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Zhang P, Feng Y, Xu T, Li Y, Xia J, Zhang H, Sun Z, Tian W, Zhang J. Brain white matter microstructural alterations in patients with systemic lupus erythematosus: an automated fiber quantification study. Brain Imaging Behav 2024:10.1007/s11682-024-00861-2. [PMID: 38332385 DOI: 10.1007/s11682-024-00861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
This study aimed to identify damaged segments of brain white matter fiber tracts in patients with systemic lupus erythematosus (SLE) using diffusion tensor imaging (DTI)-based automated fiber quantification (AFQ), and analyze their relationship with cognitive impairment. Clinical and imaging data for 39 female patients with SLE and for 44 female healthy controls (HCs) were collected. AFQ was used to track whole-brain white matter tracts in each participant, and each tract was segmented into 100 equally spaced nodes. DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated at each node. Correlations were also explored between DTI metrics in the damaged segments of white matter fiber tracts and neuropsychological test scores of patients with SLE. Compared with HCs, SLE patients exhibited significantly lower FA values, and significantly higher MD, AD, RD values in many white matter tracts (all P < 0.05, false discovery rate-corrected). FA values in nodes 97-100 of the left inferior fronto-occipital fasciculus (IFOF) positively correlated with the mini-mental state examination score. AFQ enables precise and accurate identification of damage to white matter fiber tracts in brains of patients with SLE. FA values in the left IFOF correlate with cognitive impairment in SLE.
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Affiliation(s)
- Peng Zhang
- Graduate School of Dalian Medical University, Liaoning, 116044, China
- The First Affiliated Hospital of Baotou Medical College, Baotou, 014010, China
| | - Yanhong Feng
- Graduate School of Dalian Medical University, Liaoning, 116044, China
| | - Tianye Xu
- Graduate School of Dalian Medical University, Liaoning, 116044, China
| | - Yifan Li
- School of Medicine, Nantong University, Jiangsu, 226019, China
| | - Jianguo Xia
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China.
| | - Hongxia Zhang
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China.
| | - Zhongru Sun
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China
| | - Weizhong Tian
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China
| | - Ji Zhang
- Department of Imaging, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, 225300, China
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Tay SH, Stephenson MC, Allameen NA, Ngo RYS, Ismail NAB, Wang VCC, Totman JJ, Cheong DLH, Narayanan S, Lee BTK, Mak A. Combining multimodal magnetic resonance brain imaging and machine learning to unravel neurocognitive function in non-neuropsychiatric systemic lupus erythematosus. Rheumatology (Oxford) 2024; 63:414-422. [PMID: 37184855 DOI: 10.1093/rheumatology/kead221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE To study whether multimodal brain MRI comprising permeability and perfusion measures coupled with machine learning can predict neurocognitive function in young patients with SLE without neuropsychiatric manifestations. METHODS SLE patients and healthy controls (HCs) (≤40 years of age) underwent multimodal structural brain MRI that comprised voxel-based morphometry (VBM), magnetization transfer ratio (MTR) and dynamic contrast-enhanced (DCE) MRI in this cross-sectional study. Neurocognitive function assessed by Automated Neuropsychological Assessment Metrics was reported as the total throughput score (TTS). Olfactory function was assessed. A machine learning-based model (i.e. glmnet) was constructed to predict TTS. RESULTS Thirty SLE patients and 10 HCs were studied. Both groups had comparable VBM, MTR, olfactory bulb volume (OBV), olfactory function and TTS. While after correction for multiple comparisons the uncorrected increase in the blood-brain barrier (BBB) permeability parameters compared with HCs did not remain evident in SLE patients, DCE-MRI perfusion parameters, notably an increase in right amygdala perfusion, was positively correlated with TTS in SLE patients (r = 0.636, false discovery rate P < 0.05). A machine learning-trained multimodal MRI model comprising alterations of VBM, MTR, OBV and DCE-MRI parameters mainly in the limbic system regions predicted TTS in SLE patients (r = 0.644, P < 0.0005). CONCLUSION Multimodal brain MRI demonstrated increased right amygdala perfusion that was associated with better neurocognitive performance in young SLE patients without statistically significant BBB leakage and microstructural abnormalities. A machine learning-constructed multimodal model comprising microstructural, perfusion and permeability parameters accurately predicted neurocognitive performance in SLE patients.
