department of Physical Activity and Sport Sciences, Catholic University of Valencia San Vicente Martir, 46001 Valencia, Spain;
| | - Jose Enrique de la Rubia Ortí
- Department of Nursing, Catholic University of Valencia San Vicente Martir, 46001 Valencia, Spain; (M.C.-B.); (V.I.); (D.S.); (J.E.d.l.R.O.)
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Matisz CE, Vicentini FA, Hirota SA, Sharkey KA, Gruber AJ. Behavioral adaptations in a relapsing mouse model of colitis. Physiol Behav 2020; 216:112802. [PMID: 31931038 DOI: 10.1016/j.physbeh.2020.112802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel disease (IBD) is characterized by relapsing periods of gut inflammation, and is comorbid with depression, anxiety, and cognitive deficits. Animal models of IBD that explore the behavioral consequences almost exclusively use acute models of gut inflammation, which fails to recapitulate the cyclic, chronic nature of IBD. This study sought to identify behavioral differences in digging, memory, and stress-coping strategies in mice exposed to one (acute) or three (chronic) cycles of gut inflammation, using the dextran sodium sulfate (DSS) model of colitis. Similar levels of gut pathology were observed between acute and chronically exposed mice, although mice in the chronic treatment had significantly shorter colons, suggesting more severe disease. Behavioral measures revealed an unexpected pattern in which chronic treatment evoked fewer deficits than acute treatment. Specifically, acutely-treated mice showed alterations in measures of object burying, novel object recognition, object location memory, and stress-coping (forced swim task). Chronically-treated animals, however, showed similar alterations in object burying, but not the other measures. These data suggest an adaptive or tolerizing effect of repeated cycles of peripheral gut inflammation on mnemonic function and stress-coping, whereas some other behaviors continue to be affected by gut inflammation. We speculate that the normalization of some functions may involve the reversion to the baseline state of the hypothalamic-pituitary-adrenal axis and/or levels of neuroinflammation, which are both activated by the first exposure to the colitic agent.
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Affiliation(s)
- Chelsea E Matisz
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive West, Lethbridge T1K 3M4, AB, Canada.
| | - Fernando A Vicentini
- Hotchkiss Brain Institute, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Inflammation Research Network, Snyder Institute for Chronic Diseases, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon A Hirota
- Inflammation Research Network, Snyder Institute for Chronic Diseases, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith A Sharkey
- Hotchkiss Brain Institute, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aaron J Gruber
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive West, Lethbridge T1K 3M4, AB, Canada
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Watson AES, Goodkey K, Footz T, Voronova A. Regulation of CNS precursor function by neuronal chemokines. Neurosci Lett 2020; 715:134533. [DOI: 10.1016/j.neulet.2019.134533] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023]
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Social phobia in immune-mediated inflammatory diseases. J Psychosom Res 2020; 128:109890. [PMID: 31816595 DOI: 10.1016/j.jpsychores.2019.109890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Immune-mediated inflammatory diseases (IMID) such as multiple sclerosis (MS), inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) are associated with a high prevalence of psychiatric comorbidity but little is known about the prevalence of social phobia in IMID, or the factors associated with social phobia. We aimed to determine the prevalence of social phobia in MS, IBD and RA, and the factors associated with social phobia in these IMID. METHODS We obtained data from the enrollment visit of a cohort study in IMID of whom 654 participants were eligible for this analysis (MS: 254, IBD: 247, RA: 153). Each participant underwent a semi-structured psychiatric interview which identified depression and anxiety disorders including social phobia (lifetime and current), an assessment of disease activity, and reported sociodemographic information. RESULTS Overall, 12.8% of participants had a lifetime diagnosis of social phobia (MS: 10.2%, IBD: 13.0%, RA: 17.0%). Social phobia was associated with younger age (OR 0.98; 0.97-1.00), having a high school education or less (OR 1.78; 1.08-2.91), comorbid major depressive disorder (OR 2.79; 1.63-4.78) and comorbid generalized anxiety disorder (OR 2.56; 1.30-5.05). Persons with RA had increased odds of having social phobia as compared to persons with MS (OR 2.26; 1.14-4.48) but not IBD. CONCLUSION Persons with IMIDs have a relatively high lifetime prevalence of social phobia, exceeding that reported for the Canadian general population. Strategies aimed at early detection, and effective clinical management of social phobia in IMID are warranted.
