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Qiu L, Chang A, Ma R, Strong TV, Okun MS, Foote KD, Wexler A, Gunduz A, Miller JL, Halpern CH. Neuromodulation for the treatment of Prader-Willi syndrome - A systematic review. Neurotherapeutics 2024; 21:e00339. [PMID: 38430811 PMCID: PMC10920723 DOI: 10.1016/j.neurot.2024.e00339] [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: 12/07/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
Prader-Willi syndrome (PWS) is a complex, genetic disorder characterized by multisystem involvement, including hyperphagia, maladaptive behaviors and endocrinological derangements. Recent developments in advanced neuroimaging have led to a growing understanding of PWS as a neural circuit disorder, as well as subsequent interests in the application of neuromodulatory therapies. Various non-invasive and invasive device-based neuromodulation methods, including vagus nerve stimulation (VNS), transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS) have all been reported to be potentially promising treatments for addressing the major symptoms of PWS. In this systematic literature review, we summarize the recent literature that investigated these therapies, discuss the underlying circuits which may underpin symptom manifestations, and cover future directions of the field. Through our comprehensive search, there were a total of 47 patients who had undergone device-based neuromodulation therapy for PWS. Two articles described VNS, 4 tDCS, 1 rTMS and 2 DBS, targeting different symptoms of PWS, including aberrant behavior, hyperphagia and weight. Multi-center and multi-country efforts will be required to advance the field given the low prevalence of PWS. Finally, given the potentially vulnerable population, neuroethical considerations and dialogue should guide the field.
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Affiliation(s)
- Liming Qiu
- Department of Neurosurgery, University of Pennsylvania Health System, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Andrew Chang
- Department of Neurosurgery, University of Pennsylvania Health System, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ruoyu Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Anna Wexler
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jennifer L Miller
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Casey H Halpern
- Department of Neurosurgery, University of Pennsylvania Health System, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
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Huang Z, Zhang X, Yang X, Ding S, Cai J. Aberrant brain intra- and internetwork functional connectivity in children with Prader-Willi syndrome. Neuroradiology 2024; 66:135-144. [PMID: 38001311 PMCID: PMC10761436 DOI: 10.1007/s00234-023-03259-x] [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: 04/26/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE Prader-Willi syndrome (PWS) suffers from brain functional reorganization and developmental delays during childhood, but the underlying neurodevelopmental mechanism is unclear. This paper aims to investigate the intra- and internetwork functional connectivity (FC) changes, and their relationships with developmental delays in PWS children. METHODS Resting-state functional magnetic resonance imaging datasets of PWS children and healthy controls (HCs) were acquired. Independent component analysis was used to acquire core resting-state networks (RSNs). The intra- and internetwork FC patterns were then investigated. RESULTS In terms of intranetwork FC, children with PWS had lower FC in the dorsal attention network, the auditory network, the medial visual network (VN) and the sensorimotor network (SMN) than HCs (FWE-corrected, p < 0.05). In terms of internetwork FC, PWS children had decreased FC between the following pairs of regions: posterior default mode network (DMN) and anterior DMN; posterior DMN and SMN; SMN and posterior VN and salience network and medial VN (FDR-corrected, p < 0.05). Partial correlation analyses revealed that the intranetwork FC patterns were positively correlated with developmental quotients in PWS children, while the internetwork FC patterns were completely opposite (p < 0.05). Intranetwork FC patterns showed an area under the receiver operating characteristic curve of 0.947, with a sensitivity of 96.15% and a specificity of 81.25% for differentiating between PWS and HCs. CONCLUSION Impaired intra- and internetwork FC patterns in PWS children are associated with developmental delays, which may result from neural pathway dysfunctions. Intranetwork FC reorganization patterns can discriminate PWS children from HCs. REGISTRATION NUMBER ON THE CHINESE CLINICAL TRAIL REGISTRY ChiCTR2100046551.
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Affiliation(s)
- Zhongxin Huang
- Department of Radiology, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan Second Road 400014, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, 400014, China
| | - Xiangmin Zhang
- Department of Radiology, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan Second Road 400014, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, 400014, China
| | - Xinyi Yang
- Department of Radiology, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan Second Road 400014, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, 400014, China
| | - Shuang Ding
- Department of Radiology, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan Second Road 400014, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, 400014, China
| | - Jinhua Cai
- Department of Radiology, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan Second Road 400014, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, 400014, China.
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Wieting J, Jahn K, Eberlein CK, Bleich S, Frieling H, Deest M. Hypomethylation of the dopamine transporter (DAT) gene promoter is associated with hyperphagia-related behavior in Prader-Willi syndrome: a case-control study. Behav Brain Res 2023; 450:114494. [PMID: 37182741 DOI: 10.1016/j.bbr.2023.114494] [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: 02/02/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023]
Abstract
Prader-Willi syndrome (PWS), a neurodevelopmental disorder based on the loss of paternally derived but maternally imprinted genes on chromosome 15q11-13, is typically associated with hyperphagia-related behavior leading to massive obesity. Recently, there has been increasing evidence for dysregulated expression patterns of genes outside the PWS locus that influence the behavioral phenotype and for alterations in the dopaminergic system associated with weight regulation in PWS. In this study, we investigated the epigenetic regulation of the promoter regions of the dopamine transporter (DAT) and dopamine receptor D2 (DRD2) genes and their association with hyperphagia-related behavior in PWS. Methylation of the DAT and DRD2 promoter regions was examined by DNA bisulfite sequencing in 32 individuals with PWS and compared with a control group matched for sex, age, and body mass index (BMI). Hyperphagia-related behavior was assessed using the Hyperphagia Questionnaire for Clinical Trials (HQ-CT). Analysis by linear mixed models revealed a significant effect of factor group on mean DAT promoter methylation rate with decreased mean methylation in PWS (7.3 ± 0.4%) compared to controls (18.8 ± 0.6%), p < 0.001. In the PWS group, we further identified effects of HQ-CT score and BMI on DAT promoter methylation. Although also statistically significantly different (8.4 ± 0.2 in PWS, 10.5 ± 0.3 in controls, p < 0.001), DRD2 promoter methylation visually appeared to be evenly distributed between groups, raising concerns regarding a biological effect. Here, we provide evidence for altered epigenetic regulation of the DAT gene in PWS, which is associated with PWS-typical hyperphagia-related behaviors.
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Affiliation(s)
- Jelte Wieting
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Kirsten Jahn
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christian K Eberlein
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Helge Frieling
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maximilian Deest
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Richer LP, Tan Q, Butler MG, Avedzi HM, DeLorey DS, Peng Y, Tun HM, Sharma AM, Ainsley S, Orsso CE, Triador L, Freemark M, Haqq AM. Evaluation of Autonomic Nervous System Dysfunction in Childhood Obesity and Prader-Willi Syndrome. Int J Mol Sci 2023; 24:ijms24098013. [PMID: 37175718 PMCID: PMC10179129 DOI: 10.3390/ijms24098013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
The autonomic nervous system (ANS) may play a role in the distribution of body fat and the development of obesity and its complications. Features of individuals with Prader-Willi syndrome (PWS) impacted by PWS molecular genetic classes suggest alterations in ANS function; however, these have been rarely studied and presented with conflicting results. The aim of this study was to investigate if the ANS function is altered in PWS. In this case-control study, we assessed ANS function in 20 subjects with PWS (6 males/14 females; median age 10.5 years) and 27 body mass index (BMI) z-score-matched controls (19 males/8 females; median age 12.8 years). Standardized non-invasive measures of cardiac baroreflex function, heart rate, blood pressure, heart rate variability, quantitative sudomotor axon reflex tests, and a symptom questionnaire were completed. The increase in heart rate in response to head-up tilt testing was blunted (p < 0.01) in PWS compared to controls. Besides a lower heart rate ratio with Valsalva in PWS (p < 0.01), no significant differences were observed in other measures of cardiac function or sweat production. Findings suggest possible altered sympathetic function in PWS.