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Affiliation(s)
- Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Nur Azizah Allameen
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Raymond Yeow Seng Ngo
- Department of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore
- Department of Otolaryngology, National University of Singapore, Singapore, Singapore
- Department of Otolaryngology - Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | | | - Victor Chun Chieh Wang
- Department of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - John James Totman
- Academic Radiology, National University of Singapore, Singapore, Singapore
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dennis Lai-Hong Cheong
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sriram Narayanan
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Bernett Teck Kwong Lee
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
- Centre for Biomedical Informatics, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
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Ohene Y, Harris WJ, Powell E, Wycech NW, Smethers KF, Lasič S, South K, Coutts G, Sharp A, Lawrence CB, Boutin H, Parker GJM, Parkes LM, Dickie BR. Filter exchange imaging with crusher gradient modelling detects increased blood-brain barrier water permeability in response to mild lung infection. Fluids Barriers CNS 2023; 20:25. [PMID: 37013549 PMCID: PMC10071630 DOI: 10.1186/s12987-023-00422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 04/05/2023] Open
Abstract
Blood-brain barrier (BBB) dysfunction occurs in many brain diseases, and there is increasing evidence to suggest that it is an early process in dementia which may be exacerbated by peripheral infection. Filter-exchange imaging (FEXI) is an MRI technique for measuring trans-membrane water exchange. FEXI data is typically analysed using the apparent exchange rate (AXR) model, yielding estimates of the AXR. Crusher gradients are commonly used to remove unwanted coherence pathways arising from longitudinal storage pulses during the mixing period. We first demonstrate that when using thin slices, as is needed for imaging the rodent brain, crusher gradients result in underestimation of the AXR. To address this, we propose an extended crusher-compensated exchange rate (CCXR) model to account for diffusion-weighting introduced by the crusher gradients, which is able to recover ground truth values of BBB water exchange (kin) in simulated data. When applied to the rat brain, kin estimates obtained using the CCXR model were 3.10 s-1 and 3.49 s-1 compared to AXR estimates of 1.24 s-1 and 0.49 s-1 for slice thicknesses of 4.0 mm and 2.5 mm respectively. We then validated our approach using a clinically relevant Streptococcus pneumoniae lung infection. We observed a significant 70 ± 10% increase in BBB water exchange in rats during active infection (kin = 3.78 ± 0.42 s-1) compared to before infection (kin = 2.72 ± 0.30 s-1; p = 0.02). The BBB water exchange rate during infection was associated with higher levels of plasma von Willebrand factor (VWF), a marker of acute vascular inflammation. We also observed 42% higher expression of perivascular aquaporin-4 (AQP4) in infected animals compared to non-infected controls, while levels of tight junction proteins remain consistent between groups. In summary, we propose a modelling approach for FEXI data which removes the bias in estimated water-exchange rates associated with the use of crusher gradients. Using this approach, we demonstrate the impact of peripheral infection on BBB water exchange, which appears to be mediated by endothelial dysfunction and associated with an increase in perivascular AQP4.
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Affiliation(s)
- Yolanda Ohene
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK.
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - William J Harris
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elizabeth Powell
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering and Department of Neuroinflammation, UCL, London, UK
| | - Nina W Wycech
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Katherine F Smethers
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Samo Lasič
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Random Walk Imaging, Lund, Sweden
| | - Kieron South
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Graham Coutts
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Andrew Sharp
- Evotec (UK) Ltd., Alderley Park, Block 23F, Mereside, Cheshire, SK10 4TG, UK
| | - Catherine B Lawrence
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Hervé Boutin
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Geoff J M Parker
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering and Department of Neuroinflammation, UCL, London, UK
- Bioxydyn Limited, Manchester, UK
| | - Laura M Parkes
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ben R Dickie
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Cognitive dysfunction in SLE: An understudied clinical manifestation. J Autoimmun 2022; 132:102911. [PMID: 36127204 DOI: 10.1016/j.jaut.2022.102911] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
Neuropsychiatric lupus (NPSLE) is a debilitating manifestation of SLE which occurs in a majority of SLE patients and has a variety of clinical manifestations. In the central nervous system, NPSLE may result from ischemia or penetration of inflammatory mediators and neurotoxic antibodies through the blood brain barrier (BBB). Here we focus on cognitive dysfunction (CD) as an NPSLE manifestation; it is common, underdiagnosed, and without specific therapy. For a very long time, clinicians ignored cognitive dysfunction and researchers who might be interested in the question struggled to find an approach to understanding mechanisms for this manifestation. Recent years, however, propelled by a more patient-centric approach to disease, have seen remarkable progress in our understanding of CD pathogenesis. This has been enabled through the use of novel imaging modalities and numerous mouse models. Overall, these studies point to a pivotal role of an impaired BBB and microglial activation in leading to neuronal injury. These insights suggest potential therapeutic modalities and make possible clinical trials for cognitive impairment.
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Sim TM, Mak A, Tay SH. Insights into the role of neutrophils in neuropsychiatric systemic lupus erythematosus: Current understanding and future directions. Front Immunol 2022; 13:957303. [PMID: 36016935 PMCID: PMC9396336 DOI: 10.3389/fimmu.2022.957303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/19/2022] [Indexed: 12/12/2022] Open
Abstract
Central nervous system (CNS) involvement of systemic lupus erythematosus (SLE), termed neuropsychiatric SLE (NPSLE), is a major and debilitating manifestation of the disease. While patients with SLE mostly complain of common neuropsychological symptoms such headache and mild mood disorders that may not even be technically attributed to SLE, many SLE patients present with life-threatening NPSLE syndromes such as cerebrovascular disease, seizures and psychosis that are equally challenging in terms of early diagnosis and therapy. While we are just beginning to unravel some mysteries behind the immunologic basis of NPSLE, advancements in the mechanistic understanding of the complex pathogenic processes of NPSLE have been emerging through recent murine and human studies. The pathogenic pathways implicated in NPSLE are multifarious and various immune effectors such as cell-mediated inflammation, autoantibodies and cytokines including type I interferons have been found to act in concert with the disruption of the blood-brain barrier (BBB) and other neurovascular interfaces. Beyond antimicrobial functions, neutrophils are emerging as decision-shapers during innate and adaptive immune responses. Activated neutrophils have been recognized to be involved in ischemic and infective processes in the CNS by releasing neutrophil extracellular traps (NETs), matrix metalloproteinase-9 and proinflammatory cytokines. In the context of NPSLE, these mechanisms contribute to BBB disruption, neuroinflammation and externalization of modified proteins on NETs that serve as autoantigens. Neutrophils that sediment within the peripheral blood mononuclear cell fraction after density centrifugation of blood are generally defined as low-density neutrophils (LDNs) or low-density granulocytes. LDNs are a proinflammatory subset of neutrophils that are increased with SLE disease activity and are primed to undergo NETosis and release cytokines such as interferon-α and tumor necrosis factor. This review discusses the immunopathogenesis of NPSLE with a focus on neutrophils as a core mediator of the disease and potential target for translational research in NPSLE.
