Sex differences of brain and their implications for personalized therapy

Sex-specific declines in cholinergic-targeting tRNA fragments in the nucleus accumbens in Alzheimer's disease

INTRODUCTION

Females with Alzheimer's disease (AD) suffer accelerated dementia and loss of cholinergic neurons compared to males, but the underlying mechanisms are unknown. Seeking causal contributors to both these phenomena, we pursued changes in transfer RNS (tRNA) fragments (tRFs) targeting cholinergic transcripts (CholinotRFs).

METHODS

We analyzed small RNA-sequencing (RNA-Seq) data from the nucleus accumbens (NAc) brain region which is enriched in cholinergic neurons, compared to hypothalamic or cortical tissues from AD brains; and explored small RNA expression in neuronal cell lines undergoing cholinergic differentiation.

RESULTS

NAc CholinotRFs of mitochondrial genome origin showed reduced levels that correlated with elevations in their predicted cholinergic-associated mRNA targets. Single-cell RNA seq from AD temporal cortices showed altered sex-specific levels of cholinergic transcripts in diverse cell types; inversely, human-originated neuroblastoma cells under cholinergic differentiation presented sex-specific CholinotRF elevations.

DISCUSSION

Our findings support CholinotRFs contributions to cholinergic regulation, predicting their involvement in AD sex-specific cholinergic loss and dementia.

Involvement of Oxidative Stress and Nutrition in the Anatomy of Orofacial Pain

Pain is a very important problem of our existence, and the attempt to understand it is one the oldest challenges in the history of medicine. In this review, we summarize what has been known about pain, its pathophysiology, and neuronal transmission. We focus on orofacial pain and its classification and features, knowing that is sometimes purely subjective and not well defined. We consider the physiology of orofacial pain, evaluating the findings on the main neurotransmitters; in particular, we describe the roles of glutamate as approximately 30-80% of total peripheric neurons associated with the trigeminal ganglia are glutamatergic. Moreover, we describe the important role of oxidative stress and its association with inflammation in the etiogenesis and modulation of pain in orofacial regions. We also explore the warning and protective function of orofacial pain and the possible action of antioxidant molecules, such as melatonin, and the potential influence of nutrition and diet on its pathophysiology. Hopefully, this will provide a solid background for future studies that would allow better treatment of noxious stimuli and for opening new avenues in the management of pain.

Sex differences in functional brain networks involved in interoception: An fMRI study

Interoception can be described as the ability to perceive inner body sensations and it is different between biological sex. However, no previous research correlated this ability with brain functional connectivity (FC) between males and females. In this study, we used resting-state functional magnetic resonance imaging to investigate FC of networks involved in interoception among males and females in a sample of healthy volunteers matched for age. In total, 67 participants (34 females, mean age 44.2; 33 males, mean age 37.2) underwent a functional MRI session and completed the Self-Awareness Questionnaire (SAQ) that tests the interoceptive awareness. To assess the effect of sex on scores obtained on the SAQ we performed a multivariate analysis of variance. A whole-brain seed-to-seed FC analysis was conducted to investigate the correlation between SAQ score and FC, and then to test differences in FC between males and females with SAQ score as a covariate. MANOVA revealed a significant difference in SAQ scores between males and females with higher values for the second ones. Also, significant correlations among interoception scores and FC in Salience network and fronto-temporo-parietal brain areas have been detected, with a sharp prevalence for the female. These results support the idea of a female advantage in the attention toward interoceptive sensations, suggesting common inter-network areas that concur to create the sense of self.

Sex-specific declines in cholinergic-targeting tRNA fragments in the nucleus accumbens in Alzheimer's disease

Introduction

Females with Alzheimer's disease (AD) suffer accelerated dementia and loss of cholinergic neurons compared to males, but the underlying mechanisms are unknown. Seeking causal contributors to both these phenomena, we pursued changes in tRNA fragments (tRFs) targeting cholinergic transcripts (CholinotRFs).

Methods

We analyzed small RNA-sequencing data from the nucleus accumbens (NAc) brain region which is enriched in cholinergic neurons, compared to hypothalamic or cortical tissues from AD brains; and explored small RNA expression in neuronal cell lines undergoing cholinergic differentiation.