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Affiliation(s)
- Lawrence P Richer
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Qiming Tan
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Merlin G Butler
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, Kansas University Medical Center, Kansas City, KS 66160, USA
| | - Hayford M Avedzi
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Darren S DeLorey
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Ye Peng
- JC School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Hein M Tun
- JC School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Steven Ainsley
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Camila E Orsso
- Department of Agricultural Food & Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Lucila Triador
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Michael Freemark
- Division of Pediatric Endocrinology, Duke University Medical Center, Durham, NC 27705, USA
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Division of Pediatric Endocrinology, Duke University Medical Center, Durham, NC 27705, USA
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Prader-Willi Syndrome and Chromosome 15q11.2 BP1-BP2 Region: A Review. Int J Mol Sci 2023; 24:ijms24054271. [PMID: 36901699 PMCID: PMC10002205 DOI: 10.3390/ijms24054271] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder with three PWS molecular genetic classes and presents as severe hypotonia, failure to thrive, hypogonadism/hypogenitalism and developmental delay during infancy. Hyperphagia, obesity, learning and behavioral problems, short stature with growth and other hormone deficiencies are identified during childhood. Those with the larger 15q11-q13 Type I deletion with the absence of four non-imprinted genes (NIPA1, NIPA2, CYFIP1, TUBGCP5) from the 15q11.2 BP1-BP2 region are more severely affected compared with those with PWS having a smaller Type II deletion. NIPA1 and NIPA2 genes encode magnesium and cation transporters, supporting brain and muscle development and function, glucose and insulin metabolism and neurobehavioral outcomes. Lower magnesium levels are reported in those with Type I deletions. The CYFIP1 gene encodes a protein associated with fragile X syndrome. The TUBGCP5 gene is associated with attention-deficit hyperactivity disorder (ADHD) and compulsions, more commonly seen in PWS with the Type I deletion. When the 15q11.2 BP1-BP2 region alone is deleted, neurodevelopment, motor, learning and behavioral problems including seizures, ADHD, obsessive-compulsive disorder (OCD) and autism may occur with other clinical findings recognized as Burnside-Butler syndrome. The genes in the 15q11.2 BP1-BP2 region may contribute to more clinical involvement and comorbidities in those with PWS and Type I deletions.
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6
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Progress in Brain Magnetic Resonance Imaging of Individuals with Prader-Willi Syndrome. J Clin Med 2023; 12:jcm12031054. [PMID: 36769704 PMCID: PMC9917938 DOI: 10.3390/jcm12031054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Prader-Willi syndrome (PWS), a rare epigenetic disease mapping the imprinted chromosomal domain of 15q11.2-q13.3, manifests a regular neurodevelopmental trajectory in different phases. The current multimodal magnetic resonance imaging (MRI) approach for PWS focues on morphological MRI (mMRI), diffusion MRI (dMRI) and functional MRI (fMRI) to uncover brain alterations. This technique offers another perspective to understand potential neurodevelopmental and neuropathological processes of PWS, in addition to specific molecular gene expression patterns, various clinical manifestations and metabolic phenotypes. Multimodal MRI studies of PWS patients demonstrated common brain changes in the volume of gray matter, the integrity of the fiber tracts and the activation and connectivity of some networks. These findings mainly showed that brain alterations in the frontal reward circuit and limbic system were related to molecular genetics and clinical manifestations (e.g., overwhelming eating, obsessive compulsive behaviors and skin picking). Further exploration using a large sample size and advanced MRI technologies, combined with artificial intelligence algorithms, will be the main research direction to study the structural and functional changes and potential pathogenesis of PWS.
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Rosenberg AGW, Wellink CM, Tellez Garcia JM, Pellikaan K, Van Abswoude DH, Davidse K, Van Zutven LJCM, Brüggenwirth HT, Resnick JL, Van der Lely AJ, De Graaff LCG. Health Problems in Adults with Prader-Willi Syndrome of Different Genetic Subtypes: Cohort Study, Meta-Analysis and Review of the Literature. J Clin Med 2022; 11:jcm11144033. [PMID: 35887798 PMCID: PMC9323859 DOI: 10.3390/jcm11144033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
Prader−Willi syndrome (PWS) is a complex, rare genetic disorder caused by a loss of expression of paternally expressed genes on chromosome 15q11.2-q13. The most common underlying genotypes are paternal deletion (DEL) and maternal uniparental disomy (mUPD). DELs can be subdivided into type 1 (DEL-1) and (smaller) type 2 deletions (DEL-2). Most research has focused on behavioral, cognitive and psychological differences between the different genotypes. However, little is known about physical health problems in relation to genetic subtypes. In this cross-sectional study, we compare physical health problems and other clinical features among adults with PWS caused by DEL (N = 65, 12 DEL-1, 27 DEL-2) and mUPD (N = 65). A meta-analysis, including our own data, showed that BMI was 2.79 kg/m2 higher in adults with a DEL (p = 0.001). There were no significant differences between DEL-1 and DEL-2. Scoliosis was more prevalent among adults with a DEL (80% vs. 58%; p = 0.04). Psychotic episodes were more prevalent among adults with an mUPD (44% vs. 9%; p < 0.001). In conclusion, there were no significant differences in physical health outcomes between the genetic subtypes, apart from scoliosis and BMI. The differences in health problems, therefore, mainly apply to the psychological domain.
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Affiliation(s)
- Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Charlotte M. Wellink
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
| | - Juan M. Tellez Garcia
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
| | - Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Denise H. Van Abswoude
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Laura J. C. M. Van Zutven
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.J.C.M.V.Z.); (H.T.B.)
| | - Hennie T. Brüggenwirth
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.J.C.M.V.Z.); (H.T.B.)
| | - James L. Resnick
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Aart J. Van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- ENDO-ERN, European Reference Network on Rare Endocrine Conditions
| | - Laura C. G. De Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- ENDO-ERN, European Reference Network on Rare Endocrine Conditions
- Correspondence: ; Tel.: +31-618-843-010
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Yang-Li D, Fei-Hong L, Hui-Wen Z, Ming-Sheng M, Xiao-Ping L, Li L, Yi W, Qing Z, Yong-Hui J, Chao-Chun Z. Recommendations for the diagnosis and management of childhood Prader-Willi syndrome in China. Orphanet J Rare Dis 2022; 17:221. [PMID: 35698200 PMCID: PMC9195308 DOI: 10.1186/s13023-022-02302-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a complex and multisystem neurobehavioral disease, which is caused by the lack of expression of paternally inherited imprinted genes on chromosome15q11.2-q13.1. The clinical manifestations of PWS vary with age. It is characterized by severe hypotonia with poor suck and feeding difficulties in the early infancy, followed by overeating in late infancy or early childhood and progressive development of morbid obesity unless the diet is externally controlled. Compared to Western PWS patients, Chinese patients have a higher ratio of deletion type. Although some rare disease networks, including PWS Cooperation Group of Rare Diseases Branch of Chinese Pediatric Society, Zhejiang Expert Group for PWS, were established recently, misdiagnosis, missed diagnosis and inappropriate intervention were usually noted in China. Therefore, there is an urgent need for an integrated multidisciplinary approach to facilitate early diagnosis and optimize management to improve quality of life, prevent complications, and prolong life expectancy. Our purpose is to evaluate the current literature and evidences on diagnosis and management of PWS in order to provide evidence-based guidelines for this disease, specially from China.
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Affiliation(s)
- Dai Yang-Li
- Children's Hospital of Zhejiang University School of Medicine, No. 3333 Binsheng Road, Hangzhou, 310003, China
| | - Luo Fei-Hong
- Children's Hospital of Fudan University, Shanghai, China
| | - Zhang Hui-Wen
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ma Ming-Sheng
- Peking Union Medical College Hospital, Beijing, China
| | - Luo Xiao-Ping
- Tongji Hospital, Tongji Medical College of HUST, Wuhan, China
| | - Liu Li
- Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wang Yi
- Children's Hospital of Fudan University, Shanghai, China
| | - Zhou Qing
- Fujian Children's Hospital, Fuzhou, China
| | - Jiang Yong-Hui
- Yale University, 69 Lexington Gardens, Northern Haven, CT, 06473, USA.
| | - Zou Chao-Chun
- Children's Hospital of Zhejiang University School of Medicine, No. 3333 Binsheng Road, Hangzhou, 310003, China.
