1
|
Nakase T, Tatewaki Y, Thyreau B, Mutoh T, Tomita N, Yamamoto S, Takano Y, Muranaka M, Taki Y. Impact of constipation on progression of Alzheimer's disease: A retrospective study. CNS Neurosci Ther 2022; 28:1964-1973. [PMID: 35934956 PMCID: PMC9627372 DOI: 10.1111/cns.13940] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE In terms of the gut-brain axis, constipation has been considered to be an important factor of neurodegenerative diseases, although the exact mechanism is still controversial. Herein, we aimed to investigate the contribution of constipation to the progression of dementia in a retrospective study. METHODS Patients of Alzheimer's disease(AD) and amnestic mild cognitive impairment were consecutively screened between January 2015 and December 2020, and those of whom brain MRI and neuropsychological tests were performed twice were enrolled in this study. Participants were classified into with constipation (Cons[+], n = 20) and without constipation (Cons[-], n = 64) groups. Laboratory data at the first visit were used. Regression analysis was performed in MMSE, ADAS-Cog, and the volumes of hippocampus on MRI-MPRAGE images and deep white matter lesions (DWMLs) on MRI-FLAIR images obtained at two different time points. RESULTS The main finding was that the Cons[+] group showed 2.7 times faster decline in cognitive impairment compared with the Cons[-] group, that is, the liner coefficients of ADAS-Cog were 2.3544 points/year in the Cons[+] and 0.8592 points/year in the Cons[-] groups. Ancillary, changes of DWMLs showed significant correlation with the time span (p < 0.01), and the liner coefficients of DWMLs were 24.48 ml/year in the Cons[+] and 14.83 ml/year in the Cons[-] group, although annual rate of hippocampal atrophy was not different between the two groups. Moreover, serum homocysteine level at baseline was significantly higher in the Cons[+] group than Cons[-] group (14.6 ± 6.4 and 11.5 ± 4.2 nmol/ml, respectively: p = 0.03). CONCLUSION There is a significant correlation between constipation and faster progression of AD symptoms along with expansion of DWMLs.
Collapse
Affiliation(s)
- Taizen Nakase
- Smart Aging Research CenterTohoku UniversitySendaiJapan,Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Yasuko Tatewaki
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | | | - Tatsushi Mutoh
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Naoki Tomita
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Shuzo Yamamoto
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Yumi Takano
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Michiho Muranaka
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| | - Yasuyuki Taki
- Smart Aging Research CenterTohoku UniversitySendaiJapan,Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan
| |
Collapse
|
2
|
Coelho FC, Cerchiaro G, Araújo SES, Daher JPL, Cardoso SA, Coelho GF, Guimarães AG. Is There a Connection between the Metabolism of Copper, Sulfur, and Molybdenum in Alzheimer’s Disease? New Insights on Disease Etiology. Int J Mol Sci 2022; 23:ijms23147935. [PMID: 35887282 PMCID: PMC9324259 DOI: 10.3390/ijms23147935] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Alzheimer’s disease (AD) and other forms of dementia was ranked 3rd in both the Americas and Europe in 2019 in a World Health Organization (WHO) publication listing the leading causes of death and disability worldwide. Copper (Cu) imbalance has been reported in AD and increasing evidence suggests metal imbalance, including molybdenum (Mo), as a potential link with AD occurrence.We conducted an extensive literature review of the last 60 years of research on AD and its relationship with Cu, sulfur (S), and Mo at out of range levels.Weanalyzed the interactions among metallic elements’ metabolisms;Cu and Mo are biological antagonists, Mo is a sulfite oxidase and xanthine oxidase co-factor, and their low activities impair S metabolism and reduce uric acid, respectively. We found significant evidence in the literature of a new potential mechanism linking Cu imbalance to Mo and S abnormalities in AD etiology: under certain circumstances, the accumulation of Cu not bound to ceruloplasmin might affect the transport of Mo outside the blood vessels, causing a mild Mo deficiency that might lowerthe activity of Mo and S enzymes essential for neuronal activity. The current review provides an updated discussion of the plausible mechanisms combining Cu, S, and Mo alterations in AD.
Collapse
Affiliation(s)
- Fábio Cunha Coelho
- Laboratório de Fitotecnia (LFIT), Universidade Estadual do Norte Fluminense Darcy Ribeiro—UENF, Campos dos Goytacazes 28013-602, Brazil
- Correspondence: ; Tel.: +55-22-998509469
| | - Giselle Cerchiaro
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Av. dos Estados, 5001, Bl. B, Santo André 09210-170, Brazil;
| | - Sheila Espírito Santo Araújo
- Laboratório de Biologia Celular e Tecidual (LBCT), Universidade Estadual do Norte Fluminense Darcy Ribeiro—UENF, Campos dos Goytacazes 28013-602, Brazil; (S.E.S.A.); (A.G.G.)
| | - João Paulo Lima Daher
- Departamento de Patologia, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói 24210-350, Brazil;
| | - Silvia Almeida Cardoso
- Departamento de Medicina e Enfermagem (DEM), Universidade Federal de Viçosa, Viçosa 36579-900, Brazil;
| | - Gustavo Fialho Coelho
- Instituto de Ciências Médicas, Universidade Federal do Rio de Janeiro, Macaé 27930-560, Brazil;
| | - Arthur Giraldi Guimarães
- Laboratório de Biologia Celular e Tecidual (LBCT), Universidade Estadual do Norte Fluminense Darcy Ribeiro—UENF, Campos dos Goytacazes 28013-602, Brazil; (S.E.S.A.); (A.G.G.)
| |
Collapse
|
3
|
Plasma Neurofilament Light Chain Is Associated with Cognitive Impairment after Posterior Circulation Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2466982. [PMID: 35800005 PMCID: PMC9256396 DOI: 10.1155/2022/2466982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/28/2022] [Indexed: 12/03/2022]
Abstract
Background Neurofilament light chain (NfL) is a biomarker for large-caliber axonal degeneration in the subcortex. The purpose of this research was to examine the relationship between plasma neurofilament light chain (pNfL) and cognitive impairment following a posterior circulation stroke. Methods Patients over the age of 18 with their first-ever acute ischemic stroke (AIS) of the posterior cerebral circulation within 24 h of symptom onset were included from July 1, 2017, to December 31, 2019. Blood samples were collected within 48 h after the stroke. The Montreal Cognitive Assessment (MOCA) (MOCA < 26) was adopted to define poststroke cognitive impairment (PSCI) 90 days after stroke onset. Results A total of 264 patients were analyzed in this research 101 (38.30%) patients were clinically diagnosed with PSCI. The PNfL concentration was significantly higher in the PSCI group compared with the non-PSCI group (p < 0.001). The pNfL concentration (OR 1.044; p < 0.001) remained to be a significant predictor for PSCI after a multivariable logistic regression analysis, even after adjusting for factors including age, sex, education background (OR 1.044; p < 0.001), baseline NIHSS, infarct volume, and TOAST classification (OR 1.035; p < 0.001). The diagnostic efficacy of pNfL concentration for PSCI was then explored with a ROC analysis. The optimum pNfL concentration threshold was 38.12 pg/ml, with a sensitivity of 78.20%, a specificity of 66.9%, and an AUC of 0.782 (p < 0.001). Conclusion This research showed that pNfL concentration, independent of established conventional risk factors, could predict the cognitive impairment in 90 days following posterior circulation stroke.
