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Carpi M, Fernandes M, Risino I, Benedetti R, Testone G, Cirillo F, Nuccetelli M, Bernardini S, Mercuri NB, Liguori C. Alteration of circadian sleep-wake rhythm and salivary melatonin secretion in idiopathic/isolated REM sleep behavior disorder: Preliminary evidence. Sleep Med 2024; 119:135-138. [PMID: 38678756 DOI: 10.1016/j.sleep.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE/BACKGROUND Idiopathic/isolated REM sleep behavior disorder (iRBD) is widely regarded as an early sign of neurodegeneration leading to synucleinopathies. While circadian rhythm alterations in iRBD have been preliminarily demonstrated, evidence on melatonin secretion patterns in this clinical condition is limited. To address this knowledge gap, this exploratory study aimed to integrate salivary melatonin measurement with actigraphic monitoring in individuals with iRBD and age-matched healthy controls (HC) under real-life conditions. METHODS Participants diagnosed with iRBD and HC underwent clinical evaluation and wore an actigraph for seven days and nights. Salivary melatonin concentrations were measured at five time points during the last night of recording. Comparative analyses were conducted on clinical data, actigraphic parameters, and melatonin levels between the two groups. RESULTS iRBD participants (n = 18) showed greater motor (p < 0.01) and non-motor symptoms (p < 0.001), alongside disruptions in circadian sleep-wake rhythm compared to HC (n = 10). Specifically, actigraphy revealed a delayed central phase measurement (p < 0.05), reduced activity during the most active hours (p < 0.001), and decreased relative amplitude (p < 0.05). Total salivary melatonin concentration was significantly lower in iRBD (p < 0.05), with a slight but non-significant phase delay in dim light melatonin onset. CONCLUSIONS This exploratory study highlights a dysregulation of circadian sleep-wake rhythm coupled with reduced melatonin secretion in iRBD. Future research could add to these preliminary findings to evaluate novel treatment approaches to regulate the sleep-wake cycle and elucidate the implications of circadian dysregulation in the conversion from iRBD to neurodegeneration.
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Affiliation(s)
- Matteo Carpi
- Sleep and Epilepsy Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Irene Risino
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Benedetti
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Greta Testone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Flavia Cirillo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marzia Nuccetelli
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Biagio Mercuri
- Sleep and Epilepsy Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Liguori
- Sleep and Epilepsy Centre, Neurology Unit, University Hospital Tor Vergata, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Jia X, Song Y, Li Z, Yang N, Liu T, Han D, Sun Z, Shi C, Zhou Y, Shi J, Liu Y, Guo X. Melatonin regulates the circadian rhythm to ameliorate postoperative sleep disorder and neurobehavioral abnormalities in aged mice. CNS Neurosci Ther 2024; 30:e14436. [PMID: 37736695 PMCID: PMC10916446 DOI: 10.1111/cns.14436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 06/07/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Postoperative sleep disorder (PSD) and delirium, which may be associated with surgery and inhalational anesthetics, induce adverse effects in old adults. Emerging evidence indicates that circadian rhythm contributes to various neuropathological diseases, including Alzheimer's disease. Thus, we analyzed the potential role of circadian rhythm in PSD and delirium-like behavior in aged mice and determined whether exogenous melatonin could facilitate entrainment of the circadian rhythm after laparotomy under sevoflurane anesthesia. METHODS We selected old C57BL/6J mice which receiving laparotomy/sevoflurane anesthesia as model animals. We employed buried food, open field, and Y maze test to assess delirium-like behavior, and electroencephalography/electromyography (EEG/EMG) were used to investigate sleep changes. We analyzed the transcription rhythm of clock genes in superchiasmatic nucleus (SCN) to explore the effects of surgery and melatonin pretreatment on the circadian rhythm. Then, we measured melatonin receptor levels in SCN and ERK/CREB pathway-related proteins in hippocampus and prefrontal cortex to assess their role in PSDs and delirium-like behavior. RESULTS Laparotomy under sevoflurane anesthesia had a greater influence than sevoflurane alone, leading to sleep disorder, a shift in sleep-wake rhythm, and delirium-like behavior. Bmal1, Clock, and Cry1 mRNA expression showed a peak shift, MT1 melatonin receptor expression level was increased in the SCN, and p-ERK/ERK and p-CREB/CREB were decreased in hippocampus and prefrontal cortex of aged mice 1 day after laparotomy. Melatonin showed significant efficacy in ameliorating PSD and delirium-like behavior and restoring the circadian rhythm, reversing melatonin receptor and ERK/CREB pathway expression abnormalities. In addition, most of the beneficial effect of melatonin was antagonized by luzindole, a melatonin receptor antagonist. CONCLUSIONS Melatonin receptors in SCN, circadian rhythm, and ERK/CREB signaling pathway participate in the pathophysiological processes of PSD and delirium-like behavior. Melatonin intervention could be a potential preventative approach for PSD and delirium.
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Affiliation(s)
- Xixi Jia
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Yanan Song
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Zhengqian Li
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Ning Yang
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Taotao Liu
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Dengyang Han
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Zhuonan Sun
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Chengmei Shi
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Yang Zhou
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug DependencePeking UniversityBeijingChina
| | - Yajie Liu
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
| | - Xiangyang Guo
- Department of AnesthesiologyPeking University Third HospitalBeijingChina
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Naveed M, Chao OY, Hill JW, Yang YM, Huston JP, Cao R. Circadian neurogenetics and its implications in neurophysiology, behavior, and chronomedicine. Neurosci Biobehav Rev 2024; 157:105523. [PMID: 38142983 PMCID: PMC10872425 DOI: 10.1016/j.neubiorev.2023.105523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023]
Abstract
The circadian rhythm affects multiple physiological processes, and disruption of the circadian system can be involved in a range of disease-related pathways. The genetic underpinnings of the circadian rhythm have been well-studied in model organisms. Significant progress has been made in understanding how clock genes affect the physiological functions of the nervous system. In addition, circadian timing is becoming a key factor in improving drug efficacy and reducing drug toxicity. The circadian biology of the target cell determines how the organ responds to the drug at a specific time of day, thus regulating pharmacodynamics. The current review brings together recent advances that have begun to unravel the molecular mechanisms of how the circadian clock affects neurophysiological and behavioral processes associated with human brain diseases. We start with a brief description of how the ubiquitous circadian rhythms are regulated at the genetic, cellular, and neural circuit levels, based on knowledge derived from extensive research on model organisms. We then summarize the latest findings from genetic studies of human brain disorders, focusing on the role of human clock gene variants in these diseases. Lastly, we discuss the impact of common dietary factors and medications on human circadian rhythms and advocate for a broader application of the concept of chronomedicine.
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Affiliation(s)
- Muhammad Naveed
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN 55812, USA; Department of Physiology and Pharmacology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH 43614, USA
| | - Owen Y Chao
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN 55812, USA
| | - Jennifer W Hill
- Department of Physiology and Pharmacology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH 43614, USA
| | - Yi-Mei Yang
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN 55812, USA; Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Joseph P Huston
- Center for Behavioral Neuroscience, Institute of Experimental Psychology, Heinrich-Heine University, 40225 Düsseldorf, Germany
| | - Ruifeng Cao
- Department of Neuroscience and Cell Biology, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA; Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA.
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Mogavero MP, Ferri R, Marelli S, Lanza G, Terzaghi M, Castelnuovo A, DelRosso LM, Schenck CH, Ferini‐Strambi L. Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches? CNS Neurosci Ther 2024; 30:e14569. [PMID: 38421131 PMCID: PMC10850928 DOI: 10.1111/cns.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/06/2023] [Accepted: 12/02/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS Although clonazepam (CLO) and melatonin (MLT) are the most frequently used treatments for REM sleep behavior disorder, the polysomnographic features associated with their use are little known. The aim of this study was to evaluate polysomnographic and clinical parameters of patients with idiopathic/isolated REM sleep behavior disorder (iRBD) treated chronically with CLO, sustained-release MLT, alone or in combination, and in a group of drug-free iRBD patients. METHODS A total of 96 patients were enrolled: 43 drug-free, 21 with CLO (0.5-2 mg), 20 with sustained-release MLT (1-4 mg), and 12 taking a combination of them (same doses). Clinical variables and polysomnography were collected. RESULTS Although clinical improvement was reported in all groups, MLT impacted sleep architecture more than the other treatments, with significant and large increase in N3 stage, moderate reduction in N2 and REM sleep, and moderate increase in REM latency. CLO moderately increased the percentage of both REM sleep and especially N2, while reducing N1 and wakefulness. Patients treated with both CLO and MLT did not show major changes in sleep architecture. CONCLUSION These results suggest that the administration of MLT or CLO impacts (positively) on sleep parameters of iRBD patients. However, there is a need to better stratify patients, in order to treat them in a targeted manner, depending on the patient's individual sleep architecture and expected differential effects of these agents.