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Holland A, Manning K. t-VNS to treat disorders of behaviour in Prader-Willi Syndrome and in people with other neurodevelopmental conditions. Auton Neurosci 2022; 239:102955. [DOI: 10.1016/j.autneu.2022.102955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
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10
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Reverse-translational identification of a cerebellar satiation network. Nature 2021; 600:269-273. [PMID: 34789878 DOI: 10.1038/s41586-021-04143-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
The brain is the seat of body weight homeostasis. However, our inability to control the increasing prevalence of obesity highlights a need to look beyond canonical feeding pathways to broaden our understanding of body weight control1-3. Here we used a reverse-translational approach to identify and anatomically, molecularly and functionally characterize a neural ensemble that promotes satiation. Unbiased, task-based functional magnetic resonance imaging revealed marked differences in cerebellar responses to food in people with a genetic disorder characterized by insatiable appetite. Transcriptomic analyses in mice revealed molecularly and topographically -distinct neurons in the anterior deep cerebellar nuclei (aDCN) that are activated by feeding or nutrient infusion in the gut. Selective activation of aDCN neurons substantially decreased food intake by reducing meal size without compensatory changes to metabolic rate. We found that aDCN activity terminates food intake by increasing striatal dopamine levels and attenuating the phasic dopamine response to subsequent food consumption. Our study defines a conserved satiation centre that may represent a novel therapeutic target for the management of excessive eating, and underscores the utility of a 'bedside-to-bench' approach for the identification of neural circuits that influence behaviour.
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11
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Key AP, Jones D, Zengin-Bolatkale H, Roof E, Hunt-Hawkins H. Visual food cue processing in children with Prader-Willi Syndrome. Physiol Behav 2021; 238:113492. [PMID: 34116052 DOI: 10.1016/j.physbeh.2021.113492] [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: 12/08/2020] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
Hyperphagia and the associated interest in food is a characteristic feature of Prader-Willi syndrome (PWS) that emerges during childhood and remains a life-long concern. This study examined neural responses reflecting food cue salience in children with PWS and typical controls, age 3-12 years. Visual event-related potentials were recorded while participants in satiated state passively viewed photographs of high- and low-calorie foods, animals, and neutral objects. Contrary to the prediction, children with PWS did not demonstrate greater than typical neural responses to food, suggesting that it is not an exceptionally motivationally salient stimulus in PWS. Caregiver reports of greater hyperphagia were associated with neural responses to low-calorie foods suggesting accelerated and more fine-grained visual stimulus categorization in terms of edibility and caloric content. Overall, the findings align more closely with the altered satiety rather than increased food reward models of hyperphagia in PWS.
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Affiliation(s)
- Alexandra P Key
- Vanderbilt Kennedy Center for Research on Human Development; Department of Hearing and Speech Sciences; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center.
| | - Dorita Jones
- Vanderbilt Kennedy Center for Research on Human Development
| | | | - Elizabeth Roof
- Vanderbilt Kennedy Center for Research on Human Development
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12
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Kabasakalian A, Ferretti CJ, Hollander E. Oxytocin and Prader-Willi Syndrome. Curr Top Behav Neurosci 2018; 35:529-557. [PMID: 28956320 DOI: 10.1007/7854_2017_28] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the chapter, we explore the relationship between the peptide hormone, oxytocin (OT), and behavioral and metabolic disturbances observed in the genetic disorder Prader-Willi Syndrome (PWS). Phenotypic and genotypic characteristics of PWS are described, as are the potential implications of an abnormal OT system with respect to neural development including the possible effects of OT dysfunction on interactions with other regulatory mediators, including neurotransmitters, neuromodulators, and hormones. The major behavioral characteristics are explored in the context of OT dysfunction, including hyperphagia, impulsivity, anxiety and emotion dysregulation, sensory processing and interoception, repetitive and restrictive behaviors, and dysfunctional social cognition. Behavioral overlaps with autistic spectrum disorders are discussed. The implications of OT dysfunction on the mechanisms of reward and satiety and their possible role in informing behavioral characteristics are also discussed. Treatment implications and future directions for investigation are considered.
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Affiliation(s)
- Anahid Kabasakalian
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Casara J Ferretti
- Ferkauf Graduate School of Psychology, Yeshiva University, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric Hollander
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
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13
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Key AP, Dykens EM. Incidental memory for faces in children with different genetic subtypes of Prader-Willi syndrome. Soc Cogn Affect Neurosci 2018; 12:918-927. [PMID: 28338743 PMCID: PMC5472135 DOI: 10.1093/scan/nsx013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/29/2017] [Indexed: 12/21/2022] Open
Abstract
The present study examined the effects of genetic subtype on social memory in children (7–16 years) with Prader–Willi syndrome (PWS). Visual event-related potentials (ERPs) during a passive viewing task were used to compare incidental memory traces for repeated vs single presentations of previously unfamiliar social (faces) and nonsocial (houses) images in 15 children with the deletion subtype and 13 children with maternal uniparental disomy (mUPD). While all participants perceived faces as different from houses (N170 responses), repeated faces elicited more positive ERP amplitudes (‘old/new’ effect, 250–500ms) only in children with the deletion subtype. Conversely, the mUPD group demonstrated reduced amplitudes suggestive of habituation to the repeated faces. ERP responses to repeated vs single house images did not differ in either group. The results suggest that faces hold different motivational value for individuals with the deletion vs mUPD subtype of PWS and could contribute to the explanation of subtype differences in the psychiatric symptoms, including autism symptomatology.
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Affiliation(s)
- Alexandra P Key
- Vanderbilt Kennedy Center for Research on Human Development.,Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
| | - Elisabeth M Dykens
- Vanderbilt Kennedy Center for Research on Human Development.,Department of Psychology and Human Development, Vanderbilt University, Nashville, TN 37203, USA
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Abstract
This study examined the feasibility of eye tracking measures as markers of hyperphagia in 42 children and adults with Prader-Willi syndrome (PWS). Gaze data collected during free visual exploration of complex displays revealed that food images may not have an overall superior salience in PWS. However, increased attention to food in the context of other high-interest items was associated with higher scores on caregiver reports of hyperphagia. The study also provided preliminary evidence of test-retest reliability of eye tracking measures, suggesting that gaze characteristics may be a promising objective marker of food-related interests in PWS.
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Affiliation(s)
- Alexandra P. Key
- Vanderbilt Kennedy Center for Research on Human Development
- Departments of Hearing and Speech Sciences, Psychiatry, Vanderbilt University Medical Center
| | - Elisabeth M. Dykens
- Vanderbilt Kennedy Center for Research on Human Development
- Department of Psychology and Human Development, Vanderbilt University
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Demos KE, Sweet LH, Hart CN, McCaffery JM, Williams SE, Mailloux KA, Trautvetter J, Owens MM, Wing RR. The Effects of Experimental Manipulation of Sleep Duration on Neural Response to Food Cues. Sleep 2017; 40:3980278. [PMID: 28977574 PMCID: PMC5806554 DOI: 10.1093/sleep/zsx125] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Despite growing literature on neural food cue responsivity in obesity, little is known about how the brain processes food cues following partial sleep deprivation and whether short sleep leads to changes similar to those observed in obesity. We used functional magnetic resonance imaging (fMRI) to test the hypothesis that short sleep leads to increased reward-related and decreased inhibitory control-related processing of food cues.In a within-subject design, 30 participants (22 female, mean age = 36.7 standard deviation = 10.8 years, body mass index range 20.4-40.7) completed four nights of 6 hours/night time-in-bed (TIB; short sleep) and four nights of 9 hours/night TIB (long sleep) in random counterbalanced order in their home environments. Following each sleep condition, participants completed an fMRI scan while viewing food and nonfood images.A priori region of interest analyses revealed increased activity to food in short versus long sleep in regions of reward processing (eg, nucleus accumbens/putamen) and sensory/motor signaling (ie, right paracentral lobule, an effect that was most pronounced in obese individuals). Contrary to the hypothesis, whole brain analyses indicated greater food cue responsivity during short sleep in an inhibitory control region (right inferior frontal gyrus) and ventral medial prefrontal cortex, which has been implicated in reward coding and decision-making (false discovery rate corrected q = 0.05).These findings suggest that sleep restriction leads to both greater reward and control processing in response to food cues. Future research is needed to understand the dynamic functional connectivity between these regions during short sleep and whether the interplay between these neural processes determines if one succumbs to food temptation.