Collapse
|
4
|
Nath M, Misra S, Nair P, Kumar P. Carotid intima-media thickness and risk of mild cognitive impairment: A systematic review and meta-analysis. Acta Neurol Scand 2022; 145:139-150. [PMID: 34672362 DOI: 10.1111/ane.13542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/10/2023]
Abstract
Mild cognitive impairment (MCI) is an early phase of cognitive decline signalling the beginning of severe neurological diseases. Carotid intima-media thickness (cIMT) has shown some correlation with MCI development. This study was conducted to investigate the impact of elevated cIMT on the risk of MCI in adults. A literature search was conducted in PubMed, EMBASE, Cochrane Library, Scopus, Google Scholar and CINAHL databases till 30 July 2021, with keywords: ('Carotid Intima-Media Thickness' OR 'cIMT' OR 'IMT' AND 'Cognitive Impairment' OR 'Cognition' OR 'Cognitive Decline' AND 'Mild Cognitive Impairment' OR 'MCI'). Pooled standardized mean difference (SMD)/odds ratio (OR) and 95% confidence interval (CI) were determined for factor-disease association using either fixed (when I2 <50%) or random effect (when I2 >50%) models. Eight studies involving 1,585 MCI cases and 6,700 normal subjects were included in our meta-analysis which showed no significant association of increased cIMT with the risk of MCI [SMD 1.17, 95% CI -0.09 to 2.42]. However, sensitivity analysis revealed an outlier study significantly affecting the effect size. On omitting the outlier study, the re-evaluated meta-analysis revealed a significant association of cIMT with the risk of MCI [SMD 0.52, 95% CI 0.26 to 0.78]. This significant association was also observed during subgroup analysis in Caucasian population [SMD 0.65, 95% CI 0.13 to 1.18] but not in Asian population [SMD 0.39, 95% CI -0.01 to 0.79]. Elevated cIMT poses a potential risk for MCI. However, more population-based studies are required to corroborate these findings.
Collapse
Affiliation(s)
- Manabesh Nath
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Shubham Misra
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Pallavi Nair
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Pradeep Kumar
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| |
Collapse
|
5
|
Association of Methylenetetrahydrofolate Reductase C677T Gene Polymorphisms with Mild Cognitive Impairment Susceptibility: A Systematic Review and Meta-Analysis. Behav Neurol 2021; 2021:2962792. [PMID: 34580600 PMCID: PMC8464412 DOI: 10.1155/2021/2962792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Methylenetetrahydrofolate reductase (MTHFR) C677T (rs1801133) gene polymorphisms are related to a growing risk of Alzheimer's disease; however, whether this association applies to mild cognitive impairment (MCI) remains unclear. Objective We conducted this meta-analysis to evaluate the contribution of MTHFR C677T (rs1801133) gene variants to the risk of MCI. Methods PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases were searched from their inception to March 21, 2021, with language restricted to English or Chinese. We used fixed or random effects to examine the association between MTHFR C677T (rs1801133) gene variants and MCI susceptibility. Forest plots of pooled odds ratios (ORs) and 95% confidence intervals (CIs) were generated. Results Eight articles with 2,175 participants were included in the present meta-analysis. There was no significant association between MTHFR C677T (rs1801133) gene variants and MCI susceptibility under the allelic (OR, 1.318; 95% CI, 0.964–1.801; p = 0.084), dominant (OR, 1.296; 95% CI, 0.925–1.817; p = 0.132), recessive (OR, 1.397; 95% CI, 0.845–2.312; p = 0.193), heterozygous (OR, 1.031; 95% CI, 0.855–1.243; p = 0.749), or homozygous (OR, 1.506; 95% CI, 0.850–2.667; p = 0.160) models. Conclusion The results suggest that MTHFR C677T (rs1801133) gene polymorphisms are not associated with MCI susceptibility. However, large-scale studies covering various factors are required.
Collapse
|
6
|
Etindele Sosso FA, Matos E. Socioeconomic disparities in obstructive sleep apnea: a systematic review of empirical research. Sleep Breath 2021; 25:1729-1739. [PMID: 33452999 DOI: 10.1007/s11325-020-02274-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 12/02/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Considering socioeconomic status (SES) in the diagnosis of obstructive sleep apnea (OSA) will enhance our understanding of socioeconomic disparities in clinical practice of sleep medicine. This systematic review analyzes the relations between SES and OSA measures. METHODOLOGY Eleven articles were identified through the Pubmed database. The National Institute of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to rate the quality of these studies. RESULTS This systematic review revealed that associations between socioeconomic status and OSA measures are similar for both adults, children, and adolescents. Our findings showed that: (1) A lower SES is associated with an increased risk of OSA, both in adults and children/adolescents as well as for men and women. (2) Several studies assessed sleep outcomes with a single question, an approach that is unable to capture the multi-dimensionality and day-to-day variability of sleep in general or OSA in particular, (3) Low SES has detrimental effects on sleep health. (4) Sleep questionnaires are more commonly used than objective measure to assess OSA. CONCLUSIONS Interaction between SES and OSA must be better understood to improve current clinical guidelines. Living conditions influence the trajectory of OSA with unknown speed and for an, undetermined period, pointing to the need for more studies on this topic. Future work should identify the effect of SES on the development and progression of OSA, determine the effect of behavioral intervention and local public health programs to reduce social inequalities associated with OSA.
Collapse
Affiliation(s)
- F A Etindele Sosso
- Department on Global Health and Ecoepidemiology, Redavi Institute, Montréal, Canada.
| | - E Matos
- Sleep Laboratory of Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro - Vila Real, Vila Real, Portugal
| |
Collapse
|
7
|
An Y, Feng L, Zhang X, Wang Y, Wang Y, Tao L, Qin Z, Xiao R. Dietary intakes and biomarker patterns of folate, vitamin B 6, and vitamin B 12 can be associated with cognitive impairment by hypermethylation of redox-related genes NUDT15 and TXNRD1. Clin Epigenetics 2019; 11:139. [PMID: 31601260 PMCID: PMC6787977 DOI: 10.1186/s13148-019-0741-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/08/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND B vitamins in the one-carbon metabolism pathway (folate, vitamin B6, and vitamin B12) have been implicated in DNA methylation, and their deficiency may contribute to cognitive decline through increased homocysteine (Hcy) levels and subsequent oxidative damage. The aim of this study was to investigate whether B vitamin deficiency and increased Hcy could interact with DNA methylation of oxidative-related genes and exacerbate cognitive impairment. METHODS Participants were selected from a large cohort study entitled the Effects and Mechanism Investigation of Cholesterol and Oxysterol on Alzheimer's disease (EMCOA) study. We included 2533 participants who completed a selection of comprehensive cognitive tests and a semiquantitative food frequency questionnaire (FFQ) and were followed for an average of 2.3 years. The longitudinal effects of B vitamin intake on cognitive decline were examined using linear mixed-effect models. Seven mild cognitive impairment (MCI) patients, in the predementia stage of Alzheimer's disease (AD), and fivev healthy controls were selected for the discovery of genome-wide differentially methylated CpG sites. Candidate oxidative stress-related genes significantly correlated with serum levels of B vitamins were selected for validation in 102 MCI patients and 68 controls. The correlations between DNA methylation levels and serum concentrations of B vitamins and oxidative biomarkers were analyzed with Spearman's correlation. The interactive effects of DNA methylation and B vitamins on cognitive performance were further evaluated by multiple linear regression. RESULTS In the prospective analysis, inadequate dietary intake of vitamin B12 was significantly associated with accelerated cognitive decline, whereas adequate folate, vitamin B6, and vitamin B12 intakes were significantly associated with better cognitive reserve. In the case-control analysis, the DNA methylation levels of NUDT15 and TXNRD1 were examined, and significantly hypermethylated sites were identified in MCI patients. Significant correlations of hypermethylated sites with serum levels of folate, homocysteine (Hcy), and oxidative biomarkers were observed, and interactive effects of B vitamins and hypermethylated sites were significantly associated with cognitive performance. CONCLUSION Adequate dietary folate at baseline predicted a better cognitive reserve, while decreased serum levels of B vitamins may contribute to cognitive impairment by affecting methylation levels of specific redox-related genes. TRIAL REGISTRATION EMCOA, ChiCTR-OOC-17011882, Registered 5th, July 2017-Retrospectively registered, http://www.medresman.org/uc/project/projectedit.aspx?proj=2610.