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Affiliation(s)
- Maria P. Mogavero
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| | - Raffaele Ferri
- Sleep Research Centre and Clinical Neurophysiology Research UnitOasi Research Institute – IRCCSTroinaItaly
| | - Sara Marelli
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| | - Giuseppe Lanza
- Sleep Research Centre and Clinical Neurophysiology Research UnitOasi Research Institute – IRCCSTroinaItaly
- Department of Surgery and Medical‐Surgical SpecialtiesUniversity of CataniaCataniaItaly
| | - Michele Terzaghi
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Unit of Sleep Medicine and EpilepsyIRCCS Mondino FoundationPaviaItaly
| | - Alessandra Castelnuovo
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| | | | - Carlos H. Schenck
- Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical CenterUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Luigi Ferini‐Strambi
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
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Pavithra S, Aich A, Chanda A, Zohra IF, Gawade P, Das RK. PER2 gene and its association with sleep-related disorders: A review. Physiol Behav 2024; 273:114411. [PMID: 37981094 DOI: 10.1016/j.physbeh.2023.114411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/12/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
The natural circadian rhythm in an individual governs the sleep-wake cycle over 24 h. Disruptions in this internal cycle can lead to major health hazards and sleep disorders. Reports suggest that at least 50 % of people worldwide suffer from sleep-related disorders. An increase in screen time, especially in the wake of the COVID-19 pandemic, is one of the external causative factors for this condition. While many factors govern the circadian clock and its aberrance, the PER2 gene has been strongly linked to chronotypes by many researchers. The current paper provides an extensive examination of key Single Nucleotide Polymorphisms within the PER2 gene and their potential connection to four major types of sleep disorders. This study investigates whether these SNPs play a causative role in sleep disorders or if they are solely associated with these conditions. Additionally, we explore whether these genetic variations exert a lifelong influence on these sleep patterns or if external triggers contribute to the development of sleep disorders. This gene is a crucial regulator of the circadian cycle responsible for the transcription of other clock genes. It regulates a variety of physiological systems such as metabolism, sleep, body temperature, blood pressure, endocrine, immunological, cardiovascular, and renal function. We aim to establish some clarity to the multifaceted nature of this gene, which is often overlooked, and seek to establish the mechanistic role of PER2 gene mutations in sleep disorders. This will improve further understanding, assessment, and treatment of these conditions in future.
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Affiliation(s)
- S Pavithra
- School of Biosciences and Technology (SBST), Vellore Institute of Technology, Vellore, India; Centre for Biomaterials, Cellular & Molecular Theranostics (CBCMT), Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Adrija Aich
- School of Biosciences and Technology (SBST), Vellore Institute of Technology, Vellore, India
| | - Adrita Chanda
- School of Biosciences and Technology (SBST), Vellore Institute of Technology, Vellore, India
| | - Ifsha Fatima Zohra
- School of Biosciences and Technology (SBST), Vellore Institute of Technology, Vellore, India
| | - Pranotee Gawade
- School of Biosciences and Technology (SBST), Vellore Institute of Technology, Vellore, India
| | - Raunak Kumar Das
- Centre for Biomaterials, Cellular & Molecular Theranostics (CBCMT), Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India.
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Du L, He X, Fan X, Wei X, Xu L, Liang T, Wang C, Ke Y, Yung WH. Pharmacological interventions targeting α-synuclein aggregation triggered REM sleep behavior disorder and early development of Parkinson's disease. Pharmacol Ther 2023; 249:108498. [PMID: 37499913 DOI: 10.1016/j.pharmthera.2023.108498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/24/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by elevated motor behaviors and dream enactments in REM sleep, often preceding the diagnosis of Parkinson's disease (PD). As RBD could serve as a biomarker for early PD developments, pharmacological interventions targeting α-synuclein aggregation triggered RBD could be applied toward early PD progression. However, robust therapeutic guidelines toward PD-induced RBD are lacking, owing in part to a historical paucity of effective treatments and trials. We reviewed the bidirectional links between α-synuclein neurodegeneration, progressive sleep disorders, and RBD. We highlighted the correlation between RBD development, α-synuclein aggregation, and neuronal apoptosis in key brainstem regions involved in REM sleep atonia maintenance. The current pharmacological intervention strategies targeting RBD and their effects on progressive PD are discussed, as well as current treatments for progressive neurodegeneration and their effects on RBD. We also evaluated emerging and potential pharmacological solutions to sleep disorders and developing synucleinopathies. This review provides insights into the mechanisms and therapeutic targets underlying RBD and PD, and explores bidirectional treatment effects for both diseases, underscoring the need for further research in this area.
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Affiliation(s)
- Lida Du
- Institute of Molecular Medicine & Innovative Pharmaceutics, Qingdao University, Qingdao, China; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Xiaoli He
- Institute of Medical Plant Development, Peking Union Medical College, Beijing, China
| | - Xiaonuo Fan
- Department of Biology, Boston University, Boston, USA
| | - Xiaoya Wei
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Linhao Xu
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tuo Liang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Institute of Neurological and Psychiatric Disorders, Shenzhen Bay Laboratory, Shenzhen, China
| | - Chunbo Wang
- Institute of Molecular Medicine & Innovative Pharmaceutics, Qingdao University, Qingdao, China
| | - Ya Ke
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing-Ho Yung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Neuroscience, City University of Hong Kong, Hong Kong, China.
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Malkani R. REM Sleep Behavior Disorder and Other REM Parasomnias. Continuum (Minneap Minn) 2023; 29:1092-1116. [PMID: 37590824 DOI: 10.1212/con.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article reviews rapid eye movement (REM) sleep behavior disorder (RBD) and other REM sleep parasomnias, particularly recurrent isolated sleep paralysis and nightmare disorder. LATEST DEVELOPMENTS People with RBD have dream enactment behaviors that can be distressing and cause injuries to themselves or a bed partner. Diagnosis of RBD still requires video polysomnography but new evaluative techniques are emerging. Automatic scoring of REM sleep without atonia, the polysomnographic RBD feature, has led to clearer diagnostic cutoff values. Isolated RBD is strongly linked with neurodegenerative disorders, particularly α-synucleinopathies, with a median latency to neurodegenerative disease diagnosis of 8 years. Mounting imaging, electrophysiologic, and pathologic evidence supports neurodegenerative changes in patients with isolated RBD. Safety precautions should be reviewed with patients to reduce the risk of injury. Clonazepam and melatonin are first-line agents for RBD symptoms, and rivastigmine appears to be beneficial for RBD in people with mild cognitive impairment. For nightmare disorder, image rehearsal therapy is effective and can be delivered through online platforms. ESSENTIAL POINTS While RBD symptoms can often be managed, patients with isolated RBD should be monitored for signs and symptoms of impending neurodegenerative disease. Individuals who wish to know about the associated risk should be counseled accordingly to allow planning and involvement in research if they choose. Exercise may have some neuroprotective effects, although no treatment has been shown to modify the neurodegenerative risk.
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Samizadeh MA, Fallah H, Toomarisahzabi M, Rezaei F, Rahimi-Danesh M, Akhondzadeh S, Vaseghi S. Parkinson's Disease: A Narrative Review on Potential Molecular Mechanisms of Sleep Disturbances, REM Behavior Disorder, and Melatonin. Brain Sci 2023; 13:914. [PMID: 37371392 DOI: 10.3390/brainsci13060914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Parkinson's disease (PD) is one of the most common neurodegenerative diseases. There is a wide range of sleep disturbances in patients with PD, such as insomnia and rapid eye movement (REM) sleep behavior disorder (or REM behavior disorder (RBD)). RBD is a sleep disorder in which a patient acts out his/her dreams and includes abnormal behaviors during the REM phase of sleep. On the other hand, melatonin is the principal hormone that is secreted by the pineal gland and significantly modulates the circadian clock and mood state. Furthermore, melatonin has a wide range of regulatory effects and is a safe treatment for sleep disturbances such as RBD in PD. However, the molecular mechanisms of melatonin involved in the treatment or control of RBD are unknown. In this study, we reviewed the pathophysiology of PD and sleep disturbances, including RBD. We also discussed the potential molecular mechanisms of melatonin involved in its therapeutic effect. It was concluded that disruption of crucial neurotransmitter systems that mediate sleep, including norepinephrine, serotonin, dopamine, and GABA, and important neurotransmitter systems that mediate the REM phase, including acetylcholine, serotonin, and norepinephrine, are significantly involved in the induction of sleep disturbances, including RBD in PD. It was also concluded that accumulation of α-synuclein in sleep-related brain regions can disrupt sleep processes and the circadian rhythm. We suggested that new treatment strategies for sleep disturbances in PD may focus on the modulation of α-synuclein aggregation or expression.