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Appenzeller S, Pereira DR, Julio PR, Reis F, Rittner L, Marini R. Neuropsychiatric manifestations in childhood-onset systemic lupus erythematosus. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:571-581. [PMID: 35841921 DOI: 10.1016/s2352-4642(22)00157-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Neuropsychiatric manifestations occur frequently and are challenging to diagnose in childhood-onset systemic lupus erythematosus (SLE). Most patients with childhood-onset SLE have neuropsychiatric events in the first 2 years of disease. 30-70% of patients present with more than one neuropsychiatric event during their disease course, with an average of 2-3 events per person. These symptoms are associated with disability and mortality. Serum, cerebrospinal fluid, and neuroimaging findings have been described in childhood-onset SLE; however, only a few have been validated as biomarkers for diagnosis, monitoring response to treatment, or prognosis. The aim of this Review is to describe the genetic risk, clinical and neuroimaging characteristics, and current treatment strategies of neuropsychiatric manifestations in childhood-onset SLE.
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Affiliation(s)
- Simone Appenzeller
- Department of Orthopedics, Rheumatology, and Traumatology, University of Campinas, Campinas, Brazil; Rheumatology Laboratory, University of Campinas, Campinas, Brazil.
| | - Danilo Rodrigues Pereira
- Rheumatology Laboratory, University of Campinas, Campinas, Brazil; Medical Physiopathology Graduate Program, University of Campinas, Campinas, Brazil
| | - Paulo Rogério Julio
- Rheumatology Laboratory, University of Campinas, Campinas, Brazil; Child and Adolescent Health Graduate Program, University of Campinas, Campinas, Brazil
| | - Fabiano Reis
- Department of Radiology, University of Campinas, Campinas, Brazil
| | - Leticia Rittner
- School of Medical Science; School of Electrical and Computer Engineering, University of Campinas, Campinas, Brazil
| | - Roberto Marini
- Pediatric Rheumatology Unit, Department of Pediatrics, University of Campinas, Campinas, Brazil
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Wang X, Ma L, Luo Y, Yang Y, Upreti B, Cheng Y, Cui R, Liu S, Xu J. Increasing of Blood Brain Barrier Permeability and the Association With Depression and Anxiety in Systemic Lupus Erythematosus Patients. Front Med (Lausanne) 2022; 9:852835. [PMID: 35425773 PMCID: PMC9001971 DOI: 10.3389/fmed.2022.852835] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/08/2022] [Indexed: 12/31/2022] Open
Abstract
Objective To study changes in blood brain barrier (BBB) permeability in systemic lupus erythematosus (SLE) patients, and explore the association between the alterations in BBB permeability and depression/anxiety in SLE. Methods Brain dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) images were collected from 42 SLE patients and 23 healthy controls (HCs). Based on the Patlak pharmacokinetic model, the Ktrans value of each voxel in the whole brain of each subject was calculated. BBB permeability indicator (the Ktrans value) between SLE patients and healthy control group was compared. Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to assess the mental health of SLE patients. The difference in BBB permeability was compared on SLE patients with depression/anxiety, SLE patients without depression/anxiety and HCs by ANOVA analysis. Results The Ktrans value of the right insular region of the SLE group was significantly higher than that of the healthy control group. And the Ktrans value of the right insular region in SLE patients with depression/anxiety was significantly increased compared with SLE patients without depression/anxiety and HCs. Conclusions SLE patients have increased BBB permeability, mainly in the right insular area. The increased BBB permeability in the right insular region is associated with the depression/anxiety in SLE patients.
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Affiliation(s)
- Xiangyu Wang
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lihua Ma
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuli Luo
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yifan Yang
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bibhuti Upreti
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruomei Cui
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shuang Liu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian Xu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Wilson A, Velasco CA, Herbert GW, Lucas SN, Sanchez BN, Cerrato JM, Spilde M, Li QZ, Campen MJ, Zychowski KE. Mine-site derived particulate matter exposure exacerbates neurological and pulmonary inflammatory outcomes in an autoimmune mouse model. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2021; 84:503-517. [PMID: 33682625 PMCID: PMC8052313 DOI: 10.1080/15287394.2021.1891488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The Southwestern United States has a legacy of industrial mining due to the presence of rich mineral ore deposits. The relationship between environmental inhaled particulate matter (PM) exposures and neurological outcomes within an autoimmune context is understudied. The aim of this study was to compare two regionally-relevant dusts from high-priority abandoned mine-sites, Claim 28 PM, from Blue Gap Tachee, AZ and St. Anthony mine PM, from the Pueblo of Laguna, NM and to expose autoimmune-prone mice (NZBWF1/J). Mice were randomly assigned to one of three groups (n = 8/group): DM (dispersion media, control), Claim 28 PM, or St. Anthony PM, subjected to oropharyngeal aspiration of (100 µg/50 µl), once per week for a total of 4 consecutive doses. A battery of immunological and neurological endpoints was assessed at 24 weeks of age including: bronchoalveolar lavage cell counts, lung gene expression, brain immunohistochemistry, behavioral tasks and serum autoimmune biomarkers. Bronchoalveolar lavage results demonstrated a significant increase in number of polymorphonuclear neutrophils following Claim 28 and St. Anthony mine PM aspiration. Lung mRNA expression showed significant upregulation in CCL-2 and IL-1ß following St. Anthony mine PM aspiration. In addition, neuroinflammation was present in both Claim 28 and St. Anthony mine-site derived PM exposure groups. Behavioral tasks resulted in significant deficits as determined by Y-maze new arm frequency following Claim 28 aspiration. Neutrophil elastase was significantly upregulated in the St. Anthony mine exposure group. Interestingly, there were no significant changes in serum autoantigens suggesting systemic inflammatory effects may be mediated through other molecular mechanisms following low-dose PM exposures.