Collapse
Affiliation(s)
- Yu An
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Lingli Feng
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China.,Peking University First Hospital, Beijing, China
| | - Xiaona Zhang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Ying Wang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Yushan Wang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Lingwei Tao
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | | | - Rong Xiao
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China.
| |
Collapse
|
8
|
Zhu Z, Jiang S, Li C, Liu J, Tao M. Relationship between serum homocysteine and different menopausal stage. Climacteric 2019; 23:59-64. [PMID: 31294633 DOI: 10.1080/13697137.2019.1634045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study aimed to investigate the serum level of homocysteine in menopausal women and to explore the association between menopausal status, blood lipids, and homocysteine concentrations.Methods: The study recruited females aged 40-60 years who were not receiving menopausal hormone therapy. The demographic characteristics and menopausal status of the women were collected in the form of questionnaires. The study analyzed the association between hyperhomocysteinemia and variables using binary logistic stepwise regression.Results: Among 366 enrolled subjects, menopausal status was divided into four stages: premenopause stage (n = 135), menopausal transition stage (n = 91), early postmenopause stage (n = 87), and late postmenopause stage (n = 53). The proportion of hyperhomocysteinemia in the premenopausal stage, menopausal transition stage, and postmenopausal stage was 43%, 26.4%, and 45%, respectively (χ2 = 8.999, p = 0.011). The mean concentration of homocysteine was 9.75 µmol/l. The level of homocysteine was higher in the postmenopause stage than in the other stages (p = 0.043), and the difference between postmenopause and menopausal transition was statistically significant (p < 0.01). In the binary logic analysis, menopausal transition compared with postmenopause (odds ratio = 2.027, 95% confidence interval = 1.117-3.679, p = 0.005).Conclusions: Serum homocysteine levels are associated with menopausal status. Homocysteine concentrations were progressively higher across menopausal stages. The transformation in the female body across the menopause transition stages may cause elevations in the homocysteine level in postmenopausal women.
Collapse
Affiliation(s)
- Z Zhu
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - S Jiang
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - C Li
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - J Liu
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - M Tao
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
9
|
Roostaei T, Felsky D, Nazeri A, De Jager PL, Schneider JA, Bennett DA, Voineskos AN. Genetic influence of plasma homocysteine on Alzheimer's disease. Neurobiol Aging 2018; 62:243.e7-243.e14. [PMID: 29102475 PMCID: PMC6953632 DOI: 10.1016/j.neurobiolaging.2017.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/30/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
Abstract
Observational studies have consistently reported elevated plasma homocysteine as a risk factor for Alzheimer's disease (AD). However, results from clinical trials of homocysteine-lowering treatments are inconsistent. This discrepancy may be explained by a lack of causal association between homocysteine and AD. Mendelian randomization studies have the potential to provide insight into the causality of this association through studying the effect of genetic predisposition to high homocysteine on AD. Our analyses using summarized (n = 54,162) and individual participant (n = 6987) data from Caucasian participants did not show an effect of plasma homocysteine genetic risk on susceptibility to AD. Although with smaller sample sizes, further subanalyses also did not support an effect of genetically determined plasma homocysteine on cognitive impairment and decline, beta-amyloid and tau pathology and gray matter atrophy in AD. However, we found associations with tau tangle burden (n = 251) and gray matter atrophy (n = 605) in cognitively normal elderly. Our results do not support a causal association between elevated homocysteine and risk, severity, and progression of AD. However, the relationship between genetically determined homocysteine and brain pathology in cognitively normal elderly requires further exploration.
Collapse
Affiliation(s)
- Tina Roostaei
- Kimel Family Translational Imaging-Genetics Laboratory, Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Cell Circuits Program, Broad Institute, Cambridge, MA, USA; Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Daniel Felsky
- Cell Circuits Program, Broad Institute, Cambridge, MA, USA; Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Arash Nazeri
- Kimel Family Translational Imaging-Genetics Laboratory, Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Philip L De Jager
- Cell Circuits Program, Broad Institute, Cambridge, MA, USA; Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Aristotle N Voineskos
- Kimel Family Translational Imaging-Genetics Laboratory, Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Underserved Populations Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| |
Collapse
|
10
|
Wijesinghe P, Shankar SK, Yasha TC, Gorrie C, Amaratunga D, Hulathduwa S, Kumara KS, Samarasinghe K, Suh YH, Steinbusch HWM, De Silva KRD. Vascular Contributions in Alzheimer's Disease-Related Neuropathological Changes: First Autopsy Evidence from a South Asian Aging Population. J Alzheimers Dis 2018; 54:1607-1618. [PMID: 27589527 DOI: 10.3233/jad-160425] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Evidence from various consortia on vascular contributions has been inconsistent in determining the etiology of sporadic Alzheimer's disease (AD). OBJECTIVE To investigate vascular risk factors and cerebrovascular pathologies associated in manifestation of AD-related neuropathological changes of an elderly population. METHODS Postmortem brain samples from 76 elderly subjects (≥50 years) were used to study genetic polymorphisms, intracranial atherosclerosis of the circle of Willis (IASCW), and microscopic infarcts in deep white matters. From this cohort, 50 brains (≥60 years) were subjected to neuropathological diagnosis using immunohistopathological techniques. RESULTS Besides the association with age, the apolipoprotein E ɛ4 allele was significantly and strongly associated with Thal amyloid-β phases ≥1 [odds ratio (OR) = 6.76, 95% confidence interval (CI) 1.37-33.45] and inversely with Braak neurofibrillary tangle (NFT) stages ≥III (0.02, 0.0-0.47). Illiterates showed a significant positive association for Braak NFT stages ≥IV (14.62, 1.21-176.73) and a significant negative association for microscopic infarcts (0.15, 0.03-0.71) in deep white matters. With respect to cerebrovascular pathologies, cerebral small vessel lesions (white matter hyperintensities and cerebral amyloid angiopathy) showed a higher degree of associations among them and with AD-related neuropathological changes (p < 0.05) compared to large vessel pathology (IASCW), which showed a significant association only with Braak NFT stages ≥I (p = 0.050). CONCLUSION These findings suggest that besides age, education, and genetic factors, other vascular risk factors were not associated with AD-related neuropathological changes and urge prompt actions be taken against cerebral small vessel diseases since evidence for effective prevention is still lacking.