Results

NAc CholinotRFs of mitochondrial genome origin showed reduced levels that correlated with elevations in their predicted cholinergic-associated mRNA targets. Single cell RNA seq from AD temporal cortices showed altered sex-specific levels of cholinergic transcripts in diverse cell types; inversely, human-originated neuroblastoma cells under cholinergic differentiation presented sex-specific CholinotRF elevations.

Discussion

Our findings support CholinotRFs contributions to cholinergic regulation, predicting their involvement in AD sex-specific cholinergic loss and dementia.

Long-interval intracortical inhibition in primary motor cortex related to working memory in middle-aged adults

Introduction

Excitability of the primary motor cortex measured with TMS has been associated with cognitive dysfunctions in patient populations. However, only a few studies have explored this relationship in healthy adults, and even fewer have considered the role of biological sex.

Methods

Ninety-seven healthy middle-aged adults (53 male) completed a TMS protocol and a neuropsychological assessment. Resting Motor Threshold (RMT) and Long-Interval Intracortical Inhibition (LICI) were assessed in the left motor cortex and related to attention, episodic memory, working memory, reasoning, and global cognition composite scores to evaluate the relationship between cortical excitability and cognitive functioning.

Results

In the whole sample, there was a significant association between LICI and cognition; specifically, higher motor inhibition was related to better working memory performance. When the sample was broken down by biological sex, LICI was only associated with working memory, reasoning, and global cognition in men. No associations were found between RMT and cognitive functions.

Conclusion

Greater intracortical inhibition, measured by LICI, could be a possible marker of working memory in healthy middle-aged adults, and biological sex plays a critical role in this association.

Structural Alteration of Medial Temporal Lobe Subfield in the Amnestic Mild Cognitive Impairment Stage of Alzheimer’s Disease

Objective. Volume reduction and structural abnormality is the most replicated finding in neuroimaging studies of Alzheimer’s disease (AD). Amnestic mild cognitive impairment (aMCI) is the early stage of AD development. Thus, it is necessary to investigate the link between atrophy of regions of interest (ROIs) in medial temporal lobe, the variation trend of ROI densities and volumes among patients with cognitive impairment, and the distribution characteristics of ROIs in the aMCI group, Alzheimer’s disease (AD) group, and normal control (NC) group. Methods. 30 patients with aMCI, 16 patients with AD, and 30 NC are recruited; magnetic resonance imaging (MRI) brain scans are conducted. Voxel-based morphometry was employed to conduct the quantitative measurement of gray matter densities of the hippocampus, amygdala, entorhinal cortex, and mammillary body (MB). FreeSurfer was utilized to automatically segment the hippocampus into 21 subregions and the amygdala into 9 subregions. Then, their subregion volumes and total volume were calculated. Finally, the ANOVA and multiple comparisons were performed on the above-mentioned data from these three groups. Results. AD had lower GM densities than MCI, and MCI had lower GM densities than NC, but not all of the differences were statistically significant. In the comparisons of AD-aMCI-NC, AD-aMCI, and AD-NC, the hippocampus, amygdala, and entorhinal cortex showed differences in the gray matter densities ( $p<0.05$ ); the differences of mammillary body densities were not significant in the random comparison between these three groups ( $p>0.05$ ). The hippocampus densities and volumes of the subjects from the aMCI group and the AD group were bilaterally symmetric. The gray matter densities of the right side of the entorhinal cortex inside each group and the hippocampus from the NC group were higher than those of the left side ( $p<0.05$ ), and the gray matter densities of the amygdala and mammillary body were bilaterally symmetric in the three groups ( $p>0.05$ ). There were no gender differences of four ROIs in the AD, aMCI, and NC groups ( $p>0.05$ ). The volume differences of the hippocampus presubiculum-body and parasubiculum manifest no statistical significance ( $p>0.05$ ) in the random comparison between these three groups. Volume differences of the left amygdala basal nucleus, the left lateral nucleus, the left cortical amygdala transitional area, the left paravamnion nucleus, and bilateral hippocampal amygdala transition area (HATA) had statistical differences only between the AD group and the NC group ( $p<0.05$ ). Conclusion. Structural defects of medial temporal lobe subfields were revealed in the aMCI and AD groups. Decreased gray matter densities of the hippocampus, entorhinal cortex, and amygdala could distinguish patients with early stage of AD between aMCI and NC. Volume decline of the hippocampus and amygdala subfields could only distinguish AD between NC.