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Affiliation(s)
- Kathryn E Demos
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI
| | | | - Chantelle N Hart
- Center for Obesity Research and Education, Department of Public Health, Temple University
| | - Jeanne M McCaffery
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI
| | - Samantha E Williams
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI
| | - Kimberly A Mailloux
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI
| | - Jennifer Trautvetter
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI
| | - Max M Owens
- Center for Obesity Research and Education, Department of Public Health, Temple University
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI
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Bueno M, Esteba-Castillo S, Novell R, Giménez-Palop O, Coronas R, Gabau E, Corripio R, Baena N, Viñas-Jornet M, Guitart M, Torrents-Rodas D, Deus J, Pujol J, Rigla M, Caixàs A. Lack of Postprandial Peak in Brain-Derived Neurotrophic Factor in Adults with Prader-Willi Syndrome. PLoS One 2016; 11:e0163468. [PMID: 27685845 PMCID: PMC5042477 DOI: 10.1371/journal.pone.0163468] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
Context Prader-Willi syndrome (PWS) is characterized by severe hyperphagia. Brain-derived neurotrophic factor (BDNF) and leptin are reciprocally involved in energy homeostasis. Objectives To analyze the role of BDNF and leptin in satiety in genetic subtypes of PWS. Design Experimental study. Setting University hospital. Subjects 90 adults: 30 PWS patients; 30 age-sex-BMI-matched obese controls; and 30 age-sex-matched lean controls. Interventions Subjects ingested a liquid meal after fasting ≥10 hours. Main Outcome Measures Leptin and BDNF levels in plasma extracted before ingestion and 30’, 60’, and 120’ after ingestion. Hunger, measured on a 100-point visual analogue scale before ingestion and 60’ and 120’ after ingestion. Results Fasting BDNF levels were lower in PWS than in controls (p = 0.05). Postprandially, PWS patients showed only a truncated early peak in BDNF, and their BDNF levels at 60' and 120' were lower compared with lean controls (p<0.05). Leptin was higher in PWS patients than in controls at all time points (p<0.001). PWS patients were hungrier than controls before and after eating. The probability of being hungry was associated with baseline BDNF levels: every 50-unit increment in BDNF decreased the odds of being hungry by 22% (OR: 0.78, 95%CI: 0.65–0.94). In uniparental disomy, the odds of being hungry decreased by 66% (OR: 0.34, 90%CI: 0.13–0.9). Postprandial leptin patterns did no differ among genetic subtypes. Conclusions Low baseline BDNF levels and lack of postprandial peak may contribute to persistent hunger after meals. Uniparental disomy is the genetic subtype of PWS least affected by these factors.
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Affiliation(s)
- Marta Bueno
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Susanna Esteba-Castillo
- Specialized Service in Mental Health and Intellectual Disability, Institut Assistència Sanitària (IAS), Parc Hospitalari Martí i Julià, Girona, Spain
| | - Ramon Novell
- Specialized Service in Mental Health and Intellectual Disability, Institut Assistència Sanitària (IAS), Parc Hospitalari Martí i Julià, Girona, Spain
| | - Olga Giménez-Palop
- Department of Endocrinology and Nutrition, Sabadell University Hospital, Corporació Sanitària Parc Taulí, Sabadell, Spain, Autonomous University of Barcelona, Bellaterra, Spain
| | - Ramon Coronas
- Mental Health Center, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Elisabeth Gabau
- Pediatric Endocrinology Unit, Sabadell University Hospital, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Raquel Corripio
- Pediatric Endocrinology Unit, Sabadell University Hospital, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Neus Baena
- Genetics Laboratory, UDIAT, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Marina Viñas-Jornet
- Genetics Laboratory, UDIAT, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Míriam Guitart
- Genetics Laboratory, UDIAT, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - David Torrents-Rodas
- Specialized Service in Mental Health and Intellectual Disability, Institut Assistència Sanitària (IAS), Parc Hospitalari Martí i Julià, Girona, Spain
| | - Joan Deus
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
- MRI Research Unit, Department of Radiology, CIBERSAM G21, Hospital del Mar, Barcelona, Spain
- Guttmann Neurorehabilitation Institute, Barcelona, Spain, Autonomous University of Barcelona, Bellaterra, Spain
| | - Jesús Pujol
- MRI Research Unit, Department of Radiology, CIBERSAM G21, Hospital del Mar, Barcelona, Spain
| | - Mercedes Rigla
- Department of Endocrinology and Nutrition, Sabadell University Hospital, Corporació Sanitària Parc Taulí, Sabadell, Spain, Autonomous University of Barcelona, Bellaterra, Spain
| | - Assumpta Caixàs
- Department of Endocrinology and Nutrition, Sabadell University Hospital, Corporació Sanitària Parc Taulí, Sabadell, Spain, Autonomous University of Barcelona, Bellaterra, Spain
- * E-mail:
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17
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Puzzle Pieces: Neural Structure and Function in Prader-Willi Syndrome. Diseases 2015; 3:382-415. [PMID: 28943631 PMCID: PMC5548261 DOI: 10.3390/diseases3040382] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/04/2015] [Accepted: 12/11/2015] [Indexed: 11/17/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a neurodevelopmental disorder of genomic imprinting, presenting with a behavioural phenotype encompassing hyperphagia, intellectual disability, social and behavioural difficulties, and propensity to psychiatric illness. Research has tended to focus on the cognitive and behavioural investigation of these features, and, with the exception of eating behaviour, the neural physiology is currently less well understood. A systematic review was undertaken to explore findings relating to neural structure and function in PWS, using search terms designed to encompass all published articles concerning both in vivo and post-mortem studies of neural structure and function in PWS. This supported the general paucity of research in this area, with many articles reporting case studies and qualitative descriptions or focusing solely on the overeating behaviour, although a number of systematic investigations were also identified. Research to date implicates a combination of subcortical and higher order structures in PWS, including those involved in processing reward, motivation, affect and higher order cognitive functions, with both anatomical and functional investigations indicating abnormalities. It appears likely that PWS involves aberrant activity across distributed neural networks. The characterisation of neural structure and function warrants both replication and further systematic study.
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Elliott JP, Cherpes G, Kamal K, Chopra I, Harrison C, Riedy M, Herk B, McCrossin M, Kalarchian M. Relationship between Antipsychotics and Weight in Patients with Prader-Willi Syndrome. Pharmacotherapy 2015; 35:260-8. [DOI: 10.1002/phar.1558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Gregory Cherpes
- Center for Prader-Willi Syndrome; The Children's Institute of Pittsburgh; Pittsburgh Pennsylvania
| | - Khalid Kamal
- Mylan School of Pharmacy; Duquesne University; Pittsburgh Pennsylvania
| | - Ishveen Chopra
- Mylan School of Pharmacy; Duquesne University; Pittsburgh Pennsylvania
| | - Chelsea Harrison
- Mylan School of Pharmacy; Duquesne University; Pittsburgh Pennsylvania
| | - Mary Riedy
- Mylan School of Pharmacy; Duquesne University; Pittsburgh Pennsylvania
| | - Brandon Herk
- Mylan School of Pharmacy; Duquesne University; Pittsburgh Pennsylvania
| | - Matt McCrossin
- Mylan School of Pharmacy; Duquesne University; Pittsburgh Pennsylvania
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Zhang Y, Liu J, Yao J, Ji G, Qian L, Wang J, Zhang G, Tian J, Nie Y, Zhang YE, Gold MS, Liu Y. Obesity: pathophysiology and intervention. Nutrients 2014; 6:5153-83. [PMID: 25412152 PMCID: PMC4245585 DOI: 10.3390/nu6115153] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/21/2014] [Accepted: 10/29/2014] [Indexed: 01/09/2023] Open
Abstract
Obesity presents a major health hazard of the 21st century. It promotes co-morbid diseases such as heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis. Excessive energy intake, physical inactivity, and genetic susceptibility are main causal factors for obesity, while gene mutations, endocrine disorders, medication, or psychiatric illnesses may be underlying causes in some cases. The development and maintenance of obesity may involve central pathophysiological mechanisms such as impaired brain circuit regulation and neuroendocrine hormone dysfunction. Dieting and physical exercise offer the mainstays of obesity treatment, and anti-obesity drugs may be taken in conjunction to reduce appetite or fat absorption. Bariatric surgeries may be performed in overtly obese patients to lessen stomach volume and nutrient absorption, and induce faster satiety. This review provides a summary of literature on the pathophysiological studies of obesity and discusses relevant therapeutic strategies for managing obesity.