Collapse
Affiliation(s)
- Printha Wijesinghe
- Interdisciplinary Center for Innovation in Biotechnology & Neuroscience, Genetic Diagnostic and Research Laboratory, Department of Anatomy, Faculty of Medical Sciences, University of Srijayewardenepura, Nugegoda, Sri Lanka
| | - S K Shankar
- Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - T C Yasha
- Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Catherine Gorrie
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, Australia
| | | | - Sanjayah Hulathduwa
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Srijayewardenepura, Nugegoda, Sri Lanka
| | - K Sunil Kumara
- Department of Judicial Medical Office, Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Kamani Samarasinghe
- Department of Pathology, University of Srijayewardenepura, Nugegoda, Sri Lanka
| | - Yoo-Hun Suh
- Department of Pharmacology, College of Medicine, Seoul National University, Seoul, Korea.,NRI, Gachon University, Incheon, South Korea
| | - Harry W M Steinbusch
- Department of Translational Neuroscience, Faculty Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands
| | - K Ranil D De Silva
- Interdisciplinary Center for Innovation in Biotechnology & Neuroscience, Genetic Diagnostic and Research Laboratory, Department of Anatomy, Faculty of Medical Sciences, University of Srijayewardenepura, Nugegoda, Sri Lanka
| |
Collapse
|
11
|
Hernández-Socorro CR, Rodríguez-Esparragón FJ, Celli J, López-Fernández JC. Sonographic evaluation of atherosclerosis burden in carotid arteries of ischemic stroke patients and its relation to paraoxonase 1 and 2, MTHFR and AT1R genetic variants. J Neurol Sci 2017; 378:146-151. [PMID: 28566152 DOI: 10.1016/j.jns.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Common variants of the Paraoxonase (PON), 5-Methyl-Tetrahydrofolate-Reductase (MTHFR) and Angiotensin-II receptor 1 (AT1R) genes have been associated with ischemic stroke (IS) risk. Moreover, carotid atherosclerosis is a common cause of IS. The aim of this study is to explore whether variants in these genes associate with the severity of ultrasonographic determined atherosclerosis assessed in carotid arteries. PATIENTS AND METHODS Etiologic subtype of cerebral ischemia was determined according to the TOAST classification. Genotypes were detected by PCR and restriction analysis. An ultrasonographic supra-aortic trunks study was performed to all patients to assess their atherosclerotic involvement based on predefined criteria. RESULTS In IS patients, none of the analyzed gene distributions differed concerning the stenosis degree. Nevertheless, a trend was observed for the rs662 and rs7493 variants of the PON1 and PON2 genes respectively. When evaluated the results based on different inheritance models, a significant contribution of rs7493 variant according to a dominant (OR=2.397, 95% CI (1.001-5.376); p=0.045) and log-additive inheritance forms (OR=1.85, 95% CI (1.07-3.2); p=0.03) was observed. Only rs7493 reached statistical significance (p=0.013), when genotype distribution was analyzed according to carotid intima-media thickness (cIMT) and remain significant in multivariate logistic regression analysis (OR=2.66, 95% CI (1.1 to 6.4); p=0.03). CONCLUSION In IS patients of the north area of the Gran Canaria island the PON2 (rs7493) gene variant associates with a worse ultrasonographic profile. Conversely, the Cys311Cys homozygosis of the rs7493 variant was also related to a better ultrasonographic profile in our study.
Collapse
Affiliation(s)
- Carmen Rosa Hernández-Socorro
- Servicio de Radiología, Hospital Universitario de Gran Canaria Dr. Negrín (HUGCDN), Las Palmas de Gran Canaria, Gran Canaria, Spain; Unidad de Investigación, HUGCDN, Las Palmas de Gran Canaria, Gran Canaria, Spain; Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Gran Canaria, Spain.
| | - Francisco Javier Rodríguez-Esparragón
- Unidad de Investigación, HUGCDN, Las Palmas de Gran Canaria, Gran Canaria, Spain; Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Jennifer Celli
- Servicio de Radiología, Hospital Universitario de Gran Canaria Dr. Negrín (HUGCDN), Las Palmas de Gran Canaria, Gran Canaria, Spain; Unidad de Investigación, HUGCDN, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Juan Carlos López-Fernández
- Unidad de Investigación, HUGCDN, Las Palmas de Gran Canaria, Gran Canaria, Spain; Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Gran Canaria, Spain; Servicio de Neurología, HUGCDN, Las Palmas de Gran Canaria, Gran Canaria, Spain
| |
Collapse
|
12
|
Cai C, Xiao R, Van Halm-Lutterodt N, Zhen J, Huang X, Xu Y, Chen S, Yuan L. Association of MTHFR, SLC19A1 Genetic Polymorphism, Serum Folate, Vitamin B 12 and Hcy Status with Cognitive Functions in Chinese Adults. Nutrients 2016; 8:nu8100665. [PMID: 27783031 PMCID: PMC5084051 DOI: 10.3390/nu8100665] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 12/26/2022] Open
Abstract
Background/Aim: Studies have indicated a relationship between either gene polymorphism or in vivo B vitamins’ nutritional status with cognition in the elderly. However, the combined effects of MTHFR and SLC19A1gene polymorphism with serum folate and vitamin B12 levels on cognition in Chinese adult population remain unclear. Methods: Demographic information of 426 Chinese adults aged from 55 to 90 were collected by a well designed self-administered questionnaire. The Montreal Cognitive Assessment test was utilized to evaluate the cognition status of the participants. MTHFR and SLC19A1 genotyping was analyzed using polymerase chain reaction-ligase detection reaction (PCR- LDR) method. Serum folate, vitamin B12 and homocysteine (Hcy) levels were detected by commercial assay kits. Pearson’s correlation was used for data analyses and statistical significance was set at p < 0.05. Results: Serum Hcylevels demonstrated a negative correlation with serum folate (r = −0.301) and vitamin B12 (r = −0.292) levels. The negative correlation found between serum Hcy levels and attention ability was observed in all 426 studied subjects (r = −0.122). Subjects with MTHFR 677 T/T and 1298 A/A genotypes demonstrated a higher serum Hcy levels (p < 0.05). Carriers of MTHFR (1298 A/C + C/C and 1793 G/A) and SLC19A1 80 G/G genotypes showed lower abstraction and delayed memory ability, respectively (p < 0.05). Subjects with MTHFR 1793 G/A genotype along with low serum folate concentration demonstrated the lowest name and orientation abilities. The effects of MTHFR 1793 G/A genotype on cognitive performance were dependent on the status of serum vitamin B12. Conclusion: Cognition of adults was associated with MTHFR, SLC19A1 gene polymorphism and serum Hcy levels. This study clearly establishes a combined effect of MTHFR gene polymorphism and serum B vitamins levels on cognition in Chinese adults.