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Affiliation(s)
- Alexis Wilson
- Department of Pharmaceutical Sciences, University of New Mexico-Health Sciences Center, Albuquerque, New Mexico 87131
| | - Carmen A. Velasco
- Department of Civil, Construction & Environmental Engineering, University of New Mexico, Albuquerque, New Mexico 87131
- Department of Chemical Engineering, Universidad Central del Ecuador, Ritter s/n & Bolivia, Quito 17-01-3972, Ecuador
| | - Guy W. Herbert
- Department of Pharmaceutical Sciences, University of New Mexico-Health Sciences Center, Albuquerque, New Mexico 87131
| | - Selita N. Lucas
- Department of Pharmaceutical Sciences, University of New Mexico-Health Sciences Center, Albuquerque, New Mexico 87131
| | - Bethany N. Sanchez
- Department of Pharmaceutical Sciences, University of New Mexico-Health Sciences Center, Albuquerque, New Mexico 87131
| | - José M. Cerrato
- Department of Civil, Construction & Environmental Engineering, University of New Mexico, Albuquerque, New Mexico 87131
| | - Michael Spilde
- Department of Earth and Planetary Sciences, University of New Mexico, MSC03 2040, Albuquerque, New Mexico 87131
| | - Quan-Zhen Li
- Department of Immunology and Microarray Core, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Matthew J. Campen
- Department of Pharmaceutical Sciences, University of New Mexico-Health Sciences Center, Albuquerque, New Mexico 87131
| | - Katherine E. Zychowski
- College of Nursing, University of New Mexico-Health Sciences Center, Albuquerque, New Mexico 87131
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Structural Changes on MRI Demonstrate Specific Cerebellar Involvement in SLE Patients-A VBM Study. Brain Sci 2021; 11:brainsci11040510. [PMID: 33923703 PMCID: PMC8072619 DOI: 10.3390/brainsci11040510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study is to investigate possible differences in brain structure, as measured by T1-weighted MRI, between patients with systemic lupus erythematosus (SLE) and healthy controls (HC), and whether any observed differences were in turn more severe in SLE patients with neuropsychiatric manifestations (NPSLE) than those without (non-NPSLE). Structural T1-weighted MRI was performed on 69 female SLE patients (mean age = 35.8 years, range = 18–51 years) and 24 age-matched female HC (mean age = 36.8 years, range = 23–52 years) in conjunction with neuropsychological assessment using the CNS Vital Signs test battery. T1-weighted images were preprocessed and analyzed by FSL-VBM. The results show that SLE patients had lower grey matter probability values than the control group in the VIIIa of the cerebellum bilaterally, a region that has previously been implied in sensorimotor processing in human and non-human primates. No structural differences for this region were found between NPSLE and non-NPSLE patients. VBM values from the VIIIa region showed a weak positive correlation with the psychomotor speed domain from CNS Vital Signs (p = 0.05, r = 0.21), which is in line with its presumed role as a sensorimotor processing area.
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Kamintsky L, Beyea SD, Fisk JD, Hashmi JA, Omisade A, Calkin C, Bardouille T, Bowen C, Quraan M, Mitnitski A, Matheson K, Friedman A, Hanly JG. Blood-brain barrier leakage in systemic lupus erythematosus is associated with gray matter loss and cognitive impairment. Ann Rheum Dis 2020; 79:1580-1587. [PMID: 33004325 DOI: 10.1136/annrheumdis-2020-218004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine the association between blood-brain barrier (BBB) integrity, brain volume and cognitive dysfunction in adult patients with systemic lupus erythematosus (SLE). METHODS A total of 65 ambulatory patients with SLE and 9 healthy controls underwent dynamic contrast-enhanced MRI scanning, for quantitative assessment of BBB permeability. Volumetric data were extracted using the VolBrain pipeline. Global cognitive function was evaluated using a screening battery consisting of tasks falling into five broad cognitive domains, and was compared between patients with normal versus extensive BBB leakage. RESULTS Patients with SLE had significantly higher levels of BBB leakage compared with controls (p=0.04). Extensive BBB leakage (affecting over >9% of brain volume) was identified only in patients with SLE (16/65; 24.6%), who also had smaller right and left cerebral grey matter volumes compared with controls (p=0.04). Extensive BBB leakage was associated with lower global cognitive scores (p=0.02), and with the presence of impairment on one or more cognitive tasks (p=0.01). CONCLUSION Our findings provide evidence for a link between extensive BBB leakage and changes in both brain structure and cognitive function in patients with SLE. Future studies should investigate the mechanisms underlying BBB-mediated cognitive impairment, validate the diagnostic utility of BBB imaging, and determine the potential of targeting the BBB as a therapeutic strategy in patients with SLE.