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Affiliation(s)
- Yi Zhang
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Ju Liu
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Jianliang Yao
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Gang Ji
- Xijing Gastrointestinal Hospital, the Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
| | - Long Qian
- Department of Biomedical Engineering, Peking University, Beijing 100871, China.
| | - Jing Wang
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Guansheng Zhang
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Jie Tian
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Yongzhan Nie
- Xijing Gastrointestinal Hospital, the Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
| | - Yi Edi Zhang
- Department of Psychiatry & McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL 32610, USA.
| | - Mark S Gold
- Department of Psychiatry & McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL 32610, USA.
| | - Yijun Liu
- Department of Psychiatry & McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL 32610, USA.
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Brennan ML, Adam MP, Seaver LH, Myers A, Schelley S, Zadeh N, Hudgins L, Bernstein JA. Increased body mass in infancy and early toddlerhood in Angelman syndrome patients with uniparental disomy and imprinting center defects. Am J Med Genet A 2014; 167A:142-6. [PMID: 25402239 DOI: 10.1002/ajmg.a.36831] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The diagnosis of Angelman syndrome (AS) is based on clinical features and genetic testing. Developmental delay, severe speech impairment, ataxia, atypical behavior and microcephaly by two years of age are typical. Feeding difficulties in young infants and obesity in late childhood can also be seen. The NIH Angelman-Rett-Prader-Willi Consortium and others have documented genotype-phenotype associations including an increased body mass index in children with uniparental disomy (UPD) or imprinting center (IC) defects. We recently encountered four cases of infantile obesity in non-deletion AS cases, and therefore examined body mass measures in a cohort of non-deletion AS cases. We report on 16 infants and toddlers (ages 6 to 44 months; 6 female, and 10 male) with severe developmental delay. Birth weights were appropriate for gestational age in most cases, >97th% in one case and not available in four cases. The molecular subclass case distribution consisted of: UPD (n = 2), IC defect (n = 3), UPD or IC defect (n = 3), and UBE3A mutation (n = 8). Almost all (7 out of 8) UPD, IC and UPD/IC cases went on to exhibit >90th% age- and gender-appropriate weight for height or BMI within the first 44 months. In contrast, no UBE3A mutation cases exhibited obesity or pre-obesity measures (percentiles ranged from <3% to 55%). These findings demonstrate that increased body mass may be evident as early as the first year of life and highlight the utility of considering the diagnosis of AS in the obese infant or toddler with developmental delay, especially when severe. Although a mechanism explaining the association of UPD, and IC defects with obesity has not been identified, recognition of this correlation may inform investigation of imprinting at the PWS/AS locus and obesity.
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Miller JL, Linville TD, Dykens EM. Effects of metformin in children and adolescents with Prader-Willi syndrome and early-onset morbid obesity: a pilot study. J Pediatr Endocrinol Metab 2014; 27:23-9. [PMID: 23893676 PMCID: PMC3864175 DOI: 10.1515/jpem-2013-0116] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/03/2013] [Indexed: 12/14/2022]
Abstract
Prader-Willi syndrome (PWS) is one of the most commonly recognized causes of early-onset childhood obesity. Individuals with PWS have significant hyperphagia and decreased recognition of satiety. The exact etiology of the hyperphagia remains unknown and, therefore, untreatable. We conducted a pilot, open-label study of response to metformin in 21 children with PWS and six with early morbid obesity (EMO). Participants had significant insulin resistance and glucose intolerance on oral glucose tolerance testing (OGTT) and were started on metformin for these biochemical findings. We administered the Hyperphagia Questionnaire to parents of patients before and after starting metformin treatment. Both the PWS and EMO groups showed significant improvements in food-related distress, anxiety, and ability to be redirected away from food on the Hyperphagia Questionnaire. In the PWS group, improvements were predominantly seen in females. Within the PWS group, responders to metformin had higher 2-h glucose levels on OGTT (7.48 mmol/L vs. 4.235 mmol/L; p=0.003) and higher fasting insulin levels (116 pmol/L vs. 53.5 pmol/L; p=0.04). Additionally, parents of 5/13 individuals with PWS and 5/6 with EMO reported that their child was able to feel full while on metformin (for many this was the first time they had ever described a feeling of fullness). Metformin may improve sense of satiety and decrease anxiety about food in some individuals with PWS and EMO. Positive response to metformin may depend on the degree of hyperinsulinism and glucose intolerance. Nonetheless, the results of this pilot study bear further investigation.
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Lundgren JD, Patrician TM, Breslin F, Martin L, Donnelly JE, Savage CR. Evening hyperphagia and food motivation: a preliminary study of neural mechanisms. Eat Behav 2013; 14:447-50. [PMID: 24183133 PMCID: PMC3817498 DOI: 10.1016/j.eatbeh.2013.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/24/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
Evening hyperphagia (EH; consumption of ≥25% of total daily calories after the evening meal) is a circadian delay in the pattern of daily food intake and is a core criterion of night eating syndrome (Allison et al., 2010). This preliminary study examined the brain response to food cues using functional magnetic resonance imaging (fMRI) in seven obese adults with EH compared to seven obese adults without EH. When contrasting food to non-food and blurry baseline images pre-meal, groups differed in brain activation in the inferior frontal gyrus, precentral gyrus, cingulate gyrus, superior temporal gyrus and cerebellum. At post meal, groups differed in brain activation in the fusiform gyrus, inferior frontal gyrus, inferior parietal lobule and the cerebellum. Significant interactions between time (pre-meal, post-meal) and group (EH, control) when contrasting food to non-food images were also noted in the inferior frontal gyrus and the superior temporal gyrus. Further research is necessary to replicate these findings and determine if they have a mechanistic role in the development of circadian delayed eating behavior in obese adults with EH.
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Affiliation(s)
- Jennifer D. Lundgren
- University of Missouri-Kansas City, Department of Psychology, 5030 Cherry Street, Kansas City, MO 64110, USA
| | - Trisha M. Patrician
- University of Kansas Medical Center, Center for Health Behavior Neuroscience, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Florence Breslin
- University of Kansas Medical Center, Center for Health Behavior Neuroscience, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Laura Martin
- University of Kansas Medical Center, Hoglund Brain Imaging Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Joseph E. Donnelly
- University of Kansas Medical Center, Center for Physical Activity and Weight Management, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Cary R. Savage
- University of Kansas Medical Center, Center for Health Behavior Neuroscience, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
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Zhang Y, Zhao H, Qiu S, Tian J, Wen X, Miller JL, von Deneen KM, Zhou Z, Gold MS, Liu Y. Altered functional brain networks in Prader-Willi syndrome. NMR IN BIOMEDICINE 2013; 26:622-9. [PMID: 23335390 PMCID: PMC3776442 DOI: 10.1002/nbm.2900] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 05/26/2023]
Abstract
Prader-Willi syndrome (PWS) is a genetic imprinting disorder characterized mainly by hyperphagia and early childhood obesity. Previous functional neuroimaging studies used visual stimuli to examine abnormal activities in the eating-related neural circuitry of patients with PWS. It was found that patients with PWS exhibited both excessive hunger and hyperphagia consistently, even in situations without any food stimulation. In the present study, we employed resting-state functional MRI techniques to investigate abnormal brain networks related to eating disorders in children with PWS. First, we applied amplitude of low-frequency fluctuation analysis to define the regions of interest that showed significant alterations in resting-state brain activity levels in patients compared with their sibling control group. We then applied a functional connectivity (FC) analysis to these regions of interest in order to characterize interactions among the brain regions. Our results demonstrated that patients with PWS showed decreased FC strength in the medial prefrontal cortex (MPFC)/inferior parietal lobe (IPL), MPFC/precuneus, IPL/precuneus and IPL/hippocampus in the default mode network; decreased FC strength in the pre-/postcentral gyri and dorsolateral prefrontal cortex (DLPFC)/orbitofrontal cortex (OFC) in the motor sensory network and prefrontal cortex network, respectively; and increased FC strength in the anterior cingulate cortex/insula, ventrolateral prefrontal cortex (VLPFC)/OFC and DLPFC/VLPFC in the core network and prefrontal cortex network, respectively. These findings indicate that there are FC alterations among the brain regions implicated in eating as well as rewarding, even during the resting state, which may provide further evidence supporting the use of PWS as a model to study obesity and to provide information on potential neural targets for the medical treatment of overeating.