Collapse
Affiliation(s)
- Can Cai
- School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Rong Xiao
- School of Public Health, Capital Medical University, Beijing 100069, China.
| | | | - Jie Zhen
- School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Xiaochen Huang
- School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Yao Xu
- School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Shuying Chen
- School of Public Health, Capital Medical University, Beijing 100069, China.
| | - Linhong Yuan
- School of Public Health, Capital Medical University, Beijing 100069, China.
| |
Collapse
|
13
|
Setién-Suero E, Suárez-Pinilla M, Suárez-Pinilla P, Crespo-Facorro B, Ayesa-Arriola R. Homocysteine and cognition: A systematic review of 111 studies. Neurosci Biobehav Rev 2016; 69:280-98. [PMID: 27531233 DOI: 10.1016/j.neubiorev.2016.08.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 06/14/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Elevated plasma homocysteine (Hcy) levels have been associated with cognitive dysfunction in a wide range of conditions. The aim of this review is to establish which cognitive domains and populations are the most affected. METHODS We systematically review the literature and consider all articles that showed any relationship between plasma Hcy levels and scores achieved on cognitive performance tests in both, the general population and patients suffering from central nervous system disorders and other diseases. When effect sizes were available and combinable, several meta-analyses were performed. RESULTS We found 111 pertinent articles. There were 24 cohort studies, 18 randomized trials, 21 case-control studies, and 48 cross-sectional studies. This review reveals a positive trend between cognitive decline and increased plasma Hcy concentrations in general population and in patients with cognitive impairments. Results from the meta-analyses also confirm this trend. Treatment with vitamin supplementation fails to show a reduction in cognitive decline. DISCUSSION Further investigations are warranted to clarify this relationship. Earlier detection of the elevated Hcy levels may be an effective intervention to prevent cognitive impairment and dementia.
Collapse
Affiliation(s)
- Esther Setién-Suero
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.
| | - Marta Suárez-Pinilla
- Sackler Centre for Consciousness Science, Department of Informatics, University of Sussex, United Kingdom
| | - Paula Suárez-Pinilla
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Benedicto Crespo-Facorro
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Rosa Ayesa-Arriola
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| |
Collapse
|
14
|
Casado-Naranjo I, Romero Sevilla R, Portilla Cuenca JC, Duque de San Juan B, Calle Escobar ML, Fernández Pereira L, Fuentes JM, Ramírez-Moreno JM. Association between subclinical carotid atherosclerosis, hyperhomocysteinaemia and mild cognitive impairment. Acta Neurol Scand 2016; 134:154-9. [PMID: 26503595 DOI: 10.1111/ane.12525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Evidence suggests that intima-media thickness (IMT) and plasma homocysteine (Hcy) levels are associated with one another, and both appear to be related to cognitive dysfunction. However, no connection between both factors taken together and mild cognitive impairment (MCI) has been established. This study analysed potential relationships between IMT, Hcy and MCI. METHODS We included 105 patients with MCI and 76 controls with no history of vascular disease. All participants underwent laboratory analyses, a carotid ultrasound, and clinical and neuropsychological assessment. We used the Mantel-Haenszel test (MHT), ANCOVA and multiple linear regression models (MLRM) to examine any associations between IMT, Hcy and cognitive state. RESULTS The MHT revealed a significant association between IMT and risk of MCI (z = 4.285, P < 0.0001). The OR for the upper quartile vs the lower quartile was 5.12 (95% CI: 2.12-12.36). MHT also showed a clear association between Hcy levels and risk of MCI (z = 3.01, P = 0.003). OR for the upper vs the lower quartile was 3.39 (95% CI: 1.41-8.12). Additionally, we found a correlation between IMT and Hcy (r = 0.162, P = 0.032). CONCLUSIONS Our results suggest that there is a connection between IMT, Hcy levels and presence of amnestic MCI in a population with no history of clinically manifest atherosclerosis. Furthermore, there is also a connection between the IMT and Hcy levels themselves.
Collapse
Affiliation(s)
- I. Casado-Naranjo
- Department of Neurology; Hospital San Pedro de Alcántara; Cáceres Spain
- CIBERNED; Department of Biochemistry and Molecular Biology and Genetics; Nursing College; Universidad de Extremadura; Cáceres Spain
| | - R. Romero Sevilla
- Department of Neurology; Hospital San Pedro de Alcántara; Cáceres Spain
| | | | | | | | | | - J. M. Fuentes
- CIBERNED; Department of Biochemistry and Molecular Biology and Genetics; Nursing College; Universidad de Extremadura; Cáceres Spain
| | | |
Collapse
|
15
|
Manso-Calderón R, González-Sarmiento R. Genetic susceptibility to vascular cognitive impairment: a pathophysiological view. FUTURE NEUROLOGY 2016. [DOI: 10.2217/fnl-2016-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The heterogeneity of the vascular cognitive impairment (VCI) creates challenges for research on its genetic basis and pathophysiology. Despite well-known monogenic forms may be useful to understand some pathogenic mechanisms leading to VCI, most of VCIs are sporadic disorders resulting from the interaction between environmental, vascular and genetic factors. Genetic investigation for VCI may encompass both candidate genes that affect critical biological processes to VCI and common and rare genetic variants identified across the entire genome study technology, thereby enabling us to confirm or expose new biological mechanisms in VCI and develop new therapeutic and preventive approaches. Notwithstanding genetic susceptibility to VCI remains largely unknown owing to methodological issues. Collaborative efforts emerge as an interesting strategy to overcome these problems.
Collapse
Affiliation(s)
- Raquel Manso-Calderón
- Department of Neurology, University Hospital of Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca-CSIC-SACYL, Salamanca, Spain
| | - Rogelio González-Sarmiento
- Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca-CSIC-SACYL, Salamanca, Spain
- Molecular Medicine Unit, Department of Medicine & Institute of Molecular & Cellular Biology of Cancer (IBMCC). University of Salamanca-CSIC, Salamanca, Spain
| |
Collapse
|
16
|
MMP-9 gene ablation mitigates hyperhomocystenemia-induced cognition and hearing dysfunction. Mol Biol Rep 2015; 41:4889-98. [PMID: 24874304 DOI: 10.1007/s11033-014-3425-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hyperhomocysteinemia (HHcy) is associated with cognitive decline and hearing loss due to vascular dysfunction. Although we have shown that HHcy-induced increased expression of matrix metalloproteinase-9 (MMP-9) is associated with cochlear pathology in cystathionine-β-synthase heterozygous (CBS(+/-)) mice, it is still unclear whether MMP-9 contributes to functional deficit in cognition and hearing. Therefore, we hypothesize that HHcy-induced MMP-9 activation causes vascular, cerebral and cochlear remodeling resulting in diminished cognition and hearing. Wildtype (WT), CBS(+/-), MMP-9(-/-) and CBS(+/-)/MMP-9(-/-) double knock-out (DKO) mice were genotyped and used. Doppler flowmetry of internal carotid artery (ICA) was performed for peak systolic velocity [PSV], pulsatility index [PI] and resistive index [RI]. Cognitive functions were assessed by Novel Object Recognition Test (NORT) and for cochlear function Auditory brainstem response (ABR) was elicited. Peak systolic velocity, pulsatility and resistive indices of ICA were decreased in CBS(+/-) mice, indicating reduced perfusion. ABR threshold was increased and maximum ABR amplitude and NORT indices (recognition, discrimination) were decreased in CBS(+/-) mice compared to WT and MMP-9(-/-). All these parameters were attenuated in DKO mice suggesting a significant role of MMP-9 in HHcy-induced vascular, neural and cochlear pathophysiology. Regression analysis of PSV with ABR and cognitive parameters revealed significant correlation (0.44-0.58). For the first time, MMP-9 has been correlated directly to functional deficits of brain and cochlea, and found to have a significant role. Our data suggests a dual pathology of HHcy occurring due to a decrease in blood supply (vasculo-neural and vasculo-cochlear) and direct tissue remodeling.