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Affiliation(s)
- Mohammad-Ali Samizadeh
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
| | - Hamed Fallah
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran 1417935840, Iran
| | - Mohadeseh Toomarisahzabi
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
| | - Fereshteh Rezaei
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
| | - Mehrsa Rahimi-Danesh
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran 13337159140, Iran
| | - Salar Vaseghi
- Cognitive Neuroscience Lab, Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 3365166571, Iran
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9
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Cardinali DP, Garay A. Melatonin as a Chronobiotic/Cytoprotective Agent in REM Sleep Behavior Disorder. Brain Sci 2023; 13:brainsci13050797. [PMID: 37239269 DOI: 10.3390/brainsci13050797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Dream-enactment behavior that emerges during episodes of rapid eye movement (REM) sleep without muscle atonia is a parasomnia known as REM sleep behavior disorder (RBD). RBD constitutes a prodromal marker of α-synucleinopathies and serves as one of the best biomarkers available to predict diseases such as Parkinson disease, multiple system atrophy and dementia with Lewy bodies. Most patients showing RBD will convert to an α-synucleinopathy about 10 years after diagnosis. The diagnostic advantage of RBD relies on the prolonged prodromal time, its predictive power and the absence of disease-related treatments that could act as confounders. Therefore, patients with RBD are candidates for neuroprotection trials that delay or prevent conversion to a pathology with abnormal α-synuclein metabolism. The administration of melatonin in doses exhibiting a chronobiotic/hypnotic effect (less than 10 mg daily) is commonly used as a first line treatment (together with clonazepam) of RBD. At a higher dose, melatonin may also be an effective cytoprotector to halt α-synucleinopathy progression. However, allometric conversion doses derived from animal studies (in the 100 mg/day range) are rarely employed clinically regardless of the demonstrated absence of toxicity of melatonin in phase 1 pharmacological studies with doses up to 100 mg in normal volunteers. This review discusses the application of melatonin in RBD: (a) as a symptomatic treatment in RBD; (b) as a possible disease-modifying treatment in α-synucleinopathies. To what degree melatonin has therapeutic efficacy in the prevention of α-synucleinopathies awaits further investigation, in particular multicenter double-blind trials.
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Affiliation(s)
- Daniel P Cardinali
- CENECON, Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires C1431FWO, Argentina
| | - Arturo Garay
- Unidad de Medicina del Sueño-Sección Neurología, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Buenos Aires C1431FWO, Argentina
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10
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Shin JW. Neuroprotective effects of melatonin in neurodegenerative and autoimmune central nervous system diseases. ENCEPHALITIS 2023; 3:44-53. [PMID: 37469673 PMCID: PMC10295826 DOI: 10.47936/encephalitis.2022.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 07/21/2023] Open
Abstract
The suprachiasmatic nucleus (SCN) in the anterior hypothalamus is the major circadian pacemaker in humans. Melatonin is a key hormone secreted by the pineal gland in response to darkness. Light-induced stimuli are transmitted along the retinohypothalamic tract to the SCN. Activation of the SCN inhibits the production of melatonin by the pineal gland through a complex neural pathway passing through the superior cervical ganglion. Accordingly, when light is unavailable, the pineal gland secretes melatonin. The circadian rhythm modulates sleep-wake cycles as well as many physiological functions of the endocrine system, including core body temperature, pulse rate, oxygen consumption, hormone levels, metabolism, and gastrointestinal function. In neurodegenerative disorders, the sleep-wake cycle is disrupted and circadian regulation is altered, which accelerates disease progression, further disrupting circadian regulation and setting up a vicious cycle. Melatonin plays a critical role in the regulation of circadian rhythms and is a multifunctional pleiotropic agent with broad neuroprotective effects in neurodegenerative disorders, viral or autoimmune diseases, and cancer. In this review, I discuss the neuroprotective functions of melatonin in circadian regulation and its roles in promoting anti-inflammatory activity, enhancing immune system functions, and preventing alterations in glucose metabolism and mitochondrial dysfunction in neurodegenerative disorders and autoimmune central nervous system diseases.
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Affiliation(s)
- Jung-Won Shin
- Department of Neurology, Bundang CHA Medical Center, CHA University, Seongnam, Korea
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11
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Asadpoordezaki Z, Coogan AN, Henley BM. Chronobiology of Parkinson's disease: Past, present and future. Eur J Neurosci 2023; 57:178-200. [PMID: 36342744 PMCID: PMC10099399 DOI: 10.1111/ejn.15859] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
Parkinson's disease is a neurodegenerative disorder predominately affecting midbrain dopaminergic neurons that results in a broad range of motor and non-motor symptoms. Sleep complaints are among the most common non-motor symptoms, even in the prodromal period. Sleep alterations in Parkinson's disease patients may be associated with dysregulation of circadian rhythms, intrinsic 24-h cycles that control essential physiological functions, or with side effects from levodopa medication and physical and mental health challenges. The impact of circadian dysregulation on sleep disturbances in Parkinson's disease is not fully understood; as such, we review the systems, cellular and molecular mechanisms that may underlie circadian perturbations in Parkinson's disease. We also discuss the potential benefits of chronobiology-based personalized medicine in the management of Parkinson's disease both in terms of behavioural and pharmacological interventions. We propose that a fuller understanding of circadian clock function may shed important new light on the aetiology and symptomatology of the disease and may allow for improvements in the quality of life for the millions of people with Parkinson's disease.
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Affiliation(s)
- Ziba Asadpoordezaki
- Department of Psychology, Maynooth University, Maynooth, Co Kildare, Ireland.,Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, Maynooth, Co Kildare, Ireland.,Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Beverley M Henley
- Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Co Kildare, Ireland
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12
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Kim RE, Mabunga DF, Kim HJ, Han SH, Kim HY, Shin CY, Kwon KJ. Novel Therapeutics for Treating Sleep Disorders: New Perspectives on Maydis stigma. Int J Mol Sci 2022; 23:ijms232314612. [PMID: 36498940 PMCID: PMC9740493 DOI: 10.3390/ijms232314612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022] Open
Abstract
Sleep is a restorative period that plays a crucial role in the physiological functioning of the body, including that of the immune system, memory processing, and cognition. Sleep disturbances can be caused by various physical, mental, and social problems. Recently, there has been growing interest in sleep. Maydis stigma (MS, corn silk) is a female maize flower that is traditionally used as a medicinal plant to treat many diseases, including hypertension, edema, and diabetes. It is also used as a functional food in tea and other supplements. β-Sitosterol (BS) is a phytosterol and a natural micronutrient in higher plants, and it has a similar structure to cholesterol. It is a major component of MS and has anti-inflammatory, antidepressive, and sedative effects. However, the potential effects of MS on sleep regulation remain unclear. Here, we investigated the effects of MS on sleep in mice. The effects of MS on sleep induction were determined using pentobarbital-induced sleep and caffeine-induced sleep disruption mouse models. MS extracts decreased sleep latency and increased sleep duration in both the pentobarbital-induced sleep induction and caffeine-induced sleep disruption models compared to the positive control, valerian root extract. The butanol fraction of MS extracts decreased sleep latency time and increased sleep duration. In addition, β-sitosterol enhances sleep latency and sleep duration. Both MS extract and β-sitosterol increased alpha activity in the EEG analysis. We measured the mRNA expression of melatonin receptors 1 and 2 (MT1/2) using qRT-PCR. The mRNA expression of melatonin receptors 1 and 2 was increased by MS extract and β-sitosterol treatment in rat primary cultured neurons and the brain. In addition, MS extract increased the expression of clock genes including per1/2, cry1/2, and Bmal1 in the brain. MS extract and β-sitosterol increased the phosphorylation of ERK1/2 and αCaMKII. Our results demonstrate for the first time that MS has a sleep-promoting effect via melatonin receptor expression, which may provide new scientific evidence for its use as a potential therapeutic agent for the treatment and prevention of sleep disturbance.
