Neural circuitry underlying the interaction between emotion and asthma symptom exacerbation

Research on the Mechanism and Application of Acupuncture Therapy for Asthma: A Review

Asthma is a high-risk disease based on airway hyperresponsiveness (AHR). In this review, we found that there are many studies on clinical therapy for asthma that focus on the efficacy of acupuncture therapy and its mechanisms, including the functional connectivity of different brain regions, with the aid of functional magnetic resonance imaging (fMRI), immune responses/cell recognition (innate lymphoid cells and balance of Th1/Th2 and Treg/Th17), intracellular mechanism (autophagy, endoplasmic reticulum stress, and epigenetic alteration), and ligand-receptor/chemical signaling pathway (neurotransmitter, hormone, and small molecules). In this review, we summarized the clinical and experimental evidence for the mechanisms of acupuncture therapy in asthma to offer insights into drug discovery and clinical therapy. Given the paucity of clinical studies on the mechanisms of acupuncture in the treatment of asthma, this review notably included studies based on animal models to investigate the mechanisms of acupuncture in the treatment of asthma.

Research progress on the pathogenesis of chest tightness variant asthma characterized by chest tightness

Chest tightness variant asthma (CTVA) is an atypical form of asthma with chest tightness as the sole or predominant symptom. The underlying receptors for chest tightness are bronchial C-fibers or rapidly adapting receptors. The nerve impulses are transmitted via the vagus nerve and processed in different regions of the cerebral cortex. Chest tightness is associated with sensory perception, and CTVA patients may have heightened ability to detect subtle changes in lung function, but such sensory perception is unrelated to respiratory muscle activity, lung hyperinflation, or mechanical loading of the respiratory system. Airway inflammation, pulmonary ventilation dysfunction (especially involving small airways), and airway hyperresponsiveness may underlie the sensation of chest tightness. CTVA patients are prone to comorbid anxiety and depression, which share similar central nervous system processing pathways with dyspnea, suggesting a possible neurological basis for the development of CTVA. This article examines the recognition and mechanisms of chest tightness, and explores the pathogenesis of CTVA, focusing on its association with airway inflammation, ventilation dysfunction, airway hyperresponsiveness, and psychosocial factors.

Systemic Inflammation in Asthma: What Are the Risks and Impacts Outside the Airway?

Airway inflammation in asthma has been well recognized for several decades, with general agreement on its role in asthma pathogenesis, symptoms, propensity toward exacerbation, and decline in lung function. This has led to universal recommendation in asthma management guidelines to incorporate the use of inhaled corticosteroid as an anti-inflammatory therapy for all patients with persistent asthma symptoms. However, there has been limited attention paid to the presence and potential impact of systemic inflammation in asthma. Accumulating evidence from epidemiological observations and cohort studies points to a host of downstream organ dysfunction in asthma especially among patients with longstanding or more severe disease, frequent exacerbations, and underlying risk factors for organ dysfunction. Most studies to date have focused on cognitive impairment, depression/anxiety, metabolic syndrome, and cardiovascular abnormalities. In this review, we summarize some of the evidence demonstrating these abnormalities and highlight the proposed mechanisms and potential benefits of treatment in limiting these extrapulmonary abnormalities in patients with asthma. The goal of this commentary is to raise awareness of the importance of recognizing potential extrapulmonary conditions associated with systemic inflammation of asthma. This area of treatment of patients with asthma is a large unmet need.

Resting state functional connectivity changes following mindfulness-based stress reduction predict improvements in disease control for patients with asthma

BACKGROUND

The staggering morbidity associated with chronic inflammatory diseases can be reduced by psychological interventions, including Mindfulness-Based Stress Reduction (MBSR). Proposed mechanisms for MBSR's beneficial effects include changes in salience network function. Salience network perturbations are also associated with chronic inflammation, including airway inflammation in asthma, a chronic inflammatory disease affecting approximately 10% of the population. However, no studies have examined whether MBSR-related improvements in disease control are related to changes in salience network function.

METHODS

Adults with asthma were randomized to 8 weeks of MBSR or a waitlist control group. Resting state functional connectivity was measured using fMRI before randomization, immediately post-intervention, and 4 months post-intervention. Using key salience network regions as seeds, we calculated group differences in change in functional connectivity over time and examined whether functional connectivity changes were associated with increased mindfulness, improved asthma control, and decreased inflammatory biomarkers.