Collapse
|
17
|
Qu BG, Wang H, Liu YX, Jia YG, Su JL, Wang ZD, Wang YF, Han XH, Pan JD, Guang-Ying. Causes of Thickening of Carotid Intima-Media Thickness in Patients With Alcoholic Liver Disease: A Prospective Observational Study. Medicine (Baltimore) 2015; 94:e1087. [PMID: 26181540 PMCID: PMC4617078 DOI: 10.1097/md.0000000000001087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 12/21/2022] Open
Abstract
Several studies have reported the relationship between alcoholic liver disease (ALD) and carotid intima-media thickness (CIMT). Few studies, however, have investigated the causes of CIMT thickening in patients with ALD. The authors explored the causes of CIMT thickening in patients with ALD. The authors enrolled 152 patients who were stratified into groups: nonthickening CIMT with ALD (group A); thickening CIMT with ALD (group B); nonthickening CIMT without ALD (group C); and thickening CIMT without ALD (group D). The CIMT was significantly different between patients with and without ALD (χ 2= 3.875, P = 0.049). The patients in groups A, B, and C were significantly younger than group D (P = 0.001, 0.036, and 0.001, respectively). The body mass indexes (BMI) in groups A and B were significantly higher than in group C (P = 0.000 and 0.007, respectively). The blood glucose levels in groups B and D were significantly higher than in group C (P = 0.016 and 0.018, respectively). The blood uric acid levels in group B were significantly higher than in groups A, C, and D (P = 0.009, 0.000, and 0.003, respectively). The blood uric acid in group A was significantly higher than in group C (P = 0.002). The serum total cholesterol (TC) levels of patients in group B were significantly higher than in groups A and C (P = 0.027 and 0.000, respectively) and the serum TC level in group A was significantly higher than in group C (P = 0.048). The serum triglyceride (TG) levels in groups A and B were significantly higher than in group C (P = 0.027 and 0.000, respectively). The serum of very low-density lipoprotein (VLDL) levels in group B were significantly higher than in group C (P = 0.000). Although a comparison of the low-density lipoprotein (LDL) and high-density lipoprotein (HDL) serum levels among the 4 groups indicated no changes. The serum LDL levels in group B were significantly higher than in group A (P = 0.008). No significant differences were observed among the groups with respect to serum homocysteine, C-reactive protein (CRP), interleukin-6 (IL-6), malondialdehyde (MDA), superoxide dismutase (SOD), soluble OX40 ligand (sOX40L), or heat shock protein (HSP) 60 or 70. Alcoholic liver disease may result in CIMT thickening. Carotid intima-media thickness is associated with age and metabolic factors in patients with ALD. In addition, ALD might promote the premature occurrence of CIMT thickening. The thickening of carotid artery intima thickness, however, is not associated with cytokine profiles, oxidative balance, or immune responses in patients with ALD.
Collapse
Affiliation(s)
- Bao-Ge Qu
- Department of Gastroenterology, Taishan Hospital; Taishan Medical College, Taian, Shandong, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Gupta A, Iadecola C. Impaired Aβ clearance: a potential link between atherosclerosis and Alzheimer's disease. Front Aging Neurosci 2015; 7:115. [PMID: 26136682 PMCID: PMC4468824 DOI: 10.3389/fnagi.2015.00115] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/29/2015] [Indexed: 11/14/2022] Open
Abstract
Alzheimer’s Disease (AD) and atherosclerosis remain two of the largest public health burdens in the world today. Although traditionally considered distinct pathological entities, mounting epidemiologic, clinical and experimental evidence suggests that cerebrovascular atherosclerosis and AD interact reciprocally to disrupt brain structure and function. Whereas the hypoperfusion and hypoxia caused by atherosclerosis of cerebral vessels may enhance the production of amyloid-β peptide (Aβ), a peptide central to AD pathology, Aβ, in turn, may promote formation of atherosclerotic lesions through vascular oxidative stress and endothelial dysfunction leading to additional vascular damage. Here, we briefly review evidence suggesting that impaired clearance of Aβ is an additional, simultaneously occurring mechanism by which AD and cerebrovascular disease may be causally linked. We examine the literature supporting mechanisms by which flow-limiting large-artery stenosis, arterial stiffening and microvascular dysfunction could contribute to AD pathophysiology by impairing Aβ clearance and elevating brain levels of Aβ. Finally, we highlight the need for further research to improve our understanding of the complex interactions of AD and atherosclerosis with Aβ clearance, which may ultimately serve to guide the development of novel diagnostic and therapeutic approaches for this devastating and highly prevalent condition.
Collapse
Affiliation(s)
- Ajay Gupta
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA ; Department of Radiology, Weill Cornell Medical College New York, NY, USA
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
| |
Collapse
|
19
|
Luo M, Ji H, Zhou X, Liang J, Zou T. Correlation of homocysteine metabolic enzymes gene polymorphism and mild cognitive impairment in the Xinjiang Uygur population. Med Sci Monit 2015; 21:326-32. [PMID: 25625218 PMCID: PMC4316859 DOI: 10.12659/msm.893226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate the genetic polymorphisms in the homocysteine (HCY) metabolic enzymes in the Xinjiang Uygur population who have mild cognitive impairment (MCI). Material/Methods Based on the epidemiological investigation, 129 cases of diagnosed Uygur MCI patients and a matched control group with 131 cases were enrolled for analyzing the association between the polymorphisms in the HCY metabolism related genes (C677T, A1298C, and G1968A polymorphisms in MTHFR, as well as the A2756G polymorphism in MS) and MCI by using the SNaPshot method. We then determined the homocysteine level in patients. Results In Xinjiang Uygur subjects, the A1298C polymorphisms in MTHFR and the A2756G polymorphisms in the MS gene in the MCI group were different from those in the control group. However, the C677T and G1968A polymorphisms in the MTHFR gene in MCI patients were not different from those in the control group. Multivariate logistic regression showed that, in addition to the well-known risk factors, such as low education level, high cholesterol level, high level of low-density lipoprotein, and high homocysteine levels, the A>G mutation in the MS gene at the rs1805087 locus was another independent risk factor for MCI in the Uyghur MCI population. The risk of MCI in G allele carriers was 2.265 times higher than that in matched control individuals (95% CI: 1.205~4.256, P<0.05). Conclusions The genetic polymorphism of HCY metabolizing enzymes is correlated to the occurrence of MCI in the Xinjiang Uygur population. The A2756G polymorphism in the MS gene could be an independent risk factor for MCI in the Xinjiang Uygur population.