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Marrie RA, Whitehouse C, Fisk J. Author response: Comorbid anxiety, depression, and cognition in MS and other immune-mediated disorders. Neurology 2019; 93:1081-1082. [PMID: 31819000 DOI: 10.1212/wnl.0000000000008634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
PURPOSE OF REVIEW The current review discusses the diagnosis and management of nonorgan-related symptoms that commonly arise in the setting of systemic sarcoidosis. Fatigue, small fiber neuropathy (SFN) and neuropsychological symptoms are highlighted. RECENT FINDINGS The debilitating effects of chronic nonorgan-based symptoms in sarcoidosis have led to recent studies focusing on incidence rates, contributing factors and potential therapeutic strategies. In a web-based survey of over 1000 sarcoidosis patients, the most common symptom was fatigue, which was reported by over 90% of participants, whereas memory loss and concentration problems were reported in 50%. SFN was also common, and may be diagnosed with tools such as skin biopsy measurement of intraepidermal nerve fibers and corneal confocal microscopy. In a recent cohort study of SFN patients, serologic evaluation demonstrated other contributing causes such as diabetes and vitamin B12 deficiency, which warrant-specific treatment. Finally, physical inactivity in patients with sarcoidosis correlated with lower quality-of-life (QOL) scores and possibly fatigue. Multidisciplinary programs that include physical therapy, patient education and psychological support were found to improve fatigue and mood disorders. SUMMARY Recognition of nonorgan-related symptoms and their impact on patient QOL is essential to optimal treatment of the sarcoidosis patient.
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Affiliation(s)
- Jinny Tavee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland OH
| | - Daniel Culver
- Sarcoidosis Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Brandstadter R, Sand IK, Sumowski JF. Beyond rehabilitation: A prevention model of reserve and brain maintenance in multiple sclerosis. Mult Scler 2019; 25:1372-1378. [PMID: 31469354 PMCID: PMC6719722 DOI: 10.1177/1352458519856847] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Persons with multiple sclerosis (MS) experience cognitive and physical decline despite more effective disease-modifying therapies (DMTs), and symptomatic treatments currently have limited efficacy. The best treatment of MS disability may, therefore, be prevention of decline. Here, we present a working model of reserve and brain maintenance, with a focus on modifiable risk and protective factors. At disease onset, patients have varying degrees of reserve, broadly conceptualized as the dynamic availability of cerebral resources to support functional capacity. A clinical focus on prevention aims to minimize factors that deplete reserve (e.g. disease burden, comorbidities) and maximize factors that preserve reserve (e.g. DMTs, cardiovascular health). We review evidence for cardiovascular health, diet, and sleep as three potentially important modifiable factors that may modulate cerebral reserve generally, but also in disease-specific ways. We frame the brain as a limited capacity system in which inefficient usage of available cerebral capacity (reserve) leads to or exacerbates functional deficits, and we provide examples of factors that may lead to such inefficiency (e.g. poor mood, obesity, cognitive-motor dual-tasking). Finally, we discuss the challenges and responsibilities of MS neurologists and patients in pursuing comprehensive brain maintenance as a preventive approach.