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Affiliation(s)
- Lyna Kamintsky
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steven D Beyea
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth ll Health Sciences Centre, Halifax, Nova Scotia, Canada.,Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John D Fisk
- Psychiatry, Psychology & Neuroscience and Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Javeria A Hashmi
- Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Antonina Omisade
- Acquired Brain Injury (Epilepsy Program), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Cynthia Calkin
- Psychiatry and Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Mood Disorders Clinic, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Tim Bardouille
- Physics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Bowen
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth ll Health Sciences Centre, Halifax, Nova Scotia, Canada.,Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maher Quraan
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth ll Health Sciences Centre, Halifax, Nova Scotia, Canada.,Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Alon Friedman
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Cognitive and Brain Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - John G Hanly
- Medicine and Pathology, Queen Elizabeth ll Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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11
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DiFrancesco MW, Lee G, Altaye M, Beebe DW, Meyers-Eaton J, Brunner HI. Cerebral microvascular and microstructural integrity is regionally altered in patients with systemic lupus erythematosus. Arthritis Res Ther 2020; 22:135. [PMID: 32513258 PMCID: PMC7281933 DOI: 10.1186/s13075-020-02227-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background To measure regional brain microvascular and microstructural changes in childhood-onset SLE (cSLE) using diffusion-weighted imaging (DWI) at multiple b values and investigate relationships of those measures with neurocognitive function and disease activity. Methods In this cross-sectional, case-control study, vascular volume fraction, effective diffusion, parenchymal diffusion, and blood flow parameters were regionally compared in cSLE patients and matched healthy controls. These markers of microvascular and microstructural integrity were derived by diffusion-weighted brain MRI and intravoxel incoherent motion (IVIM) modeling. Formal neurocognitive testing was completed focused on the domains of attention, visuoconstructional ability, working memory, and psychomotor speed. Test scores and measures of disease severity were regressed against regional microvascular integrity parameters among cSLE patients. Results Formal cognitive testing confirmed normal cognitive ability among all cSLE patients included in the analysis (n = 11). Nevertheless, reduction in blood volume fraction coincided with increased effective diffusion and flow parameters in cSLE patients vs. controls in posterior brain regions including the cuneus and precuneus. Regional microvascular measures correlated (|r| = 0.54–0.66) with neuropsychiatric scores and disease activity among cSLE patients. Conclusions There is imaging evidence, using IVIM, of degraded microvascular integrity in cSLE patients with normal cognitive ability. The observed regional changes correspond with posterior vascular border zones. These outcomes appear consistent with regional gray matter volume loss previously observed in cSLE patients with overt neurocognitive deficits, supporting the notion that adverse vascular changes precede loss of cognitive ability in cSLE. Longitudinal studies are needed to confirm the findings of this initial study.
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Affiliation(s)
- Mark W DiFrancesco
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA.
| | - Gregory Lee
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Dean W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Jamie Meyers-Eaton
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Hermine I Brunner
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
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12
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Chi JM, Mackay M, Hoang A, Cheng K, Aranow C, Ivanidze J, Volpe B, Diamond B, Sanelli PC. Alterations in Blood-Brain Barrier Permeability in Patients with Systemic Lupus Erythematosus. AJNR Am J Neuroradiol 2019; 40:470-477. [PMID: 30792254 DOI: 10.3174/ajnr.a5990] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 12/30/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Neuropsychiatric systemic lupus erythematosus refers to central and peripheral nervous system involvement, which may occur secondary to antineuronal antibodies crossing the blood-brain barrier that preferentially target cells in the hippocampus leading to abnormal hypermetabolism and atrophy. Thus, we hypothesized that alterations in BBB permeability, detected on dynamic contrast-enhanced MR imaging, occur in the hippocampus in patients with systemic lupus erythematosus before development of neuropsychiatric systemic lupus erythematosus. MATERIALS AND METHODS Six patients with systemic lupus erythematosus without neuropsychiatric systemic lupus erythematosus and 5 healthy controls underwent dynamic contrast-enhanced MR imaging with postprocessing into BBB permeability parameters (K trans and Ve) and CBF. Standardized methods selected ROI sampling of the abnormal brain regions detected on FDG-PET. The mean and SD of K trans, Ve, and CBF were calculated. Linear regression and nonparametric Spearman rank correlation analyses of K trans and Ve with CBF were performed. Dynamic contrast-enhanced curves and the area under the curve were generated for each brain region. Student t test comparisons were performed. RESULTS Quantitative data revealed that patients with systemic lupus erythematosus have statistically increased K trans (P < .001) and Ve (P < .001) compared with controls. In patients with systemic lupus erythematosus, statistically significant positive correlations were seen between K trans (P < .001) and Ve (P < .001) with CBF. Furthermore, the mean area under the curve revealed statistically increased BBB permeability in the hippocampus (P = .02) compared with other brain regions in patients with systemic lupus erythematosus compared with controls. CONCLUSIONS These initial findings are proof-of-concept to support the hypothesis that patients with systemic lupus erythematosus have increased BBB permeability, specifically in the hippocampus, compared with other brain regions. These findings may advance our understanding of the underlying pathophysiology affecting the brain in autoimmune diseases.
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Affiliation(s)
- J M Chi
- From the Department of Radiology (J.M.C., K.C.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - M Mackay
- Feinstein Institute for Medical Research (M.M., C.A., B.D.), The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - A Hoang
- Department of Radiology (A.H.), Northwell Health, Manhasset, New York
| | - K Cheng
- From the Department of Radiology (J.M.C., K.C.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - C Aranow
- Feinstein Institute for Medical Research (M.M., C.A., B.D.), The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - J Ivanidze
- Department of Radiology (J.I.), Weill Cornell Medical College, New York, New York
| | - B Volpe
- Feinstein Institute for Medical Research (B.V.), The Center for Biomedical Science, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - B Diamond
- Feinstein Institute for Medical Research (M.M., C.A., B.D.), The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - P C Sanelli
- Feinstein Institute for Medical Research (P.C.S.), The Center for Health Innovations and Outcomes Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.,Department of Radiology (P.C.S.), Northwell Health, Imaging Clinical Effectiveness and Outcomes Research Program, Manhasset, New York
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13
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease with a prevalence of approximately 1 in 1000. Over the last 30 years, advances in treatment such as use of corticosteroids and immunosuppressants have improved life expectancy and quality of life for patients with lupus and the key unmet needs have therefore changed. With the reduced mortality from disease activity, development of cardiovascular disease (CVD) has become an increasingly important cause of death in patients with SLE. The increased CVD risk in these patients is partly, but not fully explained by standard risk factors, and abnormalities in the immune response to lipids may play a role. Invariant natural killer T cells, which are triggered specifically by lipid antigens, may protect against progression of subclinical atherosclerosis. However, currently our recommendation is that clinicians should focus on optimal management of standard CVD risk factors such as smoking, blood pressure and lipid levels. Fatigue is one of the most common and most limiting symptoms suffered by patients with SLE. The cause of fatigue is multifactorial and disease activity does not explain this symptom. Consequently, therapies directed towards reducing inflammation and disease activity do not reliably reduce fatigue and new approaches are needed. Currently, we recommend asking about sleep pattern, optimising pain relief and excluding other causes of fatigue such as anaemia and metabolic disturbances. For the subgroup of patients whose disease activity is not fully controlled by standard treatment regimes, a range of different biologic agents have been proposed and subjected to clinical trials. Many of these trials have given disappointing results, though belimumab, which targets B lymphocytes, did meet its primary endpoint. New biologics targeting B cells, T cells or cytokines (especially interferon) are still going through trials raising the hope that novel therapies for patients with refractory SLE may be available soon.