Collapse
Affiliation(s)
- Mei Luo
- 1st Department of Cadres Internal Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Huihui Ji
- Ningbo Key Lab of Behavior Neuroscience, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang, China (mainland)
| | - Xiaohui Zhou
- 1st Department of Cadres Internal Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jie Liang
- 3rd Department of Cadres Internal Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Ting Zou
- 1st Department of Cadres Internal Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| |
Collapse
|
20
|
Mitchell ES, Conus N, Kaput J. B vitamin polymorphisms and behavior: evidence of associations with neurodevelopment, depression, schizophrenia, bipolar disorder and cognitive decline. Neurosci Biobehav Rev 2014; 47:307-20. [PMID: 25173634 DOI: 10.1016/j.neubiorev.2014.08.006] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 07/11/2014] [Accepted: 08/18/2014] [Indexed: 11/16/2022]
Abstract
The B vitamins folic acid, vitamin B12 and B6 are essential for neuronal function, and severe deficiencies have been linked to increased risk of neurodevelopmental disorders, psychiatric disease and dementia. Polymorphisms of genes involved in B vitamin absorption, metabolism and function, such as methylene tetrahydrofolate reductase (MTHFR), cystathionine β synthase (CβS), transcobalamin 2 receptor (TCN2) and methionine synthase reductase (MTRR), have also been linked to increased incidence of psychiatric and cognitive disorders. However, the effects of these polymorphisms are often quite small and many studies failed to show any meaningful or consistent associations. This review discusses previous findings from clinical studies and highlights gaps in knowledge. Future studies assessing B vitamin-associated polymorphisms must take into account not just traditional demographics, but subjects' overall diet, relevant biomarkers of nutritional status and also analyze related genetic factors that may exacerbate behavioral effects or nutritional status.
Collapse
Affiliation(s)
- E Siobhan Mitchell
- Nestle Institute of Health Science, Innovation Park, EPFL Campus, Lausanne 1015, Switzerland.
| | - Nelly Conus
- Nestle Institute of Health Science, Innovation Park, EPFL Campus, Lausanne 1015, Switzerland
| | - Jim Kaput
- Nestle Institute of Health Science, Innovation Park, EPFL Campus, Lausanne 1015, Switzerland
| |
Collapse
|
21
|
Jung JM, Kwon DY, Han C, Jo I, Jo SA, Park MH. Increased carotid intima-media thickness and plasma homocysteine levels predict cardiovascular and all-cause death: a population-based cohort study. Eur Neurol 2013; 70:1-5. [PMID: 23636001 DOI: 10.1159/000343807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/07/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is still debate over the utility of carotid intima-media thickness (C-IMT) or carotid plaque in predicting future cardiovascular events and death. Additionally, the importance of plasma homocysteine levels was raised as a predictor of cardiovascular events and death. METHODS 1,391 subjects were recruited from the Ansan Geriatric cohort. We used B-mode carotid ultrasonography to assess C-IMT and plaque, measuring average maximal IMT and average mean IMT through 6-8 measurements of far-wall IMT in both common carotid arteries. We evaluated the presence of plaque in carotid segments. Multivariable Cox regression analysis was used to predict both cardiovascular and all-cause mortality. RESULTS During a mean follow-up of 62.4 ± 12.4 months, 71 subjects (5.12%) died and 23 (1.66%) died of cardiovascular causes. Multivariable Cox regression analysis found the predictors of cardiovascular mortality to be average maximal IMT (HR = 3.709; 95% CI: 1.202-11.446) and plasma homocysteine (HR = 1.057; 95% CI: 1.012-1.103). All-cause mortality was independently associated with C-IMT (average maximal and average mean IMT) and plasma homocysteine. CONCLUSIONS C-IMT and plasma homocysteine levels were found to predict cardiovascular and all-cause mortality independently of the presence of carotid plaque and other cardiovascular risk factors.
Collapse
Affiliation(s)
- Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | | | | | | | | | | |
Collapse
|
22
|
Squitti R, Siotto M, Salustri C, Polimanti R. Metal Dysfunction in Alzheimer’s Disease. STUDIES ON ALZHEIMER'S DISEASE 2013. [DOI: 10.1007/978-1-62703-598-9_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
23
|
Kotze MJ, van Rensburg SJ. Pathology supported genetic testing and treatment of cardiovascular disease in middle age for prevention of Alzheimer's disease. Metab Brain Dis 2012; 27:255-66. [PMID: 22552896 PMCID: PMC3429783 DOI: 10.1007/s11011-012-9296-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/15/2012] [Indexed: 11/30/2022]
Abstract
Chronic, multi-factorial conditions caused by a complex interaction between genetic and environmental risk factors frequently share common disease mechanisms, as evidenced by an overlap between genetic risk factors for cardiovascular disease (CVD) and Alzheimer's disease (AD). Single nucleotide polymorphisms (SNPs) in several genes including ApoE, MTHFR, HFE and FTO are known to increase the risk of both conditions. The E4 allele of the ApoE polymorphism is the most extensively studied risk factor for AD and increases the risk of coronary heart disease by approximately 40%. It furthermore displays differential therapeutic responses with use of cholesterol-lowering statins and acetylcholinesterase inhibitors, which may also be due to variation in the CYP2D6 gene in some patients. Disease expression may be triggered by gene-environment interaction causing conversion of minor metabolic abnormalities into major brain disease due to cumulative risk. A growing body of evidence supports the assessment and treatment of CVD risk factors in midlife as a preventable cause of cognitive decline, morbidity and mortality in old age. In this review, the concept of pathology supported genetic testing (PSGT) for CVD is described in this context. PSGT combines DNA testing with biochemical measurements to determine gene expression and to monitor response to treatment. The aim is to diagnose treatable disease subtypes of complex disorders, facilitate prevention of cumulative risk and formulate intervention strategies guided from the genetic background. CVD provides a model to address the lifestyle link in most chronic diseases with a genetic component. Similar preventative measures would apply for optimisation of heart and brain health.
Collapse
Affiliation(s)
- Maritha J. Kotze
- Division of Anatomical Pathology, Faculty of Health Sciences, University of Stellenbosch, PO Box 19063 Tygerberg, 7505, South Africa
| | - Susan J. van Rensburg
- Division of Chemical Pathology, National Health Laboratory Service and University of Stellenbosch, Tygerberg Hospital, PO Box 19113 Tygerberg 7505, South Africa
| |
Collapse
|
24
|
Chen RH, Jiang XZ, Zhao XH, Qin YL, Gu Z, Gu PL, Zhou B, Zhu ZH, Xu LY, Zou YF. Risk factors of mild cognitive impairment in middle aged patients with type 2 diabetes: a cross-section study. ANNALES D'ENDOCRINOLOGIE 2012; 73:208-12. [PMID: 22704263 DOI: 10.1016/j.ando.2012.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 04/07/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED The aim of this study was to evaluate the risk factors of mild cognitive impairment (MCI) in middle-aged patients with type 2 diabetes (T2DM). METHODS Montreal Cognitive Assessment (MoCA) was applied as cognition assessment implement. One hundred and fifty-seven middle-aged type 2 diabetic patients were enrolled in this cross-section study (age 40~69, mean age 55 ± 7). There were 93 patients with MCI (MoCA score<26) in MCI group and 64 with normal cognitive function (MoCA score ≥ 26) in control group. Information of history of disease, family history, data of BMI, WHR, HbA1c, FINS, C-Peptide (C-P), SBP, DBP, blood lipid (TG, TC, LDL-C, HDL-C and carotid ultrasound (carotid IMT, carotid resistance index [RI]) was collected. RESULTS There were significant differences in the rate of patients with hypertension ([40.63 vs. 58.06%], P=0.026), duration of diabetes mellitus ([3.09 ± 4.04 y vs. 4.80 ± 4.94 y], P=0.024), C-P ([2.79 ± 1.09 ng/ml vs. 2.26 ± 1.00 ng/ml], P=0.008), Max C-IMT ([0.81 ± 0.15 mm vs. 0.91 ± 0.15 mm], P<0.001), Min C-RI (0.71 ± 0.06 vs. 0.68 ± 0.06, P<0.05), and no significant differences in the duration of hypertension and hyperlipidemia, BMI, WHR, HbA1c, SBP, DBP and blood lipid between control group and MCI group. MoCA scores were positively correlated with C-P (r=0.252, P=0.005), and negatively correlated with the history of hypertension (r=-0.244, P=0.002), duration of DM (r=-0.161, P=0.044), Max C-IMT (r=-0.253, P=0.005) and Min C-RI (r=-0.183, P=0.023). Multiple regression analysis showed that history of hypertension (Beta=-0.267, P=0.002), C-P (Beta=0.281, P=0.001) and Min C-RI (Beta=-0.221, P=0.011) were significantly independent determinants for the MoCA scores. CONCLUSIONS The longer duration of diabetes, history of hypertension, lower serum C-P levels, thickened C-IMT and higher C-RI could be risk factors of MCI in type 2 diabetic patients. This finding could have an important impact on the management of cognitive decline in diabetic patients.