The impact of aging on interhemispheric transfer time and respective sex differences

Age-related cognitive decline has been attributed to degeneration of the corpus callosum (CC), which allows for interhemispheric integration and information processing [22,69]. Along with decreased structural integrity, altered functional properties of the CC may cause impaired cognitive performance in older adults, yet this aspect of age-related decline remains insufficiently researched [59]. In this context, potential sex-related differences have been proposed [31,58]. A promising parameter, which has been suggested to estimate functional properties of the CC is the interhemispheric transfer time (IHTT), which is ideally obtained from event-related potentials (ERP) evoked by lateralized stimuli [45]. To examine the possible functional consequences of aging with regards to the CC, the present study investigated the IHTT of 107 older (67.69 ± 5.18y) as well as of 23 younger participants (25.09 ± 2.59y). IHTT was obtained using an established letter matching task and targeting early N170 ERP components at posterior electrode sites. The results revealed significantly elongated IHTT in older compared to younger participants, but no significant sex differences. Furthermore, there was a significant positive correlation between IHTT and age, predominantly driven by the female participants. The present findings add support to the notion, that IHTT is subject to age-related elongation reflecting impaired interhemispheric transmission. Age-related decline in women appears to occur at a different age range compared to men.

Sex and gender difference in cognitive and behavioral studies in developmental age: An introduction

This paper introduces a special issue focused on sex and gender (s/g) cognitive/behavioral differences at developmental ages providing an overview of this multifaceted and debated topic. It will provide a description of the biological systems that are strongly interconnected to generate s/g differences, that is, genetic determinants, sex hormones, differences in brain structure, organization, and/or function, inherited or modifiable under environmental pressures. Developmental studies are rare. Some addressed whether s/g differences in cognitive/behavioral characteristics are evident early in life and are consistent throughout development, entailing that s/g differences can follow the evolving steps in girls and boys in different domains. The data are far from being homogeneous and consistent about s/g difference in language, social skills, and visuo/spatial abilities. The differences are small, often with overlapping performances, similar to what is seen in adulthood. Given that several variables and the interactions between them are implicated, further longitudinal studies adopting adequate assessment tools, very large size multicultural samples stratified in different, well-sized and precise age groups, considering biological and sociocultural variables, are needed. Due to the complexity of the issue, there is still the need to support and adopt an s/g difference approach also in cognitive and behavioral studies at developmental ages. Finally, these studies have not only scientific importance and relevant cultural, anthropological, and social implications, but are also useful for pedagogical programming as well as for the study of the different susceptibility to develop CNS diseases and consequently to promote different therapies and treatments.

Survival Bias and Crosstalk between Chronological and Behavioral Age: Age- and Genotype-Sensitivity Tests Define Behavioral Signatures in Middle-Aged, Old, and Long-Lived Mice with Normal and AD-Associated Aging

New evidence refers to a high degree of heterogeneity in normal but also Alzheimer's disease (AD) clinical and temporal patterns, increased mortality, and the need to find specific end-of-life prognosticators. This heterogeneity is scarcely explored in very old male AD mice models due to their reduced survival. In the present work, using 915 (432 APP23 and 483 C57BL/6 littermates) mice, we confirmed the better survival curves in male than female APP23 mice and respective wildtypes, providing the chance to characterize behavioral signatures in middle-aged, old, and long-lived male animals. The sensitivity of a battery of seven paradigms for comprehensive screening of motor (activity and gait analysis), neuropsychiatric and cognitive symptoms was analyzed using a cohort of 56 animals, composed of 12-, 18- and 24-month-old male APP23 mice and wildtype littermates. Most variables analyzed detected age-related differences. However, variables related to coping with stress, thigmotaxis, frailty, gait, and poor cognition better discriminated the behavioral phenotype of male APP23 mice through the three old ages compared with controls. Most importantly, non-linear age- and genotype-dependent behavioral signatures were found in long-lived animals, suggesting crosstalk between chronological and biological/behavioral ages useful to study underlying mechanisms and distinct compensations through physiological and AD-associated aging.