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14
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Noris-García E, Arce S, Nardin P, Lanigan ME, Acuña V, Gutierrez F, Robinson-Agramonte MA, Gonçalves CA. Peripheral levels of brain-derived neurotrophic factor and S100B in neuropsychiatric systemic lupus erythematous. Lupus 2018; 27:2041-2049. [PMID: 30376438 DOI: 10.1177/0961203318804899] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to investigate serum S100B and brain-derived neurotrophic factor (BDNF) in systemic lupus erythematous (SLE) patients, with and without neuropsychiatric (NP) manifestation activity. METHODS We assessed 47 SLE patients and 20 selected healthy individuals. Disease activity was assessed according to the SLE disease activity index (SLEDAI). Serum BDNF and S100B were measured by enzyme-linked immunosorbent assay. RESULTS Serum S100B protein was significantly higher in SLE patients. BDNF levels were significantly decreased in active SLE, when compared with inactive SLE, but not when compared with controls. S100B was clearly higher in the NPSLE group, when compared with the non-NPSLE or control groups. Receiver operating characteristic analysis of S100B revealed an area under the curve of 0.706 that discriminated NPSLE patients with peripheral polyneuropathy. CONCLUSIONS Our findings reinforce the use of serum S100B as a biomarker in SLE, particularly for NPSLE. Moreover, we found a strong association between serum S100B and peripheral neuropathy, indicating a specific utility for this biomarker in SLE that warrants clinical investigation.
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Affiliation(s)
- E Noris-García
- 1 Department of Immunology, Nephrology Institute, Havana, Cuba
| | - S Arce
- 1 Department of Immunology, Nephrology Institute, Havana, Cuba
| | - P Nardin
- 2 Faculty of Pharmaceutical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - M E Lanigan
- 3 Department of Psychiatric, Joaquín Albarrán Hospital, Havana, Cuba
| | - V Acuña
- 3 Department of Psychiatric, Joaquín Albarrán Hospital, Havana, Cuba
| | - F Gutierrez
- 3 Department of Psychiatric, Joaquín Albarrán Hospital, Havana, Cuba
| | - M A Robinson-Agramonte
- 4 Department of Neuroimmunology, International Center for Neurological Restoration, Havana, Cuba
| | - C-A Gonçalves
- 5 Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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15
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16
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Nystedt J, Mannfolk P, Jönsen A, Bengtsson A, Nilsson P, Sundgren PC, Strandberg TO. Functional Connectivity Changes in Systemic Lupus Erythematosus: A Resting-State Study. Brain Connect 2018; 8:220-234. [DOI: 10.1089/brain.2017.0557] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessika Nystedt
- Department of Clinical Sciences, Lund/Diagnostic Radiology, Lund University, Lund, Sweden
- Department of Clinical Sciences, Malmö/Neurology Malmö, Lund University, Malmö, Sweden
| | - Peter Mannfolk
- Clinical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Andreas Jönsen
- Department of Clinical Sciences, Lund/Rheumatology, Lund University, Lund, Sweden
| | - Anders Bengtsson
- Department of Clinical Sciences, Lund/Rheumatology, Lund University, Lund, Sweden
| | - Petra Nilsson
- Department of Clinical Sciences, Lund/Neurology, Lund University, Lund, Sweden
| | - Pia C. Sundgren
- Department of Clinical Sciences, Lund/Diagnostic Radiology, Lund University, Lund, Sweden
- Department of Clinical Sciences/Centre for Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Tor O. Strandberg
- Department of Clinical Sciences, Lund/Memory Research Unit, Lund University, Lund, Sweden
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17
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Redel JM, DiFrancesco M, Vannest J, Altaye M, Beebe D, Khoury J, Dolan LM, Lee G, Brunner H, Holland S, Brady C, Shah AS. Brain gray matter volume differences in obese youth with type 2 diabetes: a pilot study. J Pediatr Endocrinol Metab 2018; 31:261-268. [PMID: 29373319 DOI: 10.1515/jpem-2017-0349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/22/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Adults with type 2 diabetes (T2D) have significantly lower gray matter volume (GMV) compared to healthy peers. Whether GMV differences exist in youth with T2D remains unclear. Thus, we compared global and regional GMV between obese youth with T2D with age, race and sex similar healthy controls. METHODS In a cross-sectional study, 20 obese youth with T2D underwent T1-weighted brain magnetic resonance imaging (MRI). Comparisons were made to 20 age, race and sex similar controls. Differences in global and regional GMV between groups were identified using voxel-based morphometry (VBM). RESULTS Youth with T2D had a significantly lower global GMV-to-intracranial volume ratio (0.51±0.02 in T2D vs. 0.53±0.02 in controls, p=0.02, Cohen's d=0.85). There were 14 regions where GMV was significantly lower in the T2D group, and nine of these were found in either the temporal or occipital lobes. There were six regions with increased GMV in T2D. All regional differences were significant at p<0.05 after adjusting for multiple comparisons. CONCLUSIONS Results from this pilot study show obese youth with T2D have significantly lower global GMV and regional GMV differences, when compared to their age, race and sex similar peers. Future work is needed to determine whether these brain findings are a direct result of adolescent-onset T2D.