RESULTS

The MBSR group showed greater increases in functional connectivity between salience network regions relative to the waitlist group. Improvements in asthma control correlated with increased functional connectivity between the salience network and regions important for attention control and emotion regulation. Improvements in inflammatory biomarkers were related to decreased functional connectivity between the salience network and other networks.

CONCLUSIONS

Increased resting salience network coherence and connectivity with networks that subserve attention and emotion regulation may contribute to the benefits of MBSR for patients with asthma. Understanding the neural underpinnings of MBSR-related benefits in patients is a critical step towards optimizing brain-targeted interventions for chronic inflammatory disease management.

Molecular pathways underlying lung-brain axis signaling in asthma: Relevance for psychopathology and neuroinflammation

BACKGROUND

Accumulating evidence indicates that asthma has systemic effects and affects brain function. Although airway inflammation is proposed to initiate afferent communications with the brain, the signaling pathways have not been established.

OBJECTIVE

We sought to identify the cellular and molecular pathways involved in afferent lung-brain communication during airway inflammation in asthma.

METHODS

In 23 adults with mild asthma, segmental bronchial provocation with allergen (SBP-Ag) was used to provoke airway inflammation and retrieve bronchoalveolar lavage fluid for targeted protein analysis and RNA sequencing to determine gene expression profiles. Neural responses to emotional cues in nodes of the salience network were assessed with functional magnetic resonance imaging at baseline and 48 hours after SBP-Ag.

RESULTS

Cell deconvolution and gene coexpression network analysis identified 11 cell-associated gene modules that changed in response to SBP-Ag. SBP-Ag increased bronchoalveolar lavage eosinophils and expression of an eosinophil-associated module enriched for genes related to TH17-type inflammation (eg, IL17A), as well as cell proliferation in lung and brain (eg, NOTCH1, VEGFA, and LIF). Increased expression of genes in this module, as well as several TH17-type inflammation-related proteins, was associated with an increase from baseline in salience network reactivity.

CONCLUSIONS

Our results identify a specific inflammatory pathway linking asthma-related airway inflammation and emotion-related neural function. Systemically, TH17-type inflammation has been implicated in both depression and neuroinflammation, with impacts on long-term brain health. Thus, our data emphasize that inflammation in the lung in asthma may have profound effects outside of the lung that may be targetable with novel therapeutic approaches.

Brain structural and functional alterations related to anxiety in allergic asthma

Psychiatric disorders are common in patients with allergic asthma, and they can have a significant impact on their quality of life and disease control. Recent studies have suggested that there may be potential immune-brain communication mechanisms in asthma, which can activate inflammatory responses in different brain areas, leading to structural and functional alterations and behavioral changes. However, the precise mechanisms underlying these alterations remain unclear. In this paper, we comprehensively review the relevant research on asthma-induced brain structural and functional alterations that lead to the initiation and promotion of anxiety. We summarize the possible pathways for peripheral inflammation to affect the brain's structure and function. Our review highlights the importance of addressing neuropsychiatric disorders in the clinical guidelines of asthma, to improve the quality of life of these patients. We suggest that a better understanding of the mechanisms underlying psychiatric comorbidities in asthma could lead to the development of more effective treatments for these patients.

Efficacy of catgut embedding in Baihui (GV20) and Feishu (BL13) and Pishu (BL20) on lung tissue, brain tissue and blood related indexes in rats with allergic rhinitis of lung deficiency type

OBJECTIVE

To investigate the effects of acupoint catgut embedding for 3 weeks on lung tissue, blood immunoglobulin E (IgE) and interleutin-4 (IL-4), brain tissue microglia x-42 (OX-42) and toll-like receptor-2 (TLR-2) in rats with allergic rhinitis of lung deficiency type.