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Affiliation(s)
- Ryeong-Eun Kim
- Department of Neuroscience, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Darine Froy Mabunga
- Department of Neuroscience, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Hee Jin Kim
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul 01795, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk Hospital Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk Hospital Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Chan Young Shin
- Department of Pharmacology, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Kyoung Ja Kwon
- Department of Neuroscience, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
- Department of Neurology, Konkuk Hospital Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
- Correspondence: ; Tel.: +82-2-454-5630; Fax: +82-2030-7899
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13
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Si X, Guo T, Wang Z, Fang Y, Gu L, Cao L, Yang W, Gao T, Song Z, Tian J, Yin X, Guan X, Zhou C, Wu J, Bai X, Liu X, Zhao G, Zhang M, Pu J, Zhang B. Neuroimaging evidence of glymphatic system dysfunction in possible REM sleep behavior disorder and Parkinson's disease. NPJ Parkinsons Dis 2022; 8:54. [PMID: 35487930 PMCID: PMC9055043 DOI: 10.1038/s41531-022-00316-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/31/2022] [Indexed: 12/21/2022] Open
Abstract
Alpha-synucleinopathy is postulated to be central to both idiopathic rapid eye movement sleep behaviour disorder (iRBD) and Parkinson’s disease (PD). Growing evidence suggests an association between the diminished clearance of α-synuclein and glymphatic system dysfunction. However, evidence accumulating primarily based on clinical data to support glymphatic system dysfunction in patients with iRBD and PD is currently insufficient. This study aimed to use diffusion tensor image analysis along the perivascular space (DTI-ALPS) to evaluate glymphatic system activity and its relationship to clinical scores of disease severity in patients with possible iRBD (piRBDs) and those with PD. Further, we validated the correlation between the ALPS index and the prognosis of PD longitudinally. Overall, 168 patients with PD, 119 piRBDs, and 129 healthy controls were enroled. Among them, 50 patients with PD had been longitudinally reexamined. Patients with PD exhibited a lower ALPS index than those with piRBDs (P = 0.036), and both patient groups showed a lower ALPS index than healthy controls (P < 0.001 and P = 0.001). The ALPS index and elevated disease severity were negatively correlated in the piRBD and PD subgroups. Moreover, the ALPS index was correlated with cognitive decline in patients with PD in the longitudinal analyses. In conclusion, DTI-ALPS provided neuroimaging evidence of glymphatic system dysfunction in piRBDs and patients with PD; however, the potential of assessing the pathological progress of α-synucleinopathies as an indicator is worth verifying. Further development of imaging methods for glymphatic system function is also warranted.
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Affiliation(s)
- Xiaoli Si
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China.,Department of Neurology, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, N1 Avenue, 322000, Yiwu, Zhejiang, China
| | - Tao Guo
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Zhiyun Wang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Yi Fang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Luyan Gu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Lanxiao Cao
- Department of Neurology, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, N1 Avenue, 322000, Yiwu, Zhejiang, China
| | - Wenyi Yang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Ting Gao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Zhe Song
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Jun Tian
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Xinzhen Yin
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Xiaojun Guan
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Cheng Zhou
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Jingjing Wu
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Xueqin Bai
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Xiaocao Liu
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China
| | - Guohua Zhao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China. .,Department of Neurology, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, N1 Avenue, 322000, Yiwu, Zhejiang, China.
| | - Minming Zhang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China.
| | - Jiali Pu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China.
| | - Baorong Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, Zhejiang, China.
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14
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Hu S, Luo L, Zeng L. Tea combats circadian rhythm disorder syndrome via the gut-liver-brain axis: potential mechanisms speculated. Crit Rev Food Sci Nutr 2022; 63:7126-7147. [PMID: 35187990 DOI: 10.1080/10408398.2022.2040945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Circadian rhythm is an intrinsic mechanism developed by organisms to adapt to external environmental signals. Nowadays, owing to the job and after-work entertainment, staying up late - Circadian rhythm disorders (CRD) are common. CRD is linked to the development of fatty liver, type 2 diabetes, and chronic gastroenteritis, which affecting the body's metabolic and inflammatory responses via multi-organ crosstalk (gut-liver-brain axis, etc.). However, studies on the mechanisms of multi-organ interactions by CRD are still weak. Current studies on therapeutic agents for CRD remain inadequate, and phytochemicals have been shown to alleviate CRD-induced syndromes that may be used for CRD-therapy in the future. Tea, a popular phytochemical-rich beverage, reduces glucolipid metabolism and inflammation. But it is immature and unclear in the mechanisms of alleviation of CRD-mediated syndrome. Here, we have analyzed the threat of CRD to hosts and their offspring' health from the perspective of the "gut-liver-brain" axis. The potential mechanisms of tea in alleviating CRD were further explored. It might be by interfering with bile acid metabolism, tryptophan metabolism, and G protein-coupled receptors, with FXR, AHR, and GPCR as potential targets. We hope to provide new perspectives on the role of tea in the prevention and mitigation of CRD.HighlightsThe review highlights the health challenges of CRD via the gut-liver-brain axis.CRD research should focus on the health effects on healthy models and its offspring.Tea may prevent CRD by regulating bile acid, tryptophan, and GPCR.Potential targets for tea prevention and mitigation of CRD include FXR, AHR and GPCR.A comprehensive assessment mechanism for tea in improving CRD should be established.
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Affiliation(s)
- Shanshan Hu
- College of Food Science, Southwest University, Beibei, Chongqing, People's Republic of China
| | - Liyong Luo
- College of Food Science, Southwest University, Beibei, Chongqing, People's Republic of China
| | - Liang Zeng
- College of Food Science, Southwest University, Beibei, Chongqing, People's Republic of China
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15
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Yin W, Zhang J, Guo Y, Wu Z, Diao C, Sun J. Melatonin for premenstrual syndrome: A potential remedy but not ready. Front Endocrinol (Lausanne) 2022; 13:1084249. [PMID: 36699021 PMCID: PMC9868742 DOI: 10.3389/fendo.2022.1084249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Premenstrual syndrome (PMS), a recurrent and moderate disorder that occurs during the luteal phase of the menstrual cycle and quickly resolves after menstruation, is characterized by somatic and emotional discomfort that can be severe enough to impair daily activities. Current therapeutic drugs for PMS such as selective serotonin reuptake inhibitors are not very satisfying. As a critical pineal hormone, melatonin has increasingly been suggested to modulate PMS symptoms. In this review, we update the latest progress on PMS-induced sleep disturbance, mood changes, and cognitive impairment and provide possible pathways by which melatonin attenuates these symptoms. Moreover, we focus on the role of melatonin in PMS molecular mechanisms. Herein, we show that melatonin can regulate ovarian estrogen and progesterone, of which cyclic fluctuations contribute to PMS pathogenesis. Melatonin also modulates gamma-aminobutyric acid and the brain-derived neurotrophic factor system in PMS. Interpreting the role of melatonin in PMS is not only informative to clarify PMS etiology but also instructive to melatonin and its receptor agonist application to promote female health. As a safe interaction, melatonin treatment can be effective in alleviating symptoms of PMS. However, symptoms such as sleep disturbance, depressive mood, cognitive impairment are not specific and can be easily misdiagnosed. Connections between melatonin receptor, ovarian steroid dysfunction, and PMS are not consistent among past studies. Before final conclusions are drawn, more well-organized and rigorous studies are recommended.
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Affiliation(s)
- Wei Yin
- Shandong Key Laboratory of Mental Disorders, Department of Anatomy and Neurobiology, Shandong University, Jinan, Shandong, China
| | - Jie Zhang
- Department of Neurosurgery, Laizhou City People’s Hospital, Laizhou, Shandong, China
| | - Yao Guo
- Department of Psychiatry, Shandong Provincial Mental Health Center, Jinan, Shandong, China
| | - Zhibing Wu
- Department of Anatomy, Changzhi Medical College, Changzhi, Shanxi, China
| | - Can Diao
- School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jinhao Sun
- Shandong Key Laboratory of Mental Disorders, Department of Anatomy and Neurobiology, Shandong University, Jinan, Shandong, China
- *Correspondence: Jinhao Sun,
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16
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Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG. Current Treatment Options for REM Sleep Behaviour Disorder. J Pers Med 2021; 11:1204. [PMID: 34834556 PMCID: PMC8624088 DOI: 10.3390/jpm11111204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
The symptomatic treatment of REM sleep behaviour disorder (RBD) is very important to prevent sleep-related falls and/or injuries. Though clonazepam and melatonin are usually considered the first-line symptomatic therapy for RBD, their efficiency has not been proven by randomized clinical trials. The role of dopamine agonists in improving RBD symptoms is controversial, and rivastigmine, memantine, 5-hydroxytryptophan, and the herbal medicine yokukansan have shown some degree of efficacy in short- and medium-term randomized clinical trials involving a low number of patients. The development of potential preventive therapies against the phenoconversion of isolated RBD to synucleinopathies should be another important aim of RBD therapy. The design of long-term, multicentre, randomized, placebo-controlled clinical trials involving a large number of patients diagnosed with isolated RBD with polysomnographic confirmation, directed towards both symptomatic and preventive therapy for RBD, is warranted.