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Affiliation(s)
- Rachel Brandstadter
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Corinne Goldsmith Dickinson Center for MS, Mount Sinai Hospital, New York, NY, USA
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Corinne Goldsmith Dickinson Center for MS, Mount Sinai Hospital, New York, NY, USA
| | - James F. Sumowski
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Corinne Goldsmith Dickinson Center for MS, Mount Sinai Hospital, New York, NY, USA
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Vitturi BK, Nascimento BAC, Alves BR, de Campos FSC, Torigoe DY. Cognitive impairment in patients with rheumatoid arthritis. J Clin Neurosci 2019; 69:81-87. [PMID: 31447371 DOI: 10.1016/j.jocn.2019.08.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Neurological manifestations of Rheumatoid Arthritis (RA) are usually uncommon. However, a number of recent studies have reported that the burden of cognitive impairment in RA could be significant. We sought to explore the prevalence and clinical predictors of cognitive impairment in persons with RA. METHODS This is a cross-sectional case-control study with patients with RA. Different trained and blinded interviewers registered clinical-epidemiological data and applied a standardized neurological assessment for each subject of the study. At baseline, functional limitations were characterized using the Health Assessment Questionnaire (HAQ). Cognitive impairment was evaluated with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) while neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale (HADS). Using a proper statistical analysis, we compared the neurological outcomes between case and controls and we determined the clinical predictors of cognitive decline. RESULTS A total of 210 patients with RA and 70 healthy controls were included in our study. More than two thirds of our patients were classified as cognitively impaired. The mean MMSE and MoCA scores were significantly lower in RA subjects compared to the control group (p < 0.001). Neuropshychiatric impairment was more prevalent in RA patients (59.5%) than in controls (17.1%) as well (p < 0.001). Greater functional limitations were correlated with worse MMSE, MoCA and HADS scores (p < 0.001). CONCLUSION The findings of this study suggest that there is evidence of cognitive impairment in adults with RA.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Departament of Neurology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
| | | | - Beatriz Rizkallah Alves
- Departament of Rheumatology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | | | - Dawton Yukito Torigoe
- Departament of Rheumatology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Alavi MS, Karimi G, Roohbakhsh A. The role of orphan G protein-coupled receptors in the pathophysiology of multiple sclerosis: A review. Life Sci 2019; 224:33-40. [PMID: 30904492 DOI: 10.1016/j.lfs.2019.03.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 01/19/2023]
Abstract
G protein-coupled receptors (GPCRs) are a large family of transmembrane proteins that are expressed in many organs and serve as important drug targets. A new subgroup, namely orphan GPCRs, comprising many of these receptors has been discovered. These receptors exhibit diverse physiological functions and have been considered in many neurological disorders including Alzheimer's disease, Parkinson's disease, and multiple sclerosis (MS). GPR17, GPR30, GPR37, GPR40, GPR50, GPR54, GPR56, GPR65, GPR68, GPR75, GPR84, GPR97, GPR109, GPR124, and GPR126 are orphan GPCRs that have been reported with considerable effects in the prevention and/or treatment of MS in preclinical studies. In the present article, we reviewed the most recent findings regarding the role of orphan GPCRs in the treatment of MS.
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Affiliation(s)
- Mohaddeseh Sadat Alavi
- Division of Neurocognitive Sciences, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Gholamreza Karimi
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Roohbakhsh
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Feinstein A, Brochet B, Sumowski J. The cognitive effects of anxiety and depression in immune-mediated inflammatory diseases. Neurology 2019; 92:211-212. [PMID: 30635489 DOI: 10.1212/wnl.0000000000006840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Anthony Feinstein
- From the Department of Psychiatry (A.F.), Sunnybrook and Women's College Health Science Centre, Toronto, Canada; Inserm U 862 and Department of Neurology (B.B.), University of Bordeaux and CHU of Bordeaux, France; and Department of Neurology (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Bruno Brochet
- From the Department of Psychiatry (A.F.), Sunnybrook and Women's College Health Science Centre, Toronto, Canada; Inserm U 862 and Department of Neurology (B.B.), University of Bordeaux and CHU of Bordeaux, France; and Department of Neurology (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - James Sumowski
- From the Department of Psychiatry (A.F.), Sunnybrook and Women's College Health Science Centre, Toronto, Canada; Inserm U 862 and Department of Neurology (B.B.), University of Bordeaux and CHU of Bordeaux, France; and Department of Neurology (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY
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