METHODS

Forty-five female Sprague-Dawley rats were randomly divided for two times. The first time, they were randomly divided into model group and blank group (Group C) according to 2:1, and the second time, the model group were randomly divided into model control group (Group B) and intervention treatment group (Group A) according to 1:1. 15 in each group. For Group A and Group B, the lung deficiency model was made by "sulfur-moxa fumigation", and then the allergic rhinitis model was established by "ovalbumin (OVA) sensitization". Then catgut embedding was performed at acupoints in Group A and not in Group B. After 3 weeks, collect lung tissue samples for hematoxylin-eosin staining, then take blood to observe the concentration of IgE and IL-4, and finally take brain tissue to observe the results of OX-42 and TLR-2.

RESULTS

IgE level (μg/mL) was (3.11 ± 0.20) in the Group A, (4.19 ± 0.44) in the Group B, and (2.29 ± 0.30) in the Group C (all < 0.001). IL-4 level (pg/mL) was (14.2 ± 0.7) in the Group A, (18.6 ± 2.4) in the Group B, and (11.4 ± 1.2) for the Group C (all < 0.001). The mean OD for OX-42 is (0.1728 ± 0.0016) in the Group A, (0.1810 ± 0.0046) in the Group B and (0.1674 ± 0.0025) in the Group C (all < 0.001).

CONCLUSION

Although 3 weeks of acupoint catgut embedding already showed obvious efficacy on rats with allergic rhinitis, the allergic reaction in the body still continued. To achieve further treatment, prolonging the catgut embedding time is necessary.

Effects of inhaled corticosteroids on brain volumetry, depression and anxiety-like behaviors in a rat model of asthma

Brain functional deficits have been reported in asthma patients which can result in behavioral disorders like depression and anxiety. These deficits may be associated with factors like resistance to treatment, incorrect self-evaluation, and inadequate self-control. However, changes in the brain volume in allergic asthma and the effects of inhaled corticosteroids, the most common anti-inflammatory agents for asthma treatment, on these alterations remain largely unclear. Here, we evaluated depression and anxiety-like behavior as well as volume changes in different brain area, using magnetic resonance imaging in an animal model of allergic asthma with pretreatment of inhaled fluticasone propionate. Asthma-induced behavioral changes were partially, but not completely, prevented by pretreatment with inhaled fluticasone propionate. Volumetry findings showed that the allergen decreased volumes of the corpus callosum and subcortical white matter, as well as the septal region and hippocampus (especially CA1 and fimbria). However, volumes of neocortex, insular, and anterior cingulate cortex increased in asthmatic rats compared to controls. Namely, pretreatment with inhaled fluticasone propionate partially prevented asthma-induced brain volume changes, but not completely. These findings suggest that asthma is associated with structural alterations in the brain, which may contribute to the induction of psychological disorders. Thus, considering brain changes in the clinical assessments could have important implications for asthma treatment.

Impact of asthma on the brain: evidence from diffusion MRI, CSF biomarkers and cognitive decline

Chronic systemic inflammation increases the risk of neurodegeneration, but the mechanisms remain unclear. Part of the challenge in reaching a nuanced understanding is the presence of multiple risk factors that interact to potentiate adverse consequences. To address modifiable risk factors and mitigate downstream effects, it is necessary, although difficult, to tease apart the contribution of an individual risk factor by accounting for concurrent factors such as advanced age, cardiovascular risk, and genetic predisposition. Using a case-control design, we investigated the influence of asthma, a highly prevalent chronic inflammatory disease of the airways, on brain health in participants recruited to the Wisconsin Alzheimer's Disease Research Center (31 asthma patients, 186 non-asthma controls, aged 45-90 years, 62.2% female, 92.2% cognitively unimpaired), a sample enriched for parental history of Alzheimer's disease. Asthma status was determined using detailed prescription information. We employed multi-shell diffusion weighted imaging scans and the three-compartment neurite orientation dispersion and density imaging model to assess white and gray matter microstructure. We used cerebrospinal fluid biomarkers to examine evidence of Alzheimer's disease pathology, glial activation, neuroinflammation and neurodegeneration. We evaluated cognitive changes over time using a preclinical Alzheimer cognitive composite. Using permutation analysis of linear models, we examined the moderating influence of asthma on relationships between diffusion imaging metrics, CSF biomarkers, and cognitive decline, controlling for age, sex, and cognitive status. We ran additional models controlling for cardiovascular risk and genetic risk of Alzheimer's disease, defined as a carrier of at least one apolipoprotein E (APOE) ε4 allele. Relative to controls, greater Alzheimer's disease pathology (lower amyloid-β42/amyloid-β40, higher phosphorylated-tau-181) and synaptic degeneration (neurogranin) biomarker concentrations were associated with more adverse white matter metrics (e.g. lower neurite density, higher mean diffusivity) in patients with asthma. Higher concentrations of the pleiotropic cytokine IL-6 and the glial marker S100B were associated with more salubrious white matter metrics in asthma, but not in controls. The adverse effects of age on white matter integrity were accelerated in asthma. Finally, we found evidence that in asthma, relative to controls, deterioration in white and gray matter microstructure was associated with accelerated cognitive decline. Taken together, our findings suggest that asthma accelerates white and gray matter microstructural changes associated with aging and increasing neuropathology, that in turn, are associated with more rapid cognitive decline. Effective asthma control, on the other hand, may be protective and slow progression of cognitive symptoms.