Collapse
Affiliation(s)
- Rui-Hua Chen
- Department of Endocrinology, Pudong New Area People's Hospital, Chuan Huan Nan Road No. 490, Shanghai, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
The 894G > T (Glu298Asp) variant in the endothelial NOS gene and MTHFR polymorphisms influence homocysteine levels in patients with cognitive decline. Neuromolecular Med 2011; 13:167-74. [PMID: 21607713 DOI: 10.1007/s12017-011-8148-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 05/10/2011] [Indexed: 02/07/2023]
Abstract
The presence and severity of cerebrovascular pathological findings have been shown to increase the risk and stage of cognitive decline observed in Alzheimer's disease and vascular dementia. Thus, the modification of vascular risk factors seems useful to reduce the risk of dementia regardless of type. Hyperhomocysteinemia has long been known as a major independent risk factor for vascular dysfunction. In this study, we evaluated the relationships between plasma homocysteine levels and genetic risk factors for hyperhomocysteinemia, i.e., the presence of gene variants for methylenetetrahydrofolate reductase (MTHFR) and endothelial nitric oxide synthase (eNOS) in patients with cognitive impairment. Genotyping for MTHFR C677T and eNOS 894G > T polymorphisms was carried out in 69 patients with probable diagnosis of AD and anamnestic mild cognitive impairment, matched for age and gender with 69 healthy volunteers. Patients with MTHFR TT677 genotype showed higher plasma Hcy levels than controls, even after adjustment for folate levels (P < 0.05). Moreover, Hcy plasma levels were higher in cases than controls for any given eNOS genotype. In particular, the presence of eNOS TT894 genotype in patients with cognitive decline resulted significantly associated with increased plasma Hcy levels when compared with controls having the same genotype or patients having other eNOS genotypes (P = 0.02). These data suggest that both MTHFR C677T and eNOS G894T variants should be regarded as genetic risk factors for hyperhomocysteinemia in patients with cognitive decline.
Collapse
|
26
|
Roher AE, Garami Z, Tyas SL, Maarouf CL, Kokjohn TA, Belohlavek M, Vedders LJ, Connor D, Sabbagh MN, Beach TG, Emmerling MR. Transcranial doppler ultrasound blood flow velocity and pulsatility index as systemic indicators for Alzheimer's disease. Alzheimers Dement 2011; 7:445-55. [PMID: 21388892 DOI: 10.1016/j.jalz.2010.09.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 06/30/2010] [Accepted: 09/21/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND Multiple lines of evidence suggest that cardiovascular co-morbidities hasten the onset of Alzheimer's disease (AD) or accelerate its course. METHODS To evaluate the utility of cerebral vascular physical function and/or condition parameters as potential systemic indicators of AD, transcranial Doppler (TCD) ultrasound was used to assess cerebral blood flow and vascular resistance of the 16 arterial segments comprising the circle of Willis and its major tributaries. RESULTS Our study showed that decreased arterial mean flow velocity and increased pulsatility index are associated with a clinical diagnosis of presumptive AD. Cerebral blood flow impairment shown by these parameters reflects the global hemodynamic and structural consequences of a multifaceted disease process yielding diffuse congestive microvascular pathology, increased arterial rigidity, and decreased arterial compliance, combined with putative age-associated cardiovascular output declines. CONCLUSIONS TCD evaluation offers direct physical confirmation of brain perfusion impairment and might ultimately provide a convenient and a noninvasive means to assess the efficacy of medical interventions on cerebral blood flow or reveal incipient AD. In the near term, TCD-based direct assessments of brain perfusion might offer the prospect of preventing or mitigating AD simply by revealing patients who would benefit from interventions to improve circulatory system function.
Collapse
Affiliation(s)
- Alex E Roher
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, AZ, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Givvimani S, Sen U, Tyagi N, Munjal C, Tyagi SC. X-ray imaging of differential vascular density in MMP-9-/-, PAR-1-/+, hyperhomocysteinemic (CBS-/+) and diabetic (Ins2-/+) mice. Arch Physiol Biochem 2011; 117:1-7. [PMID: 20839901 PMCID: PMC3236441 DOI: 10.3109/13813455.2010.512042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although protease activated receptor-1 (PAR-1) and matrix metalloproteinase-9 (MMP-9) play significant role in vascular remodelling in hyperhomocysteinemia (HHcy due to cystathionine beta synthase deficiency, CBS-/+) and diabetes, mechanism remains nebulous. We hypothesized that differential vascular density and remodelling in different vascular beds in HHcy and diabetes were responsible for an adaptive metabolic homeostasis during the pathogenesis. To test this hypothesis, vascular density in mice lacking PAR-1, MMP-9, CBS and Insulin-2 gene mutant (Ins2-/+, Akita) was measured and compared with wild type (WT, C57BL/6J) mice. The vascular density was detected by x-ray angiography using KODAK 4000 MM image station, using barium sulphate as contrasting agent. The % vascular density in the hearts of WT, CBS-/+ (HHcy), MMP-9-/-, PAR-1-/+ and Ins2-/+ (type-1 diabetes) was 100 ± 2.8, 85 ± 3.3, 90 ± 3.3, 95 ± 3.8 and 73 ± 1.7, respectively. The vascular density in CBS-/+ and Akita hearts decreased while it was increased in lungs of CBS-/+ and MMP-9-/-.There was decreased vascular density in liver and kidney of Akita mice. Vascular density in brain, kidney and mesentery was decreased in CBS-/+ mice. These findings support the notation that metabolic derangement in diabetes and HHcy causes the chronic decline and/or rarefaction in vascular density.
Collapse
Affiliation(s)
- S Givvimani
- Department of Physiology and Biophysics, University of Louisville School of Medicine, KY 40202, USA
| | | | | | | | | |
Collapse
|
28
|
Liu H, Yang M, Li GM, Qiu Y, Zheng J, Du X, Wang JL, Liu RW. The MTHFR C677T polymorphism contributes to an increased risk for vascular dementia: A meta-analysis. J Neurol Sci 2010; 294:74-80. [DOI: 10.1016/j.jns.2010.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 04/01/2010] [Indexed: 11/24/2022]
|
29
|
Nitric Oxide as an Initiator of Brain Lesions During the Development of Alzheimer Disease. Neurotox Res 2009; 16:293-305. [DOI: 10.1007/s12640-009-9066-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 05/16/2009] [Accepted: 05/16/2009] [Indexed: 01/11/2023]
|