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Affiliation(s)
- Yi Zhang
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi’an, Shaanxi, China
- Department of Psychiatry and McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Heng Zhao
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Siyou Qiu
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Jie Tian
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi’an, Shaanxi, China
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Xiaotong Wen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jennifer L. Miller
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Karen M. von Deneen
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi’an, Shaanxi, China
- Department of Psychiatry and McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Zhenyu Zhou
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Mark S. Gold
- Department of Psychiatry and McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Yijun Liu
- Department of Psychiatry and McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
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Ogura K, Fujii T, Abe N, Hosokai Y, Shinohara M, Fukuda H, Mori E. Regional cerebral blood flow and abnormal eating behavior in Prader-Willi syndrome. Brain Dev 2013; 35:427-34. [PMID: 22921862 DOI: 10.1016/j.braindev.2012.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/14/2012] [Accepted: 07/15/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a genetically determined neurodevelopmental disorder and is generally regarded as a genetic model of obesity. Individuals with PWS exhibit behavioral symptoms including temper tantrums, rigid thinking, and compulsive behavior. The most striking feature of PWS is abnormal eating behavior, including hyperphagia, intense preoccupation with food, and incessant food seeking. To explore brain regions associated with the behavioral symptoms of PWS, we investigated differences in resting-state regional cerebral blood flow (rCBF) between individuals with PWS and healthy controls. Correlation analyses were also performed to examine the relationship between rCBF and altered eating behavior in PWS individuals. METHODS Twelve adults with PWS and 13 age- and gender-matched controls underwent resting-state single photon emission computerized tomography (SPECT) with N-isopropyl-p-[(123)I] iodoamphetamine (IMP). The rCBF data were analyzed on a voxel-by-voxel basis using SPM5 software. RESULTS The results demonstrated that compared with controls, individuals with PWS had significantly lower rCBF in the right thalamus, left insular cortex, bilateral lingual gyrus, and bilateral cerebellum. They had significantly higher rCBF in the right inferior frontal gyrus, left middle/inferior frontal gyrus (anterior and posterior clusters), and bilateral angular gyrus. Additionally, rCBF in the left insula, which was significantly lower in PWS individuals, was negatively correlated with the eating behavior severity score. CONCLUSIONS These results suggest that specific brain regions, particularly the left insula, may be partly responsible for the behavioral symptoms in PWS.
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Affiliation(s)
- Kaeko Ogura
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan.
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25
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Key AP, Jones D, Dykens EM. Social and emotional processing in Prader-Willi syndrome: genetic subtype differences. J Neurodev Disord 2013; 5:7. [PMID: 23536992 PMCID: PMC3637538 DOI: 10.1186/1866-1955-5-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/08/2013] [Indexed: 12/03/2022] Open
Abstract
Background People with Prader-Willi syndrome (PWS) demonstrate social dysfunction and increased risk of autism spectrum disorder, especially those with the maternal uniparental disomy (mUPD) versus paternal deletion genetic subtype. This study compared the neural processing of social (faces) and nonsocial stimuli, varying in emotional valence, across genetic subtypes in 24 adolescents and adults with PWS. Methods Upright and inverted faces, and nonsocial objects with positive and negative emotional valence were presented to participants with PWS in an oddball paradigm with smiling faces serving as targets. Behavioral and event-related potential (ERP) data were recorded. Results There were no genetic subtype group differences in accuracy, and all participants performed above chance level. ERP responses revealed genetic subtype differences in face versus object processing. In those with deletions, the face-specific posterior N170 response varied in size for face stimuli versus inverted faces versus nonsocial objects. Persons with mUPD generated N170 of smaller amplitude and showed no stimulus differentiation. Brain responses to emotional content did not vary by subtype. All participants elicited larger posterior and anterior late positive potential responses to positive objects than to negative objects. Emotion-related differences in response to faces were limited to inverted faces only in the form of larger anterior late positive potential amplitudes to negative emotions over the right hemisphere. Detection of the target smiling faces was evident in the increased amplitude of the frontal and central P3 responses but only for inverted smiling faces. Conclusion Persons with the mUPD subtype of PWS may show atypical face versus object processes, yet both subtypes demonstrated potentially altered processing, attention to and/or recognition of faces and their expressions.
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Affiliation(s)
- Alexandra P Key
- Vanderbilt Kennedy Center for Research on Human Development, Vanderbilt University, 230 Appleton Place, Peabody Box 74, Nashville, TN, 37203, USA.
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Miller JL, Lynn CH, Shuster J, Driscoll DJ. A reduced-energy intake, well-balanced diet improves weight control in children with Prader-Willi syndrome. J Hum Nutr Diet 2012; 26:2-9. [PMID: 23078343 DOI: 10.1111/j.1365-277x.2012.01275.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children with Prader-Willi syndrome (PWS) have a predictable pattern of weight gain, with obesity beginning in early childhood and worsening as they get older and hyperphagia increases. Data on the most effective dietary modifications are scant and primarily anecdotal. As part of a longitudinal study investigating the natural history of PWS, we evaluated the effect of a well-balanced, energy-restricted diet on body composition and weight in young children with PWS. METHODS Sixty-three children, aged 2-10 years, with genetically proven PWS participated in the present study. These children had measurements of body composition by dual-energy X-ray absorptiometry and resting energy expenditure (REE), as well as a 3-day diet history analysis both before and after intervention. Energy calculations were based on the individual's REE, with the recommendation that the macronutrients of the diet consist of 30% fat, 45% carbohydrates and 25% protein, with at least 20 g of fibre per day. RESULTS Thirty-three families adhered to our dietary recommendations for both energy intake and macronutrient distribution. Those 33 children had lower body fat (19.8% versus 41.9%; P < 0.001) and weight management (body mass index SD score 0.3 versus 2.23; P < 0.001) than those whose parents followed the energy intake recommendations but did not alter the macronutrient composition of the diet. Those who followed our recommendations also had a lower respiratory quotient (0.84 versus 0.95; P = 0.002). CONCLUSIONS Our recommendation for an energy-restricted diet with a well-balanced macronutrient composition and fibre intake improves both weight and body composition in children with PWS compared to a simple energy-restricted diet.
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Affiliation(s)
- J L Miller
- University of Florida, Department of Pediatrics, Gainesville, FL 32608, USA.
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27
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Changes in brain activation to food pictures after adjustable gastric banding. Surg Obes Relat Dis 2012; 8:602-8. [DOI: 10.1016/j.soard.2011.07.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 07/05/2011] [Accepted: 07/07/2011] [Indexed: 11/23/2022]
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Honea RA, Holsen LM, Lepping RJ, Perea R, Butler MG, Brooks WM, Savage CR. The neuroanatomy of genetic subtype differences in Prader-Willi syndrome. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:243-53. [PMID: 22241551 PMCID: PMC3296480 DOI: 10.1002/ajmg.b.32022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite behavioral differences between genetic subtypes of Prader-Willi syndrome (PWS), no studies have been published characterizing brain structure in these subgroups. Our goal was to examine differences in the brain structure phenotype of common subtypes of PWS [chromosome 15q deletions and maternal uniparental disomy 15 (UPD)]. Fifteen individuals with PWS due to a typical deletion [(DEL) type I; n = 5, type II; n = 10], eight with PWS due to UPD, and 25 age-matched healthy-weight individuals (HWC) participated in structural magnetic resonance imaging (MRI) scans. A custom voxel-based morphometry processing stream was used to examine regional differences in gray and white matter volume (WMV) between groups, covarying for age, sex, and body mass index (BMI). Overall, compared to HWC, PWS individuals had lower gray matter volumes (GMV) that encompassed the prefrontal, orbitofrontal and temporal cortices, hippocampus and parahippocampal gyrus, and lower WMVs in the brain stem, cerebellum, medial temporal, and frontal cortex. Compared to UPD, the DEL subtypes had lower GMV primarily in the prefrontal and temporal cortices, and lower white matter in the parietal cortex. The UPD subtype had more extensive lower gray and WMVs in the orbitofrontal and limbic cortices compared to HWC. These preliminary findings are the first structural neuroimaging findings to support potentially separate neural mechanisms mediating the behavioral differences seen in these genetic subtypes.