Multi-dimensional analyses of the associations between depression, nocturnal awakening and asthmatic outcomes

BACKGROUND

Depression plays an important role in the occurrence and development of asthma. Nocturnal awakening secondary to asthma is a crucial sign of the deterioration of asthmatic outcomes. This study plans to determine the associations between depression, nocturnal awakening and asthmatic outcomes by using multi-dimensional analyses.

METHODS

Study population came from the Adult Asthma Call-Back Survey 2013-2017. Multivariable regression analysis with binomial or Poisson models, dose-dependent analysis and mediation analysis were used to explore the associations between depression and nocturnal awakening with asthmatic episodes/attacks, emergency room (ER) and hospital visits.

RESULTS

18,684 physician-diagnosis asthmatics were included into this study. This population consisted of 31.4 % with nocturnal awakening and 37.6 % with depression. Multivariable binomial analyses suggested that nocturnal awakening and depression were positively associated with asthmatic episodes/attacks and ER visits. Dose-dependent analyses demonstrated that the increase of nocturnal awakening was positively associated with the increase of depression and three asthmatic outcomes. Asthmatics with depression had the higher prevalence (adjusted OR = 1.17, 95%CI: 1.08-1.27) and frequency (adjusted RR = 1.08, 95%CI: 1.07-1.10) of nocturnal awakening than those without depression. Mediation analyses suggested that clarification of verbiage denoted trivial effect of depression on the associations between nocturnal awakening with asthmatic outcomes, while nocturnal awakening mildly mediated these associations between depression with asthmatic episodes/attacks (15.26 %, 95%CI: 7.29 %-28.7 %) and ER visits (13.29 %, 95%CI: 5.33 %-44.12 %).

LIMITATION

The cross-sectional nature limited inferences on causality.

CONCLUSIONS

Our findings showed that depression and nocturnal awakening might affect asthmatic outcomes. Nocturnal awakening harbored the mediated effect in the correlations between depression and asthmatic outcomes.

Asthma's effect on brain connectivity and cognitive decline

Objective

To investigate the changes in dynamic voxel mirror homotopy connection (dVMHC) between cerebral hemispheres in patients with asthma.

Methods

Our study was designed using a case-control method. A total of 31 subjects with BA and 31 healthy subjects with matching basic information were examined using rsfMRI. We also calculated and obtained the dVMHC value between the cerebral cortexes.

Results

Compared with the normal control group, the dVMHC of the lingual gyrus (Ling) and the calcarine sulcus (CAL), which represented the visual network (VN), increased significantly in the asthma group, while the dVMHC of the medial superior frontal gyrus (MSFG), the anterior/middle/posterior cingulate gyrus (A/M/PCG), and the supplementary motor area (SMA) of the sensorimotor network decreased significantly in the asthma group.

Conclusion

This study showed that the ability of emotion regulation and the efficiency of visual and cognitive information processing in patients with BA was lower than in those in the HC group. The dVMHC analysis can be used to sensitively evaluate oxygen saturation, visual function changes, and attention bias caused by emotional disorders in patients with asthma, as well as to predict airway hyperresponsiveness, inflammatory progression, and dyspnea.