Gender Brain Structural Differences and Interoception

Interoception, the ability to perceive inner body sensations, has been demonstrated to be different among genders, with a stronger female attention toward interoceptive information. No study correlated this capability with brain differences between males and females. This study aims to detect behavioral variances and structural neuroimaging interoception correlates in a sample of healthy volunteers matched for age. Seventy-three participants (37 females, mean age 43.5; 36 males, mean age 37.4) completed the Self-Awareness Questionnaire (SAQ) for interoceptive sensibility and underwent a structural MRI session. A t test corrected for Bonferroni multiple comparisons was performed to compare brain morphological parameters (cortical thickness and parcel volume) in both groups. A multivariate analysis of variance was performed to assess the effect of gender on scores obtained on the SAQ. A moderation model through multiple linear regression analysis was performed between gray matter volumes or parcels, cortical thickness, and the interoception score. Group analysis showed significant differences in morphometric brain data between males and females, both for cortical and subcortical volumes, but not for cortical thickness analyses. MANOVA underlined a significant difference in SAQ scores between males and females with higher values for the second ones. Moreover, a significant correlation between the interoception scores and gray matter volumes of the two groups has been detected, with a sharp prevalence for the female gender in the left insula with F1, F2, and SAQ interoception scores (R ² = 0.41, p < 0.001). Our results demonstrated that in the female group, a stronger predisposition was found toward interoceptive sensations, and that multiple brain areas were correlated with interoceptive measure. These data sustain a female advantage in the attention toward this process and support the idea that interoception in females is a process more shared across several regions that participate in creating the sense of self.

Gender medicine: Lessons from COVID-19 and other medical conditions for designing health policy

Gender-specific differences in the prevalence, incidence, comorbidities, prognosis, severity, risk factors, drug-related aspects and outcomes of various medical conditions are well documented. We present a literature review on the extent to which research in this field has developed over the years, and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens, guidelines and into gender-oriented preventive strategies and health policies. Subsequently, through the lens of gender, we describe these domains in detail for four selected medical conditions: Asthma, obesity and overweight, chronic kidney disease and coronavirus disease 2019. As some of the key gender differences become more apparent during adolescence, we focus on this developmental stage. Finally, we propose a model which is based on three influential issues: (1) Investigating gender-specific medical profiles of related health conditions, rather than a single disease; (2) The dynamics of gender disparities across developmental stages; and (3) An integrative approach which takes into account additional risk factors (ethnicity, socio-demographic variables, minorities, lifestyle habits etc.). Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines, already among adolescents, may reduce inequities, facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.

Impact of Chronic Risperidone Use on Behavior and Survival of 3xTg-AD Mice Model of Alzheimer's Disease and Mice With Normal Aging

Psychosis and/or aggression are common problems in dementia, and when severe or persistent, cause considerable patient distress and disability, caregiver stress, and early institutionalization. In 2005, the Food and Drug Administration (FDA) determined that atypical antipsychotics were associated with a significantly greater mortality risk compared to placebo, which prompted the addition of an FDA black-box warning. The American College of Neuropsychopharmacology (ACNP) White Paper, 2008, reviewed this issue and made clinical and research recommendations regarding the use of antipsychotics in dementia patients with psychosis and/or agitation. Increased mortality risk has also been described in cerebrovascular adverse events in elderly users of antipsychotics. In the present work, at the translational level, we used male 3xTg-AD mice (PS1M146V, APPSwe, tauP301L) at advanced stages of the disease reported to have worse survival than females, to study the behavioral effects of a low chronic dose of risperidone (0.1 mg/kg, s.c., 90 days, from 13 to 16 months of age) and its impact on long-term survival, as compared to mice with normal aging. Animals were behaviorally assessed for cognitive and BPSD (behavioral and psychological symptoms of dementia)-like symptoms in naturalistic and experimental conditions (open-field test, T-maze, social interaction, Morris water maze, and marble test) before and after treatment. Weight, basal glucose levels, and IPGTT (i.p. glucose tolerance test) were also recorded. Neophobia in the corner test was used for behavioral monitoring. Survival curves were recorded throughout the experiment until natural death. The benefits of risperidone were limited, both at cognitive and BPSD-like level, and mostly restricted to burying, agitation/vibrating tail, and other social behaviors. However, the work warns about a clear early mortality risk window during the treatment and long-lasting impact on survival. Reduced life expectancy and life span were observed in the 3xTg-AD mice, but total lifespan (36 months) recorded in C57BL/6 × 129Sv counterparts with normal aging was also truncated to 28 months in those with treatment. Sarcopenia at time of death was found in all groups, but was more severe in wild-type animals treated with risperidone. Therefore, the 3xTg-AD mice and their non-transgenic counterparts can be useful to delimitate critical time windows and for studying the physio-pathogenic factors and underlying causal events involved in this topic of considerable public health significance.