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Affiliation(s)
- Jacob M Redel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, Phone: 513-636-4479, Fax: 513-803-1174
| | - Mark DiFrancesco
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dean Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jane Khoury
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lawrence M Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gregory Lee
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hermine Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott Holland
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cassandra Brady
- Division of Endocrinology and Diabetes, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Amy S Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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18
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Altered white matter microstructure in lupus patients: a diffusion tensor imaging study. Arthritis Res Ther 2018; 20:21. [PMID: 29415762 PMCID: PMC5803933 DOI: 10.1186/s13075-018-1516-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether white matter microstructure is altered in patients suffering from systemic lupus erythematosus (SLE), and if so, whether such alterations differed between patients with and without neuropsychiatric symptoms. METHODS Structural MRI and diffusion tensor imaging (DTI) were performed in 64 female SLE patients (mean age 36.9 years, range 18.2-52.2 years) and 21 healthy controls (mean age 36.7 years, range 23.3-51.2 years) in conjunction with clinical examination, laboratory tests, cognitive evaluation, and self-assessment questionnaires. The patients were subgrouped according to the American College of Rheumatology Neuropsychiatric Systemic Lupus Erythematosus case definitions into non-neuropsychiatric SLE (nonNPSLE) and neuropsychiatric SLE (NPSLE). RESULTS Comparisons between the SLE group and healthy controls showed that the mean fractional anisotropy (FA) was significantly reduced in the right rostral cingulum (p = 0.038), the mid-sagittal corpus callosum (CC) (p = 0.050), and the forceps minor of the CC (p = 0.015). The mean diffusivity (MD) was significantly increased in the left hippocampal cingulum (p = 0.017). No significant differences in MD or FA values were identified between NPSLE and nonNPSLE patients. Disease duration among all SLE patients correlated significantly with reduced FA in the CC (p < 0.05). No correlations were found between DTI parameters and white matter hyperintensities, SLE Disease Activity Index-2000, Systemic Lupus International Collaborating Clinical/ACR Organ Damage Index, or Montgomery Asberg Depression Rate Score Self-report. CONCLUSIONS We found alterations of white matter microstructure in SLE patients that were related to disease duration and fatigue. Our results indicate that cerebral involvement in SLE is not isolated to the NPSLE subgroup.
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19
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Zhen H, Zhao L, Ling Z, Kuo L, Xue X, Feng J. Wip1 regulates blood-brain barrier function and neuro-inflammation induced by lipopolysaccharide via the sonic hedgehog signaling signaling pathway. Mol Immunol 2017; 93:31-37. [PMID: 29128669 DOI: 10.1016/j.molimm.2017.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 12/20/2022]
Abstract
The blood brain barrier (BBB) is a diffusion barrier that maintains the brain environment. Wip1 is a nuclear phosphatase induced by many factors and involved in various stresses, tumorigenesis, organismal aging, and neurogenesis. Wip1's role in BBB integrity has not been thoroughly investigated. The purpose of the present study was to investigate the effect and mechanism of Wip1 on lipopolysaccharide (LPS)-induced BBB dysfunction and inflammation in an in vitro BBB model. The in vitro BBB model was established by co-culturing human brain-microvascular endothelial cells and human astrocytes and then exposing them to 1μg/ml LPS for 6, 12, 18, 24, and 48h. Wip1 expression was significantly elevated by LPS treatment. Knockdown of Wip1 aggravated the increased permeability and decreased transepithelial electrical resistance, protein expression of ZO-1, and occludin induced by LPS. Wip1 silencing augmented the elevated inflammatory cytokines TNF-α, IL-1β, IL-12, and IL-6 of the BBB induced by LPS, whereas overexpression of Wip1 showed a contrary effect. Sonic hedgehog signaling (SHH) was activated by Wip1 overexpression and inhibited by Wip1 silencing. Additionally, activating or inhibiting the SHH pathway by purmorphamine or cyclopamine, respectively, abolished the Wip1-induced changes in transepithelial electrical resistance and permeability and inflammatory responses in the LPS-injured BBB model. Our results demonstrate that Wip1 may protect the BBB against LPS-induced integrity disruption and inflammatory response through the SHH signaling pathway.
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Affiliation(s)
- Hong Zhen
- No. 2 Department of Neurology, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Cangzhou City, Hebei Province, China
| | - Lize Zhao
- No. 2 Department of Neurology, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Cangzhou City, Hebei Province, China
| | - Zhangjun Ling
- No. 2 Department of Neurology, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Cangzhou City, Hebei Province, China
| | - Li Kuo
- No. 2 Department of Neurology, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Cangzhou City, Hebei Province, China
| | - Xiarui Xue
- No. 2 Department of Neurology, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Cangzhou City, Hebei Province, China
| | - Jiaxiu Feng
- No. 2 Department of Neurology, Cangzhou Central Hospital, No. 16 Xinhua Western Road, Cangzhou City, Hebei Province, China.