Brain-Airway Interactions in Asthma

Asthma and brain interactions have long been appreciated and initially centered on increased anxiety and depression. Epidemiology studies have shown that early life stressors and situational disadvantages are risk factors for asthma. Conversely, the presence of asthma is a risk for mood and anxiety disorders, thus indicating a bidirectional effect between asthma and brain-related health. To substantiate asthma-brain interactions, validated instruments indicate and elucidate that communication likely exists between asthma and the brain. For example, provocation of an asthmatic response with an allergen challenge modulates how the brain responds to emotion-laden information. As detected by imaging studies, emotion-related brain activation is associated with generating airway inflammation. However, the specific mediators and processes mediating airway communication with the brain have yet to be established.Systemic inflammation is also associated with asthma and can affect other organ systems such as the cardiovascular system and the brain. Epidemiology studies have shown that asthma is a risk factor for dementia and Alzheimer's disease. In support of the importance of asthma as a risk factor for impaired cognitive function, imaging studies have shown changes to the white matter of the brain in asthma patients that resemble neuroinflammation changes seen in Alzheimer's disease and other neurodegenerative diseases. Therefore, bidirectional links between asthma and the brain exist with an important next research step to define asthma-brain interactions linked to neurodegeneration and dementia and explore whether treatments directed toward asthma-related inflammation can prevent the deleterious effects of asthma on brain health.

Chronic allergic lung inflammation negatively influences neurobehavioral outcomes in mice

BACKGROUND

Asthma is a major public health problem worldwide. Emerging data from epidemiological studies show that allergies and allergic diseases may be linked to anxiety, depression and cognitive decline. However, little is known about the effect of asthma, an allergic lung inflammation, on cognitive decline/behavioral changes. Therefore, we investigated the hypothesis that allergic lung inflammation causes inflammation in the brain and leads to neurobehavioral changes in mice.

METHODS

Wild-type C57BL/6J female mice were sensitized with nasal house dust mite (HDM) antigen or control PBS for 6 weeks to induce chronic allergic lung inflammation. A series of neurocognitive tests for anxiety and/or depression were performed before and after the intranasal HDM administration. After the behavior tests, tissues were harvested to measure inflammation in the lungs and the brains.

RESULTS

HDM-treated mice exhibited significantly increased immobility times during tail suspension tests and significantly decreased sucrose preference compared with PBS controls, suggesting a more depressed and anhedonia phenotype. Spatial memory impairment was also observed in HDM-treated mice when assessed by the Y-maze novel arm tests. Development of lung inflammation after 6 weeks of HDM administration was confirmed by histology, bronchoalveolar lavage (BAL) cell count and lung cytokine measurements. Serum pro-inflammatory cytokines and Th2-related cytokines levels were elevated in HDM-sensitized mice. In the brain, the chemokine fractalkine was increased in the HDM group. The c-Fos protein, a marker for neuronal activity, Glial Fibrillary Acidic Protein (GFAP) and chymase, a serine protease from mast cells, were increased in the brains from mice in HDM group. Chymase expression in the brain was negatively correlated with the results of sucrose preference rate in individual mice.

CONCLUSIONS

6 weeks of intranasal HDM administration in mice to mimic the chronic status of lung inflammation in asthma, caused significant inflammatory histological changes in the lungs, and several behavioral changes consistent with depression and altered spatial memory. Chymase and c-Fos proteins were increased in the brain from HDM-treated mice, suggesting links between lung inflammation and brain mast cell activation, which could be responsible for depression-like behavior.

Neuroimaging and biomarker evidence of neurodegeneration in asthma

BACKGROUND

Epidemiologic studies have shown that Alzheimer's disease (AD) and related dementias (ADRD) are seen more frequently with asthma, especially with greater asthma severity or exacerbation frequency.

OBJECTIVE

To examine the changes in brain structure that may underlie this phenomenon, we examined diffusion-weighted magnetic resonance imaging (dMRI) and blood-based biomarkers of AD (phosphorylated tau 181, p-Tau181), neurodegeneration (neurofilament light chain, NfL), and glial activation (glial fibrillary acidic protein, GFAP).

METHODS

dMRI data were obtained in 111 individuals with asthma, ranging in disease severity from mild to severe, and 135 healthy controls. Regression analyses were used to test the relationships between asthma severity and neuroimaging measures, as well as AD pathology, neurodegeneration, and glial activation, indexed by plasma p-Tau181, NfL, and GFAP, respectively. Additional relationships were tested with cognitive function.