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Affiliation(s)
| | - Hortensia Alonso-Navarro
- Section of Neurology, Hospital Universitario del Sureste, Arganda del Rey, E-28500 Madrid, Spain;
| | - Elena García-Martín
- University Institute of Molecular Pathology Biomarkers, Universidad de Extremadura, ARADyAL Instituto de Salud Carlos III, E-10071 Cáceres, Spain; (E.G.-M.); (J.A.G.A.)
| | - José A. G. Agúndez
- University Institute of Molecular Pathology Biomarkers, Universidad de Extremadura, ARADyAL Instituto de Salud Carlos III, E-10071 Cáceres, Spain; (E.G.-M.); (J.A.G.A.)
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17
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Abstract
Endogenous biological clocks, orchestrated by the suprachiasmatic nucleus, time the circadian rhythms that synchronize physiological and behavioural functions in humans. The circadian system influences most physiological processes, including sleep, alertness and cognitive performance. Disruption of circadian homeostasis has deleterious effects on human health. Neurodegenerative disorders involve a wide range of symptoms, many of which exhibit diurnal variations in frequency and intensity. These disorders also disrupt circadian homeostasis, which in turn has negative effects on symptoms and quality of life. Emerging evidence points to a bidirectional relationship between circadian homeostasis and neurodegeneration, suggesting that circadian function might have an important role in the progression of neurodegenerative disorders. Therefore, the circadian system has become an attractive target for research and clinical care innovations. Studying circadian disruption in neurodegenerative disorders could expand our understanding of the pathophysiology of neurodegeneration and facilitate the development of novel, circadian-based interventions for these disabling disorders. In this Review, we discuss the alterations to the circadian system that occur in movement (Parkinson disease and Huntington disease) and cognitive (Alzheimer disease and frontotemporal dementia) neurodegenerative disorders and provide directions for future investigations in this field.
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18
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Circadian Rhythm Dysregulation and Restoration: The Role of Melatonin. Nutrients 2021; 13:nu13103480. [PMID: 34684482 PMCID: PMC8538349 DOI: 10.3390/nu13103480] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Sleep is an essential component of overall human health but is so tightly regulated that when disrupted can cause or worsen certain ailments. An important part of this process is the presence of the well-known hormone, melatonin. This compound assists in the governing of sleep and circadian rhythms. Previous studies have postulated that dysregulation of melatonin rhythms is the driving force behind sleep and circadian disorders. A computer-aided search spanning the years of 2015–2020 using the search terms melatonin, circadian rhythm, disorder yielded 52 full text articles that were analyzed. We explored the mechanisms behind melatonin dysregulation and how it affects various disorders. Additionally, we examined associated therapeutic treatments including bright light therapy (BLT) and exogenous forms of melatonin. We found that over the past 5 years, melatonin has not been widely investigated in clinical studies thus there remains large gaps in its potential utilization as a therapy.
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19
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Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG. Neurochemical Features of Rem Sleep Behaviour Disorder. J Pers Med 2021; 11:jpm11090880. [PMID: 34575657 PMCID: PMC8468296 DOI: 10.3390/jpm11090880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 12/13/2022] Open
Abstract
Dopaminergic deficiency, shown by many studies using functional neuroimaging with Single Photon Emission Computerized Tomography (SPECT) and Positron Emission Tomography (PET), is the most consistent neurochemical feature of rapid eye movement (REM) sleep behaviour disorder (RBD) and, together with transcranial ultrasonography, and determination of alpha-synuclein in certain tissues, should be considered as a reliable marker for the phenoconversion of idiopathic RBD (iRBD) to a synucleopathy (Parkinson’s disease –PD- or Lewy body dementia -LBD). The possible role in the pathogenesis of RBD of other neurotransmitters such as noradrenaline, acetylcholine, and excitatory and inhibitory neurotransmitters; hormones such as melatonin, and proinflammatory factors have also been suggested by recent reports. In general, brain perfusion and brain glucose metabolism studies have shown patterns resembling partially those of PD and LBD. Finally, the results of structural and functional MRI suggest the presence of structural changes in deep gray matter nuclei, cortical gray matter atrophy, and alterations in the functional connectivity within the basal ganglia, the cortico-striatal, and the cortico-cortical networks, but they should be considered as preliminary.
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Affiliation(s)
- Félix Javier Jiménez-Jiménez
- Section of Neurology, Hospital Universitario del Sureste, Arganda del Rey, C/Marroquina 14, 3 B, E28030 Madrid, Spain;
- Correspondence: or ; Tel.: +34-636968395; Fax: +34-913280704
| | - Hortensia Alonso-Navarro
- Section of Neurology, Hospital Universitario del Sureste, Arganda del Rey, C/Marroquina 14, 3 B, E28030 Madrid, Spain;
| | - Elena García-Martín
- UNEx, ARADyAL, Instituto de Salud Carlos III, University Institute of Molecular Pathology, E10071 Cáceres, Spain; (E.G.-M.); (J.A.G.A.)
| | - José A. G. Agúndez
- UNEx, ARADyAL, Instituto de Salud Carlos III, University Institute of Molecular Pathology, E10071 Cáceres, Spain; (E.G.-M.); (J.A.G.A.)
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20
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Liu Y, Niu L, Liu X, Cheng C, Le W. Recent Progress in Non-motor Features of Parkinson's Disease with a Focus on Circadian Rhythm Dysregulation. Neurosci Bull 2021; 37:1010-1024. [PMID: 34128188 DOI: 10.1007/s12264-021-00711-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease, which manifests with both motor and non-motor symptoms. Circadian rhythm dysregulation, as one of the most challenging non-motor features of PD, usually appears long before obvious motor symptoms. Moreover, the dysregulated circadian rhythm has recently been reported to play pivotal roles in PD pathogenesis, and it has emerged as a hot topic in PD research. In this review, we briefly introduce the circadian rhythm and circadian rhythm-related genes, and then summarize recent research progress on the altered circadian rhythm in PD, ranging from clinical features to the possible causes of PD-related circadian disorders. We believe that future comprehensive studies on the topic may not only help us to explore the mechanisms of PD, but also shed light on the better management of PD.
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Affiliation(s)
- Yufei Liu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Long Niu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Xinyao Liu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Cheng Cheng
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Weidong Le
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China.
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China.
- Institute of Neurology, Sichuan Academy of Medical Science-Sichuan Provincial Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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21
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Iranzo A, Ramos LA, Novo S. The Isolated Form of Rapid Eye Movement Sleep Behavior Disorder: The Upcoming Challenges. Sleep Med Clin 2021; 16:335-348. [PMID: 33985658 DOI: 10.1016/j.jsmc.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnosis of rapid eye movement (REM) sleep behavior disorder (SBD) requires videopolysomnography detection of excessive electromyographic activity during REM sleep, which is time consuming and difficult. An easier, faster, reliable, and reproducible methodology is needed for its diagnosis. The isolated form of RBD represents an early manifestation of the synucleinopathies Parkinson disease and dementia with Lewy bodies. There is a need to find neuroprotective drugs capable of preventing parkinsonism and dementia onset in isolated RBD. Clonazepam and melatonin ameliorate the RBD symptoms, but therapeutic alternatives are needed when these medications fail or show produce side effects.
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Affiliation(s)
- Alex Iranzo
- Neurology Service, Sleep Disorders Center, Hospital Clinic de Barcelona, CIBERNED, IDIBAPS, University of Barcelona, Spain.
| | - Lina Agudelo Ramos
- Neurology Service, Instituto Neurológico de Colombia (INDEC), Calle 55, 46-36, Medellín 050012, Colombia
| | - Sabela Novo
- Instituto de Investigaciones del Sueño, Calle Padre Damián, 44, Madrid 28036, Spain; Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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22
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Zhang X, Molsberry SA, Pavlova M, Schwarzschild MA, Ascherio A, Gao X. Association of Sleepwalking and REM Sleep Behavior Disorder With Parkinson Disease in Men. JAMA Netw Open 2021; 4:e215713. [PMID: 33847749 PMCID: PMC8044732 DOI: 10.1001/jamanetworkopen.2021.5713] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Previous studies conducted among patients with Parkinson disease (PD) reported that parasomnias other than rapid eye movement (REM) sleep behavior disorder (RBD), particularly sleepwalking (SW), are associated with PD severity. However, it remains unclear whether the presence of SW is associated with altered odds of having PD in a population-based study. OBJECTIVE To evaluate whether probable SW, either alone or co-occurring with probable RBD, is associated with higher odds of PD in men. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 25 694 men from the Health Professionals Follow-up Study, a population-based cohort of male health professionals in the US with information on probable SW and probable RBD. Data collection took place between January 2012 and June 2018, and data analysis took place from July 2020 to October 2020. EXPOSURES Probable SW and probable RBD were measured by questions adapted from the Mayo Sleep Questionnaire in 2012. MAIN OUTCOMES AND MEASURES PD, confirmed after review of medical records by a movement disorder specialist. RESULTS Of the 25 694 studied men (mean [SD] age, 75.6 [7.4] years), 223 (0.9%) had probable SW, 2720 (10.6%) had probable RBD, and 257 (1.0%) had PD. After adjusting for potential confounders (eg, age, smoking, caffeine intake, chronic disease status, and other sleep disorders), compared with individuals without probable SW and probable RBD, participants with probable SW, probable RBD, and both probable SW and probable RBD had higher odds of PD, (probable SW: odds ratio [OR], 4.80; 95% CI, 1.61-14.26; probable RBD: OR, 6.36; 95% CI, 4.83-8.37; both probable SW and probable RBD: OR, 8.44; 95% CI, 3.90-18.27). CONCLUSIONS AND RELEVANCE In this cross-sectional study of a male population, probable sleep parasomnias, including both SW and RBD, were associated with higher odds of having PD. PD-related neurodegeneration may impair arousal regulation during sleep.