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Affiliation(s)
- Robyn A Honea
- Department of Neurology, University of Kansas School of Medicine, Kansas City, USA
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Benarroch F, Pollak Y, Wertman M, Hirsch HJ, Genstil L, Gross-Tsur V. Individuals with hyperphagia can voluntarily fast: Experience from Prader-Willi Syndrome. Health (London) 2012. [DOI: 10.4236/health.2012.412a222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Holsen LM, Savage CR, Martin LE, Bruce AS, Lepping RJ, Ko E, Brooks WM, Butler MG, Zarcone JR, Goldstein JM. Importance of reward and prefrontal circuitry in hunger and satiety: Prader-Willi syndrome vs simple obesity. Int J Obes (Lond) 2011; 36:638-47. [PMID: 22024642 PMCID: PMC3270121 DOI: 10.1038/ijo.2011.204] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The majority of research on obesity has focused primarily on clinical features (eating behavior, adiposity measures), or peripheral appetite-regulatory peptides (leptin, ghrelin). However, recent functional neuroimaging studies have demonstrated that some reward circuitry regions which are associated with appetite-regulatory hormones are also involved in the development and maintenance of obesity. Prader-Willi syndrome (PWS), characterized by hyperphagia and hyperghrelinemia reflecting multi-system dysfunction in inhibitory and satiety mechanisms, serves as an extreme model of genetic obesity. Simple (non-PWS) obesity (OB) represents an obesity control state. Objective This study investigated subcortical food motivation circuitry and prefrontal inhibitory circuitry functioning in response to food stimuli before and after eating in individuals with PWS compared with OB. We hypothesized that groups would differ in limbic regions (i.e., hypothalamus, amygdala) and prefrontal regions associated with cognitive control [i.e., dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex (OFC)] after eating. Design and Participants Fourteen individuals with PWS, 14 BMI- and age-matched individuals with OB, and 15 age-matched healthy-weight controls (HWC) viewed food and non-food images while undergoing functional MRI before (pre-meal) and after (post-meal) eating. Using SPM8, group contrasts were tested for hypothesized regions: hypothalamus, nucleus accumbens (NAc), amygdala, hippocampus, OFC, medial PFC, and DLPFC. Results Compared with OB and HWC, PWS demonstrated higher activity in reward/limbic regions (NAc, amygdala) and lower activity in hypothalamus and hippocampus, in response to food (vs. non-food) images pre-meal. Post-meal, PWS exhibited higher subcortical activation (hypothalamus, amygdala, hippocampus) compared to OB and HWC. OB showed significantly higher activity versus PWS and HWC in cortical regions (DLPFC, OFC) associated with inhibitory control. Conclusion In PWS compared with obesity per se, results suggest hyperactivations in subcortical reward circuitry and hypoactivations in cortical inhibitory regions after eating, which provides evidence of neural substrates associated with variable abnormal food motivation phenotypes in PWS and simple obesity.
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Affiliation(s)
- L M Holsen
- Departments of Psychiatry and Medicine, Harvard Medical School, Boston, MA, USA.
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31
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Cataletto M, Angulo M, Hertz G, Whitman B. Prader-Willi syndrome: A primer for clinicians. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2011; 2011:12. [PMID: 22008714 PMCID: PMC3217845 DOI: 10.1186/1687-9856-2011-12] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 10/18/2011] [Indexed: 01/25/2023]
Abstract
The advent of sensitive genetic testing modalities for the diagnosis of Prader-Willi syndrome has helped to define not only the phenotypic features of the syndrome associated with the various genotypes but also to anticipate clinical and psychological problems that occur at each stage during the life span. With advances in hormone replacement therapy, particularly growth hormone children born in circumstances where therapy is available are expected to have an improved quality of life as compared to those born prior to growth hormone. This manuscript was prepared as a primer for clinicians-to serve as a resource for those of you who care for children and adults with Prader-Willi syndrome on a daily basis in your practices. Appropriate and anticipatory interventions can make a difference.
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Affiliation(s)
- Mary Cataletto
- The Prader-Willi Syndrome Center at Winthrop University Hospital, 120 Mineola Blvd,-Suite 210, Mineola, N,Y, 11501, USA.
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Grugni G, Giardino D, Crinò A, Malvestiti F, Ballarati L, Di Giorgio G, Marzullo P. Growth hormone secretion among adult patients with Prader-Willi syndrome due to different genetic subtypes. J Endocrinol Invest 2011; 34:493-7. [PMID: 20651469 DOI: 10.3275/7203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with Prader-Willi syndrome (PWS) due to maternal uniparental disomy of the chromosome 15 (UPD15) have fewer facial features, less hypopigmentation and higher levels of psychosis compared to subjects with deletion in chromosome 15 (del15q11-q13). PWS individuals carrying the larger type I (TI) deletion suffer from greater behavioral problems than patients with the smaller type II (TII) deletion. Few data are currently available on the relationship existing between endocrine abnormalities in PWS subjects and the different genotypes. AIM To investigate the stimulated GH levels in PWS patients with different types of deletion and those with UPD15. SUBJECTS AND METHODS Thirty-seven patients, 14 males, aged 17.5-41.2 yr, with PWS due to TI deletion (no.=6), TII deletion (no.=15) or UPD15 (no.=16), were studied. Pituitary GH secretion was evaluated by dynamic testing with GHRH+arginine. RESULTS Both the mean peak GH response and the integrated GH secretion (GH area under the curve and GH area under the curve corrected for basal values) for the UPD15 patients (4.6 ± 1.6 μg/l, 241.6 ± 71.7 μg/l/h and 228.3 ± 71.6 μg/l/h, respectively) were lower than that observed in all subjects with del15q11-q13 (9.1±1.8 μg/l, 547.0 ± 132.3 μg/l/h and 514.9 ± 127.6 μg/l/h: p<0.005), as well as in TI (7.7 ± 1.2 μg/l: p<0.02; 424.2 ± 88.8 and 393.4 ± 88.8 μg/l/h: p<0.05) and TII (9.6 ± 2.6 μg/l, 587.9 ± 174.2 μg/l/h and 555.4 ± 167.6 μg/l/h: p<0.01) deletion groups. TI and TII groups had similar stimulated GH levels and integrated GH secretion. CONCLUSIONS Our results point at differentiating the pattern of GH secretion by genetic subtypes, with higher GH responses in typical deletion subjects when compared to patients with UPD15.
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Affiliation(s)
- G Grugni
- Division of Auxology, S. Giuseppe Hospital, Research Institute, Istituto Auxologico Italiano, Verbania, Italy.
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Miller JL, Lynn CH, Driscoll DC, Goldstone AP, Gold JA, Kimonis V, Dykens E, Butler MG, Shuster JJ, Driscoll DJ. Nutritional phases in Prader-Willi syndrome. Am J Med Genet A 2011; 155A:1040-9. [PMID: 21465655 DOI: 10.1002/ajmg.a.33951] [Citation(s) in RCA: 277] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 01/25/2011] [Indexed: 11/10/2022]
Abstract
Prader-Willi syndrome (PWS) is a complex neurobehavioral condition which has been classically described as having two nutritional stages: poor feeding, frequently with failure to thrive (FTT) in infancy (Stage 1), followed by hyperphagia leading to obesity in later childhood (Stage 2). We have longitudinally followed the feeding behaviors of individuals with PWS and found a much more gradual and complex progression of the nutritional phases than the traditional two stages described in the literature. Therefore, this study characterizes the growth, metabolic, and laboratory changes associated with the various nutritional phases of PWS in a large cohort of subjects. We have identified a total of seven different nutritional phases, with five main phases and sub-phases in phases 1 and 2. Phase 0 occurs in utero, with decreased fetal movements and growth restriction compared to unaffected siblings. In phase 1 the infant is hypotonic and not obese, with sub-phase 1a characterized by difficulty feeding with or without FTT (ages birth-15 months; median age at completion: 9 months). This phase is followed by sub-phase 1b when the infant grows steadily along a growth curve and weight is increasing at a normal rate (median age of onset: 9 months; age quartiles 5-15 months). Phase 2 is associated with weight gain-in sub-phase 2a the weight increases without a significant change in appetite or caloric intake (median age of onset 2.08 years; age quartiles 20-31 months;), while in sub-phase 2b the weight gain is associated with a concomitant increased interest in food (median age of onset: 4.5 years; quartiles 3-5.25 years). Phase 3 is characterized by hyperphagia, typically accompanied by food-seeking and lack of satiety (median age of onset: 8 years; quartiles 5-13 years). Some adults progress to phase 4 which is when an individual who was previously in phase 3 no longer has an insatiable appetite and is able to feel full. Therefore, the progression of the nutritional phases in PWS is much more complex than previously recognized. Awareness of the various phases will aid researchers in unraveling the pathophysiology of each phase and provide a foundation for developing rational therapies. Counseling parents of newly diagnosed infants with PWS as to what to expect with regard to these nutritional phases may help prevent or slow the early-onset of obesity in this syndrome.