RESULTS

Asthma participants had widespread and large-magnitude differences in several dMRI metrics, which were indicative of neuroinflammation and neurodegeneration, and which were robustly associated with GFAP and, to a lesser extent, NfL. The AD biomarker p-Tau181 was only minimally associated with neuroimaging outcomes. Further, asthma severity was associated with deleterious changes in neuroimaging outcomes, which in turn were associated with slower processing speed, a test of cognitive performance.

CONCLUSIONS

Asthma, particularly when severe, is associated with characteristics of neuroinflammation and neurodegeneration, and may be a potential risk factor for neural injury and cognitive dysfunction. There is a need to determine how asthma may affect brain health and whether treatment directed toward characteristics of asthma associated with these risks can mitigate these effects.

Association of Food Allergy, Respiratory Allergy, and Skin Allergy with Attention Deficit/Hyperactivity Disorder among Children

BACKGROUND

Previous studies have predominately examined associations of respiratory allergy and skin allergy with ADHD, but little is known about the association between food allergy and ADHD.

METHODS

We included 192,573 children aged 4-17 years from the National Health Interview Survey (NHIS), a leading health survey in a nationally representative sample of the US population. Allergy conditions and ADHD were defined based on an affirmative response in the NHIS questionnaire. We used weighted logistic regression to estimate the odds ratio (OR) of ADHD.

RESULTS

Among the 192,573 children, 15,376 reported ADHD diagnosis. The prevalence of ADHD was higher among children with allergic conditions: 12.66% vs. 7.99% among children with and without food allergy; 12.16% vs. 7.63% among children with and without respiratory allergy; and 11.46% vs. 7.83% among children with and without skin allergy. After adjusting for covariates, the OR of ADHD was 1.72 (95% CI, 1.55-1.91) comparing children with and without food allergy, 1.50 (95% CI, 1.41-1.59) comparing children with and without respiratory allergy, and 1.65 (95% CI, 1.55-1.75) comparing children with and without skin allergy. The observed associations remained significant after mutual adjustment for other allergic conditions.

CONCLUSIONS

In a nationally representative sample of US children, we found a significant association of common allergic conditions (food allergy, respiratory allergy, and skin allergy) with ADHD.

Role of amygdala in stress-induced upregulation of airway IL-1 signaling in asthma

Psychological stress, an important contributor to asthma morbidity, potentiates the immune response to allergen, but the brain mechanisms mediating this response are not fully understood. The amygdala is likely to play an important role, given its sensitivity to threat and connectivity with descending immune modulatory pathways. In this study, we recruited thirty asthmatic participants and examined glucose metabolism in the amygdala, using [F-18]fluorodeoxyglucose positron emission tomography, during a laboratory stressor. Stress hormone and airway inflammatory measurements were also acquired. Results showed that activity in the amygdala was significantly increased during the stressor, compared to a matched control task (p < .05 corrected). Moreover, the increase in amygdala activity was associated with a greater increase in sputum IL-1R1 mRNA and alpha amylase response (p < .05 corrected), which were also positively correlated (p = .01). These findings suggest that heightened amygdala reactivity may contribute to asthma morbidity via descending proinflammatory sympathetic signaling pathways.

Dyspnea

The clinical term dyspnea (a.k.a. breathlessness or shortness of breath) encompasses at least three qualitatively distinct sensations that warn of threats to breathing: air hunger, effort to breathe, and chest tightness. Air hunger is a primal homeostatic warning signal of insufficient alveolar ventilation that can produce fear and anxiety and severely impacts the lives of patients with cardiopulmonary, neuromuscular, psychological, and end-stage disease. The sense of effort to breathe informs of increased respiratory muscle activity and warns of potential impediments to breathing. Most frequently associated with bronchoconstriction, chest tightness may warn of airway inflammation and constriction through activation of airway sensory nerves. This chapter reviews human and functional brain imaging studies with comparison to pertinent neurorespiratory studies in animals to propose the interoceptive networks underlying each sensation. The neural origins of their distinct sensory and affective dimensions are discussed, and areas for future research are proposed. Despite dyspnea's clinical prevalence and impact, management of dyspnea languishes decades behind the treatment of pain. The neurophysiological bases of current therapeutic approaches are reviewed; however, a better understanding of the neural mechanisms of dyspnea may lead to development of novel therapies and improved patient care.