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Affiliation(s)
- Xinyuan Zhang
- Department of Nutritional Sciences, The Pennsylvania State University, University Park
| | - Samantha A. Molsberry
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Milena Pavlova
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Alberto Ascherio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park
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23
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Asah C, Frandsen R, Ibsen R, Kjellberg J, Jennum P. Morbidity, Mortality, and Conversion to Neurodegenerative Diseases in Patients with REM Sleep Behavior Disorder and REM Sleep without Atonia. Neuroepidemiology 2021; 55:141-153. [PMID: 33780948 DOI: 10.1159/000514175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/29/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The underlying pathophysiology of idiopathic REM sleep behavior disorder (iRBD) is not fully understood, although the condition is currently recognized as an early-stage alpha-synuclein disorder. We evaluated the morbidity, mortality, and rate of conversion to a neurodegenerative disorder in a national group of patients. METHODS All patients in Denmark with a diagnosis of RBD between 2006 and 2013 were identified from the Danish National Patient Registry (NPR) records. We excluded patients who had received a diagnosis of narcolepsy or any of the following neurodegenerative diseases before their diagnosis of RBD: Parkinson's disease, multiple system atrophy, progressive supranuclear paralysis, Alzheimer's, and Lewy body dementia. We used randomly chosen controls matched for age, gender, and municipality. RESULTS In total, 246 iRBD patients and 982 matched controls were analyzed. The mortality rate was the same in both groups. The morbidity rate was significantly higher in the years before and after an RBD diagnosis, due to a wide variety of disorders in the following major disease groups: mental/behavioral disorders; endocrine/metabolic diseases; diseases of the eye; diseases of the nervous, digestive, musculoskeletal, circulatory, and respiratory systems; abnormal findings not classified elsewhere; external causes; and factors influencing health status. The conversion rate from RBD to a neurodegenerative disease was 13% over the 8 years after a diagnosis of RBD. CONCLUSIONS A diagnosis of RBD is associated with increased morbidity several years before and after a diagnosis is made. Patients have a higher risk of converting to a neurodegenerative disorder than matched controls. Mortality rates are unchanged.
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Affiliation(s)
- Cresta Asah
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rune Frandsen
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Kjellberg
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - Poul Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Carter B, Justin HS, Gulick D, Gamsby JJ. The Molecular Clock and Neurodegenerative Disease: A Stressful Time. Front Mol Biosci 2021; 8:644747. [PMID: 33889597 PMCID: PMC8056266 DOI: 10.3389/fmolb.2021.644747] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/01/2021] [Indexed: 12/14/2022] Open
Abstract
Circadian rhythm dysfunction occurs in both common and rare neurodegenerative diseases. This dysfunction manifests as sleep cycle mistiming, alterations in body temperature rhythms, and an increase in symptomatology during the early evening hours known as Sundown Syndrome. Disruption of circadian rhythm homeostasis has also been implicated in the etiology of neurodegenerative disease. Indeed, individuals exposed to a shifting schedule of sleep and activity, such as health care workers, are at a higher risk. Thus, a bidirectional relationship exists between the circadian system and neurodegeneration. At the heart of this crosstalk is the molecular circadian clock, which functions to regulate circadian rhythm homeostasis. Over the past decade, this connection has become a focal point of investigation as the molecular clock offers an attractive target to combat both neurodegenerative disease pathogenesis and circadian rhythm dysfunction, and a pivotal role for neuroinflammation and stress has been established. This review summarizes the contributions of molecular clock dysfunction to neurodegenerative disease etiology, as well as the mechanisms by which neurodegenerative diseases affect the molecular clock.
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Affiliation(s)
- Bethany Carter
- Gamsby Laboratory, USF Health Byrd Alzheimer's Center and Research Institute, University of South Florida Health, Tampa, FL, United States
| | - Hannah S Justin
- Gamsby Laboratory, USF Health Byrd Alzheimer's Center and Research Institute, University of South Florida Health, Tampa, FL, United States
| | - Danielle Gulick
- Gamsby Laboratory, USF Health Byrd Alzheimer's Center and Research Institute, University of South Florida Health, Tampa, FL, United States.,Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Joshua J Gamsby
- Gamsby Laboratory, USF Health Byrd Alzheimer's Center and Research Institute, University of South Florida Health, Tampa, FL, United States.,Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
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25
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Disorders of Arousal: A Chronobiological Perspective. Clocks Sleep 2021; 3:53-65. [PMID: 33494408 PMCID: PMC7838780 DOI: 10.3390/clockssleep3010004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
Non-rapid eye movement (NREM) sleep parasomnias are characterized by motor and emotional behaviors emerging from incomplete arousals from NREM sleep and they are currently referred to as disorders of arousal (DoA). Three main clinical entities are recognized, namely confusional arousal, sleep terror and sleepwalking. DoA are largely present in pediatric populations, an age in which they are considered as transitory, unhabitual physiological events. The literature background in the last twenty years has extensively shown that DoA can persist in adulthood in predisposed individuals or even appear de novo in some cases. Even though some episodes may arise from stage 2 of sleep, most DoA occur during slow wave sleep (SWS), and particularly during the first two sleep cycles. The reasons for this timing are linked to the intrinsic structure of SWS and with the possible influence on this sleep phase of predisposing, priming and precipitating factors for DoA episodes. The objective of this paper is to review the intrinsic sleep-related features and chronobiological aspects affecting SWS, responsible for the occurrence of the majority of DoA episodes during the first part of the night.
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26
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Liu YL, Gong SY, Xia ST, Wang YL, Peng H, Shen Y, Liu CF. Light therapy: a new option for neurodegenerative diseases. Chin Med J (Engl) 2020; 134:634-645. [PMID: 33507006 PMCID: PMC7990011 DOI: 10.1097/cm9.0000000000001301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT Given the increasing incidence of neurodegenerative disease (ND), recent research efforts have intensified the search for curative treatments. Despite significant research, however, existing therapeutic options for ND can only slow down the progression of the disease, but not provide a cure. Light therapy (LT) has been used to treat some mental and sleep disorders. This review illustrates recent studies of the use of LT in patients with ND and highlights its potential for clinical applications. The literature was collected from PubMed through June 2020. Selected studies were primarily English articles or articles that could be obtained with English abstracts and Chinese main text. Articles were not limited by type. Additional potential publications were also identified from the bibliographies of identified articles and the authors' reference libraries. The identified literature suggests that LT is a safe and convenient physical method of treatment. It may alleviate sleep disorders, depression, cognitive function, and other clinical symptoms. However, some studies have reported limited or no effects. Therefore, LT represents an attractive therapeutic approach for further investigation in ND. LT is an effective physical form of therapy and a new direction for research into treatments for ND. However, it requires further animal experiments to elucidate mechanisms of action and large, double-blind, randomized, and controlled trials to explore true efficacy in patients with ND.