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20
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Li K, Zhu X, Zhao S, Jackson A. Blood-brain barrier permeability of normal-appearing white matter in patients with vestibular schwannoma: A new hybrid approach for analysis of T 1 -W DCE-MRI. J Magn Reson Imaging 2017; 46:79-93. [PMID: 28117925 PMCID: PMC5484377 DOI: 10.1002/jmri.25573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/15/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To develop and assess a "hybrid" method that combines a first-pass analytical approach and the Patlak plot (PP) to improve assessment of low blood-brain barrier permeability from dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) data. MATERIALS AND METHODS Seven patients with vestibular schwannoma were enrolled. T1 -W DCE imaging was acquired on a 1.5T scanner. Normal-appearing white matter (NAWM) was divided into four regions of interest (ROIs) based on the magnitude of changes in longitudinal relaxation rate (ΔR1) after gadolinium administration. Kinetic analysis of ROI-averaged contrast agent concentration curves was performed using both the conventional PP and the hybrid method. Computer simulated uptake curves that resemble those from NAWM were analyzed with both methods. Percent deviations (PD) of the "measured" values from the "true" values were calculated to evaluate accuracy and precision of the two methods. RESULTS The simulation showed that, at a noise level of 4% (a noise level similar to the in vivo data) and using a signal intensity (SI) averaging scheme, the new hybrid method achieved a PD of 0.9 ± 2.7% for vp , and a PD of -5.4 ± 5.9% for Ktrans . In comparison, the PP method obtained a PD of 3.6 ± 11.3% for vp , and -8.3 ± 12.8% for Ktrans . One-way analyses of variance (ANOVAs) showed significant variations from the four WM regions (P < 10-15 for ΔR1; P < 10-6 for Ktrans ; P < 10-4 for vp ). CONCLUSION Both computer simulation and in vivo studies demonstrate improved reliability in vp and Ktrans estimates with the hybrid method. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:79-93.
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Affiliation(s)
- Ka‐Loh Li
- Division of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- CRUK and EPSRC Cancer Imaging Centre in Cambridge and ManchesterManchesterUK
| | - Xiaoping Zhu
- Division of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- CRUK and EPSRC Cancer Imaging Centre in Cambridge and ManchesterManchesterUK
| | - Sha Zhao
- Division of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- CRUK and EPSRC Cancer Imaging Centre in Cambridge and ManchesterManchesterUK
| | - Alan Jackson
- Division of Informatics, Imaging and Data SciencesUniversity of ManchesterManchesterUK
- CRUK and EPSRC Cancer Imaging Centre in Cambridge and ManchesterManchesterUK
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21
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Groot N, de Graeff N, Avcin T, Bader-Meunier B, Brogan P, Dolezalova P, Feldman B, Kone-Paut I, Lahdenne P, Marks SD, McCann L, Ozen S, Pilkington C, Ravelli A, Royen-Kerkhof AV, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European evidence-based recommendations for diagnosis and treatment of childhood-onset systemic lupus erythematosus: the SHARE initiative. Ann Rheum Dis 2017. [PMID: 28630236 DOI: 10.1136/annrheumdis-2016-210960] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a rare, multisystem and potentially life-threatening autoimmune disorder with significant associated morbidity. Evidence-based guidelines are sparse and management is often based on clinical expertise. SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) was launched to optimise and disseminate management regimens for children and young adults with rheumatic diseases like cSLE. Here, we provide evidence-based recommendations for diagnosis and treatment of cSLE. In view of extent and complexity of cSLE and its various manifestations, recommendations for lupus nephritis and antiphospholipid syndrome will be published separately. Recommendations were generated using the EULAR (European League Against Rheumatism) standard operating procedure. An expert committee consisting of paediatric rheumatologists and representation of paediatric nephrology from across Europe discussed evidence-based recommendations during two consensus meetings. Recommendations were accepted if >80% agreement was reached. A total of 25 recommendations regarding key approaches to diagnosis and treatment of cSLE were made. The recommendations include 11 on diagnosis, 9 on disease monitoring and 5 on general treatment. Topics included: appropriate use of SLE classification criteria, disease activity and damage indices; adequate assessment of autoantibody profiles; secondary macrophage activation syndrome; use of hydroxychloroquine and corticosteroid-sparing regimens; and the importance of addressing poor adherence. Ten recommendations were accepted regarding general diagnostic strategies and treatment indications of neuropsychiatric cSLE. The SHARE recommendations for cSLE and neuropsychiatric manifestations of cSLE have been formulated by an evidence-based consensus process to support uniform, high-quality standards of care for children with cSLE.
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Affiliation(s)
- Noortje Groot
- Wilhelmina Children's Hospital, Utrecht, Netherlands.,Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Tadej Avcin
- University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Paul Brogan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pavla Dolezalova
- General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Brian Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Pekka Lahdenne
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Stephen D Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Liza McCann
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Seza Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | | | - Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
| | | | - Yosef Uziel
- Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bas Vastert
- Wilhelmina Children's Hospital, Utrecht, Netherlands
| | | | - Sylvia Kamphuis
- Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Michael W Beresford
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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The blood brain barrier and neuropsychiatric lupus: new perspectives in light of advances in understanding the neuroimmune interface. Autoimmun Rev 2017; 16:612-619. [PMID: 28428121 DOI: 10.1016/j.autrev.2017.04.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 12/20/2022]
Abstract
Experts have previously postulated a linkage between lupus associated vascular pathology and abnormal brain barriers in the immunopathogenesis of neuropsychiatric lupus. Nevertheless, there are some discrepancies between the experimental evidence, or its interpretation, and the working hypotheses prevalent in this field; specifically, that a primary contributor to neuropsychiatric disease in lupus is permeabilization of the blood brain barrier. In this commonly held view, any contribution of the other known brain barriers, including the blood-cerebrospinal fluid and meningeal barriers, is mostly excluded from the discussion. In this review we will shed light on some of the blood brain barrier hypotheses and try to trace their roots. In addition, we will suggest new research directions to allow for confirmation of alternative interpretations of the experimental evidence linking the pathology of intra-cerebral vasculature to the pathogenesis of neuropsychiatric lupus.
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