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Affiliation(s)
- Jennifer L Miller
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, 32610-0296, USA
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PET scan perfusion imaging in the Prader-Willi syndrome: new insights into the psychiatric and social disturbances. J Cereb Blood Flow Metab 2011; 31:275-82. [PMID: 20588317 PMCID: PMC3049491 DOI: 10.1038/jcbfm.2010.87] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Prader-Willi syndrome (PWS), a rare multisystem genetic disease, leads to severe disabilities, such as morbid obesity, endocrine dysfunctions, psychiatric disorders, and social disturbances. We explored the whole brain of patients with PWS to detect abnormalities that might explain the behavioral and social disturbances, as well as the psychiatric disorders of these patients. Nine patients with PWS (six males, three females; mean age 16.4 years) underwent a positron emission tomography (PET) scan with H(2)(15)O as a tracer to measure regional cerebral blood flow (rCBF). The images were compared with those acquired from nine controls (six males, three females; mean age 21.2 years). A morphologic magnetic resonance imaging (MRI) was also performed in PWS patients, and their cognitive and behavioral skills were assessed with Wechsler Intelligence Scale for Children III and the Child Behavior Check List (CBCL). The MRI images showed no evident anatomic abnormalities, whereas PET scans revealed hypoperfused brain regions in PWS patients compared with controls, particularly in the anterior cingulum and superior temporal regions. We observed a significant relationship (P<0.05) between rCBF in the hypoperfused regions and CBCL scores. The functional consequences of these perfusion abnormalities in specific brain regions might explain the behavioral and social problems observed in these individuals.
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Bruce AS, Holsen LM, Chambers RJ, Martin LE, Brooks WM, Zarcone JR, Butler MG, Savage CR. Obese children show hyperactivation to food pictures in brain networks linked to motivation, reward and cognitive control. Int J Obes (Lond) 2010; 34:1494-500. [PMID: 20440296 PMCID: PMC6800141 DOI: 10.1038/ijo.2010.84] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the neural mechanisms of food motivation in children and adolescents, and examine brain activation differences between healthy weight (HW) and obese participants. SUBJECTS Ten HW children (ages 11-16; BMI < 85%ile) and 10 obese children (ages 10-17; BMI >95%ile) matched for age, gender and years of education. MEASUREMENTS Functional magnetic resonance imaging (fMRI) scans were conducted twice: when participants were hungry (pre-meal) and immediately after a standardized meal (post-meal). During the fMRI scans, the participants passively viewed blocked images of food, non-food (animals) and blurred baseline control. RESULTS Both groups of children showed brain activation to food images in the limbic and paralimbic regions (PFC/OFC). The obese group showed significantly greater activation to food pictures in the PFC (pre-meal) and OFC (post-meal) than the HW group. In addition, the obese group showed less post-meal reduction of activation (vs pre-meal) in the PFC, limbic and the reward-processing regions, including the nucleus accumbens. CONCLUSION Limbic and paralimbic activation in high food motivation states was noted in both groups of participants. However, obese children were hyper-responsive to food stimuli as compared with HW children. In addition, unlike HW children, brain activations in response to food stimuli in obese children failed to diminish significantly after eating. This study provides initial evidence that obesity, even among children, is associated with abnormalities in neural networks involved in food motivation, and that the origins of neural circuitry dysfunction associated with obesity may begin early in life.
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Affiliation(s)
- AS Bruce
- Department of Preventive Medicine, Hoglund Brain Imaging Center, The University of Kansas Medical Center, Kansas City, KS, USA
| | - LM Holsen
- Department of Psychiatry, Brigham & Women’s Hospital/Harvard Medical School, Boston, MA, USA
| | - RJ Chambers
- Department of Preventive Medicine, Hoglund Brain Imaging Center, The University of Kansas Medical Center, Kansas City, KS, USA
| | - LE Martin
- Department of Preventive Medicine, Hoglund Brain Imaging Center, The University of Kansas Medical Center, Kansas City, KS, USA
| | - WM Brooks
- Department of Preventive Medicine, Hoglund Brain Imaging Center, The University of Kansas Medical Center, Kansas City, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - JR Zarcone
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - MG Butler
- University of Missouri-Kansas City School of Medicine, MO, USA
| | - CR Savage
- Department of Preventive Medicine, Hoglund Brain Imaging Center, The University of Kansas Medical Center, Kansas City, KS, USA
- Department of Psychiatry, University of Kansas Medical Center, Kansas City, KS, USA
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TPH2 polymorphisms and expression in Prader-Willi syndrome subjects with differing genetic subtypes. J Neurodev Disord 2010; 2:144-8. [PMID: 22127900 PMCID: PMC3164046 DOI: 10.1007/s11689-010-9051-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 05/07/2010] [Indexed: 12/29/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a genetic imprinting disease that causes developmental and behavioral disturbances resulting from loss of expression of genes from the paternal chromosome 15q11-q13 region. In about 70% of subjects, this portion of the paternal chromosome is deleted, while 25% have two copies of the maternal chromosome 15, or uniparental maternal disomy (UPD; the remaining subjects have imprinting center defects. There are several documented physical and behavioral differences between the two major PWS genetic subtypes (deletion and UPD) indicating the genetic subtype plays a role in clinical presentation. Serotonin is known to be disturbed in PWS and affects both eating behavior and compulsion, which are reported to be abnormal in PWS. We investigated the tryptophan hydroxylase gene (TPH2), the rate-limiting enzyme in the production of brain serotonin, by analyzing three different TPH2 gene polymorphisms, transcript expression, and correlation with PWS genetic subtype. DNA and RNA from lymphoblastoid cell lines derived from 12 PWS and 12 comparison subjects were used for the determination of genetic subtype, TPH2 polymorphisms and quantitative RT-PCR analysis. A similar frequency of TPH2 polymorphisms was seen in the PWS and comparison subjects with PWS deletion subjects showing increased expression with one or more TPH2 polymorphism. Both PWS deletion and PWS UPD subjects had significantly lower TPH2 expression than control subjects and PWS deletion subjects had significantly lower TPH2 expression compared with PWS UPD subjects. PWS subjects with 15q11-q13 deletions had lower TPH2 expression compared with PWS UPD or control subjects, requiring replication and further studies to identify the cause including identification of disturbed gene interactions resulting from the deletion process.
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Martin LE, Holsen LM, Chambers RJ, Bruce AS, Brooks WM, Zarcone JR, Butler MG, Savage CR. Neural mechanisms associated with food motivation in obese and healthy weight adults. Obesity (Silver Spring) 2010; 18:254-60. [PMID: 19629052 DOI: 10.1038/oby.2009.220] [Citation(s) in RCA: 215] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One out of three adults in the United States is clinically obese. Excess food intake is associated with food motivation, which has been found to be higher in obese compared to healthy weight (HW) individuals. Little is known, however, regarding the neural mechanisms associated with food motivation in obese compared to HW adults. The current study used functional magnetic resonance imaging (fMRI) to examine changes in the hemodynamic response in obese and HW adults while they viewed food and nonfood images in premeal and postmeal states. During the premeal condition, obese participants showed increased activation, compared to HW participants, in anterior cingulate cortex (ACC) and medial prefrontal cortex (MPFC). Moreover, in the obese group, self-report measures of disinhibition were negatively correlated with premeal ACC activations and self-report measures of hunger were positively correlated with premeal MPFC activations. During the postmeal condition, obese participants also showed greater activation than HW participants in the MPFC. These results indicate that brain function associated with food motivation differs in obese and HW adults and may have implications for understanding brain mechanisms contributing to overeating and obesity, and variability in response to diet interventions.
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Affiliation(s)
- Laura E Martin
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA
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Current Opinion in Lipidology. Current world literature. Curr Opin Lipidol 2010; 21:84-8. [PMID: 20101119 DOI: 10.1097/mol.0b013e32833592e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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