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Affiliation(s)
- Yu-Lu Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Si-Yi Gong
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Shu-Ting Xia
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China
| | - Ya-Li Wang
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, Jiangsu 215008, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215006 China
| | - Yun Shen
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Chun-Feng Liu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China
- Department of Neurology, Suqian First Hospital, Suqian, Jiangsu 223800, China
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27
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Liguori C, Zuccarelli V, Spanetta M, Izzi F, Biagio Mercuri N, Placidi F. Sleep-wake cycle dysregulation in idiopathic REM sleep behaviour disorder. J Sleep Res 2020; 30:e13234. [PMID: 33260265 DOI: 10.1111/jsr.13234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/23/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022]
Abstract
Alteration of the circadian sleep-wake rhythm has been suggested in patients affected by idiopathic rapid eye movement sleep behaviour disorder. Because actigraphy is the validated instrument to monitor the sleep-wake cycle, the aim of the present study was to investigate the circadian sleep-wake rhythm in patients with idiopathic rapid eye movement sleep behaviour disorder compared with healthy aged controls. Fourteen-day actigraphic recording, a comprehensive sleep interview, and cognitive and behavioural domains were investigated in patients affected by idiopathic rapid eye movement sleep behaviour disorder, and compared with controls similar for age, sex and cognitive performances. Patients with idiopathic rapid eye movement sleep behaviour disorder showed reduced relative amplitude and alteration of both sleep and wake compared with controls. Patients with idiopathic rapid eye movement sleep behaviour disorder also showed subjective sleep and wake complaints, and higher scores at the Beck Depression Inventory, compared with controls. Beck Depression Inventory scores correlated with sleep actigraphic parameters, such as sleep latency, sleep efficiency, time in bed, and relative amplitude. Therefore, the present study showed the dysregulation of the sleep-wake cycle in patients with idiopathic rapid eye movement behaviour disorder. Moreover, depressive symptoms documented in patients with idiopathic rapid eye movement sleep behaviour disorder correlated with the sleep-wake rhythm dysregulation.
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Affiliation(s)
- Claudio Liguori
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Neurology Unit, Sleep Medicine Centre, University Hospital "Tor Vergata", Rome, Italy
| | - Vittorio Zuccarelli
- Neurology Unit, Sleep Medicine Centre, University Hospital "Tor Vergata", Rome, Italy
| | - Matteo Spanetta
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Francesca Izzi
- Neurology Unit, Sleep Medicine Centre, University Hospital "Tor Vergata", Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Fabio Placidi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Neurology Unit, Sleep Medicine Centre, University Hospital "Tor Vergata", Rome, Italy
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28
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Hao EY, Wang DH, Chang LY, Huang CX, Chen H, Yue QX, Zhou RY, Huang RL. Melatonin regulates chicken granulosa cell proliferation and apoptosis by activating the mTOR signaling pathway via its receptors. Poult Sci 2020; 99:6147-6162. [PMID: 33142533 PMCID: PMC7647829 DOI: 10.1016/j.psj.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 07/24/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
Melatonin is a key regulator of follicle granular cell maturation and ovulation. The mammalian target of rapamycin (mTOR) pathway plays an important role in cell growth regulation. Therefore, our aim was to investigate whether the mTOR signaling pathway is involved in the regulation of melatonin-mediated proliferation and apoptotic mechanisms in granulosa cells. Chicken follicle granular cells were cultured with melatonin (0, 2, 20, or 200 μmol/L) for 48 h. The results showed that melatonin treatment enhanced proliferation and suppressed apoptosis in granular cells at 20 μmol/L and 200 μmol/L (P < 0.05) by upregulation of cyclin D1 (P < 0.01) and Bcl-2 (P < 0.01) and downregulation of P21, caspase-3, Beclin1, and LC3-II (P < 0.01). The effects resulted in the activation of the mTOR signaling pathway by increasing the expression of avTOR, PKC, 4E-BP1, S6K (P < 0.05), p-mTOR, and p-S6K. We added an mTOR activator and inhibitor to the cells and identified the optimal dose (10 μmol/L MHY1485 and 100 nmol/L rapamycin) for subsequent experiments. The combination of 20 μmol/L melatonin and 10 μmol/L MHY1485 significantly enhanced granulosa cell proliferation (P < 0.05), while 100 nmol/L rapamycin significantly inhibited proliferation and enhanced apoptosis (P < 0.05), but this action was reversed in the 20-μmol/L melatonin and 100-nmol/L rapamycin cotreatment groups (P < 0.05). This was confirmed by mRNA and protein expression that was associated with proliferation, apoptosis, and autophagy (P < 0.05). The combination of 20 μmol/L melatonin and 10 μmol/L MHY1485 also activated the mTOR pathway upstream genes PI3K, AKT1, and AKT2 and downstream genes PKC, 4E-BP1, and S6K (P < 0.05), as well as protein expression of p-mTOR and p-S6K. Rapamycin significantly inhibited the mTOR pathway-related genes mRNA levels (P < 0.05). In addition, activation of the mTOR pathway increased melatonin receptor mRNA levels (P < 0.05). In conclusion, these findings demonstrate that melatonin regulates chicken granulosa cell proliferation and apoptosis by activating the mTOR signaling pathway via its receptor.
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Affiliation(s)
- Er-Ying Hao
- College of Animal Science and Technology, Hebei Agricultural University, Baoding Hebei 071001, China
| | - De-He Wang
- College of Animal Science and Technology, Hebei Agricultural University, Baoding Hebei 071001, China
| | - Li-Yun Chang
- College of Veterinary Medicine, Hebei Agricultural University, Baoding Hebei 071001, China
| | - Chen-Xuan Huang
- College of Animal Science and Technology, Hebei Agricultural University, Baoding Hebei 071001, China
| | - Hui Chen
- College of Animal Science and Technology, Hebei Agricultural University, Baoding Hebei 071001, China.
| | - Qiao-Xian Yue
- College of Animal Science and Technology, Hebei Agricultural University, Baoding Hebei 071001, China
| | - Rong-Yan Zhou
- College of Animal Science and Technology, Hebei Agricultural University, Baoding Hebei 071001, China
| | - Ren-Lu Huang
- College of Animal Science and Technology, Hebei Agricultural University, Baoding Hebei 071001, China
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29
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Feng H, Chen L, Liu Y, Chen X, Wang J, Yu MWM, Huang B, Li SX, Chau SWH, Chan JWY, Chen J, Mok VCT, Wing YK, Zhang J. Rest‐Activity Pattern Alterations in Idiopathic
REM
Sleep Behavior Disorder. Ann Neurol 2020; 88:817-829. [DOI: 10.1002/ana.25853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Hongliang Feng
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Lauren Chen
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Yaping Liu
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Xinru Chen
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Jing Wang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Mandy Wai Man Yu
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Bei Huang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Shirley Xin Li
- Department of Psychology The University of Hong Kong Shatin, Hong Kong China
- The State Key Laboratory of Brain and Cognitive Sciences The University of Hong Kong, Pokfulam Hong Kong China
| | - Steven Wai Ho Chau
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Joey Wing Yan Chan
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Jie Chen
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Vincent Chung Tong Mok
- Margaret K.L. Cheung Research Centre in Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Division of Neurology, Department of Medicine and Therapeutics The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Yun Kwok Wing
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Jihui Zhang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Guangzhou Guangdong China
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30
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Roguski A, Rayment D, Whone AL, Jones MW, Rolinski M. A Neurologist's Guide to REM Sleep Behavior Disorder. Front Neurol 2020; 11:610. [PMID: 32733361 PMCID: PMC7360679 DOI: 10.3389/fneur.2020.00610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/25/2020] [Indexed: 01/10/2023] Open
Abstract
REM Sleep Behavior Disorder (RBD) is a chronic sleep condition characterized by dream enactment and loss of REM atonia. Individuals often present to clinic with complaints of injury to themselves or their bed-partner due to violent movements during sleep. RBD patients have a high risk of developing one of the neurodegenerative α-synucleinopathy diseases: over 70% will develop parkinsonism or dementia within 12 years of their diagnosis. RBD patients also exhibit accelerated disease progression and a more severe phenotype than α-synucleinopathy sufferers without RBD. The disease's low prevalence and the relatively limited awareness of the condition amongst medical professionals makes the diagnosis and treatment of RBD challenging. Uncertainty in patient management is further exacerbated by a lack of clinical guidelines for RBD patient care. There are no binary prognostic markers for RBD disease course and there are no clinical guidelines for neurodegeneration scaling or tracking in these patients. Both clinicians and patients are therefore forced to deal with uncertain outcomes. In this review, we summarize RBD pathology and differential diagnoses, diagnostic, and treatment guidelines as well as prognostic recommendations with a look to current research in the scientific field. We aim to raise awareness and develop a framework for best practice for RBD patient management.
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Affiliation(s)
- Amber Roguski
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Dane Rayment
- Rosa Burden Centre, Southmead Hospital, Bristol, United Kingdom
| | - Alan L Whone
- Department of Neurology, Southmead Hospital, Bristol, United Kingdom.,Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Matt W Jones
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Michal Rolinski
- Department of Neurology, Southmead Hospital, Bristol, United Kingdom.,Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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31
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Filardi M, Stefani A, Holzknecht E, Pizza F, Plazzi G, Högl B. Objective rest–activity cycle analysis by actigraphy identifies isolated rapid eye movement sleep behavior disorder. Eur J Neurol 2020; 27:1848-1855. [DOI: 10.1111/ene.14386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022]
Affiliation(s)
- M. Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
| | - A. Stefani
- Sleep Disorders Unit Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - E. Holzknecht
- Sleep Disorders Unit Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - F. Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - G. Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - B. Högl
- Sleep Disorders Unit Department of Neurology Medical University of Innsbruck Innsbruck Austria
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32
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Self-Reported Rapid Eye Movement Sleep Behavior Disturbance and Its Associated Factors among Medicine and Health Science Students at the University of Gondar. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1810836. [PMID: 32509850 PMCID: PMC7245670 DOI: 10.1155/2020/1810836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022]
Abstract
Introduction Rapid eye movement sleep behavior disorder (RBD) is characterized by dream-enacting behavior (shouting, punching, and falling out of bed) related to unpleasant dreams and loss of normal rapid eye movement (REM) sleep muscle atonia. Rapid eye movement sleep enhances learning and memory by regulating neuronal synapses, and if it is undesirable, it can lead to cognitive impairment and poor academic performance and may end up with death. To the best of our searching databases, there is no such study conducted in Ethiopia. Therefore, this study is aimed at determining self-reported symptoms of RBD and its associated factors among the University of Gondar medicine and health science students (2019). Methods We conducted a cross-sectional study from June 1 to July 2019, among medicine and health science students at the University of Gondar using a simple random sampling technique. A self-reported RBD screening questionnaire was used to collect the data. We used Epi Info™ 7.0.8.3 and Stata 14 for data entry and statistical analyses, respectively. Descriptive statistics (frequency with percent and mean with standard deviation) and adjusted odds ratio (AOR) with 95% uncertainty interval (UI) were computed. In a multivariable binary logistic regression, variables with a p < 0.05 were declared as significant. Results Three hundred and eighty-seven students took part in the study. The mean age of participants was 20.81 (±1.83) years. The prevalence of self-reported RBD was 46.25% [95% UI (41.26%-51.24)]. Physical exercise immediately before sleep (AOR = 2.50, 95% UI (1.24-5.02)), using Facebook immediately before sleep (AOR = 1.93, 95% UI (1.18-3.15)), having daytime sleepiness (AOR = 1.92, 95% UI (1.16-3.19)), and self-reported depressive symptoms (AOR = 2.40, 95% UI (1.45-3.99)) were significantly associated with self-reported RBD. Conclusion The current study revealed a high prevalence of self-reported RBD. This remarkable problem suggested a need to design strategies to prevent RBD symptoms among university students through targeting screening of depression, daytime sleepiness, and adjusting bedtime routines such as physical exercise and internet use immediately before going to bed.
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33
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Rzepka-Migut B, Paprocka J. Melatonin-Measurement Methods and the Factors Modifying the Results. A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1916. [PMID: 32183489 PMCID: PMC7142625 DOI: 10.3390/ijerph17061916] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 01/11/2023]
Abstract
Melatonin plays an important role in regulating the sleep-wake cycle and adaptation to environmental changes. Concentration measurements in bioliquids such as serum/plasma, saliva and urine are widely used to assess peripheral rhythm. The aim of the study was to compare methods and conditions of determinations carried out with the identification of factors potentially affecting the measurements obtained. We have identified a group of modifiable and unmodifiable factors that facilitate data interpretation. Knowledge of modifiers allows you to carefully plan the test protocol and then compare the results. There is no one universal sampling standard, because the choice of method and biofluid depends on the purpose of the study and the research group.
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Affiliation(s)
- Beata Rzepka-Migut
- Department of Pediatric Neurology and Pediatrics, St. Queen Jadwiga’s Regional Clinical Hospital No 2 Rzeszów, 35-301 Rzeszów, Poland;
| | - Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
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34
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Gonzalez A. Antioxidants and Neuron-Astrocyte Interplay in Brain Physiology: Melatonin, a Neighbor to Rely on. Neurochem Res 2020; 46:34-50. [PMID: 31989469 DOI: 10.1007/s11064-020-02972-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 12/19/2022]
Abstract
This manuscript is a review focused onto the role of astrocytes in the protection of neurons against oxidative stress and how melatonin can contribute to the maintenance of brain homeostasis. The first part of the review is dedicated to the dependence of neurons on astrocytes by terms of survival under oxidative stress conditions. Additionally, the effects of melatonin against oxidative stress in the brain and its putative role in the protection against diseases affecting the brain are highlighted. The effects of melatonin on the physiology of neurons and astrocytes also are reviewed.
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Affiliation(s)
- Antonio Gonzalez
- Department of Physiology, Institute of Molecular Pathology Biomarkers, University of Extremadura, Avenida de las Ciencias s/n, 10003, Cáceres, Spain.
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35
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Brock MS, Shirley S, Rohena L, Moore BA, Mysliwiec V. Unexpected Finding of Idiopathic REM Sleep Behavior Disorder in a Young Healthy Male With Snoring: A Case Report. J Clin Sleep Med 2019; 15:1369-1371. [PMID: 31538609 PMCID: PMC6760398 DOI: 10.5664/jcsm.7938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/13/2022]
Abstract
None Idiopathic rapid eye movement sleep behavior disorder is characterized by vocalizations and complex motor behaviors during sleep. We report a case of a 44-year-old male with a 20-year history of dream enactment behavior that was incidentally captured on a polysomnogram during an evaluation for obstructive sleep apnea. Genetic testing found the patient had a homozygous deletion for one of the five tandem repeats in exon 18 of the PER3 gene. This case highlights a potential genetic basis for idiopathic rapid eye movement sleep behavior disorder. CITATION Brock MS, Shirley S, Rohena L, Moore BA, Mysliwiec V. Unexpected finding of idiopathic REM sleep behavior disorder in a young healthy male with snoring: a case report. J Clin Sleep Med. 2019;15(9):1369-1371.
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Affiliation(s)
- Matthew S. Brock
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
| | - Sean Shirley
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
| | - Luis Rohena
- Department of Pediatrics, Division of Medical Genetics, San Antonio Military Medical Center, San Antonio, Texas
| | - Brian A. Moore
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- The University of Texas at San Antonio, San Antonio, Texas
| | - Vincent Mysliwiec
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
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Xu G, Zhao J, Liu H, Wang J, Lu W. Melatonin Inhibits Apoptosis and Oxidative Stress of Mouse Leydig Cells via a SIRT1-Dependent Mechanism. Molecules 2019; 24:molecules24173084. [PMID: 31450679 PMCID: PMC6749417 DOI: 10.3390/molecules24173084] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/21/2019] [Accepted: 08/24/2019] [Indexed: 12/15/2022] Open
Abstract
The purpose of the present study is to examine the effects of melatonin on apoptosis and oxidative stress in mouse Leydig cells and to elucidate the mechanisms responsible for these effects. Our results indicated that 10 ng/mL of melatonin significantly promoted cell viability, the ratio of EdU-positive (5-Ethynyl-2'-deoxyuridine) cells, and increased the mRNA expression of proliferating cell nuclear antigen (PCNA), cyclin D1(CCND1), and cell division control protein 42 (CDC42) (p < 0.05). We also observed that melatonin inhibited apoptosis of mouse Leydig cells, accompanied with increased B-cell lymphoma-2 (BCL-2) and decreased BCL2 associated X (BAX) mRNA and protein expression. Moreover, addition of melatonin significantly decreased the reactive oxygen species (ROS) production and malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels, while it increased superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels (p < 0.05). In addition, we also found that melatonin increased the expression of SIRT1 (Silent information regulator 1) (p < 0.05). To explore the role of SIRT1 signaling in melatonin-induced cells, mouse Leydig cells were pretreated with EX527, an inhibitor of SIRT1. The protective effects of melatonin on mouse Leydig cells were reversed by EX527, as shown by decreased cell proliferation and increased cell apoptosis and oxidative stress. In summary, our results demonstrated that melatonin inhibited apoptosis and oxidative stress of mouse Leydig cells through a SIRT1-dependent mechanism.
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Affiliation(s)
- Gaoqing Xu
- College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China
| | - Jing Zhao
- College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China
| | - Hongyu Liu
- College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China
| | - Jun Wang
- College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China.
| | - Wenfa Lu
- College of Animal Science and Technology, Jilin Agricultural University, Changchun 130118, China.
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Pyun JM, Kang MJ, Yun Y, Park YH, Kim S. APOE ɛ4 and REM Sleep Behavior Disorder as Risk Factors for Sundown Syndrome in Alzheimer’s Disease. J Alzheimers Dis 2019; 69:521-528. [DOI: 10.3233/jad-190032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jung-Min Pyun
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Min Ju Kang
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Younghwa Yun
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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