The A118G single-nucleotide polymorphism in OPRM1 is a risk factor for asthma severity

BACKGROUND

Although population studies have implicated emotional burden in asthma severity, the underlying genetic risk factors are not completely understood. We aimed to evaluate the genetic influence of a functional single-nucleotide polymorphism (SNP) in the stress-related μ-opioid receptor gene (OPRM1; A118G SNP, rs1799971) on asthma severity.

METHODS

We initially assessed disease severity in asthmatic outpatients carrying A118G. Using an ovalbumin-induced experimental asthma rodent model harboring the functionally equivalent SNP, we investigated the mechanism by which this SNP influences the allergic immune response.

RESULTS

Among 292 outpatients, 168 underwent airway hyperresponsiveness (AHR) to methacholine testing. Compared with patients carrying the AA and AG genotypes, those carrying the GG genotype exhibited enhanced AHR. The stress levels were presumed to be moderate among patients and were comparable among genotypes. Compared with Oprm1 AA mice, GG mice demonstrated aggravated asthma-related features and increased pulmonary interleukin-4⁺CD4⁺ effector and effector memory T cells under everyday life stress conditions. Intraperitoneal naloxone methiodide injection reduced effector CD4⁺ T cell elevation associated with increased eosinophil numbers in bronchoalveolar lavage fluid of GG mice to the levels in AA mice, suggesting that elevated Th2 cell generation in the bronchial lymph node (BLN) of GG mice induces enhanced eosinophilic inflammation.

CONCLUSIONS

Without forced stress exposure, patients with asthma carrying the OPRM1 GG genotype exhibit enhanced AHR, attributable to enhanced Th2 cell differentiation in the regional lymph node. Further research is necessary to elucidate the role of the OPRM1 A118G genotype in the Th2 cell differentiation pathway in the BLN.

Altered spontaneous brain activity in patients with asthma: a resting-state functional MRI study using regional homogeneity analysis

OBJECTIVE

Studies have shown that patients with asthma have changes in brain function activities, but the specific relationship is still unknown. This study aims to investigate the potential regional homogeneity (ReHo) brain activity changes in patients with asthma and healthy controls.

METHODS

Thirty-one patients with asthma and 31 healthy controls closely matched in age, sex, and weight underwent resting-state functional MRI scans, respectively. The ReHo method was applied to evaluate synchronous neural activity changes. Receiver operating characteristic curve was used to show high test-retest stability and a high degree of sensitivity and specificity.

RESULTS

Compared with the healthy controls, asthma patients had significantly increased ReHo values in left cerebellum posterior lobe and left superior frontal gyrus, and decreased ReHo values of right middle temporal gyrus, right Putamen, right inferior temporal gyrus, right inferior middle frontal gyrus, left middle occipital gyrus, and right precentral/middle frontal gyrus.

CONCLUSION

Patients with asthma have different functional changes in different brain regions, mainly including the cerebellum, frontal lobe, temporal lobe, and occipital lobe, which provides important pieces of evidence to support the role of brain networks in the pathophysiology of asthma and offers an entirely new target for potential therapeutic intervention in asthma.

Impaired Interhemispheric Synchrony in Bronchial Asthma

Purpose

Methods

Results

Conclusion

Activation of Dopamine D2 Receptor Alleviates Neuroinflammation in a Mouse Model of Allergic Rhinitis With Olfactory Dysfunction

Purpose

Allergic rhinitis (AR) is a common otolaryngology disease and one of the clinical causes of olfactory dysfunction (OD). The olfactory bulb serves as a transfer station for olfactory information transmission, and alleviating its neuroinflammation may be expected to improve AR-induced OD. Recent studies have suggested that the dopamine D2 receptor acts as a key target in regulating immune functions and neuroinflammatory reaction. However, the effect of dopamine D2 receptor on AR-induced neuroinflammation is still unknown.

Methods

An AR mouse model with OD induced by ovalbumin were constructed. The buried food pellet test was to evaluate the olfactory function of the mice. Immunofluorescence staining, hematoxylin and eosin staining, enzyme-linked immunosorbent assay and western blotting were also used to investigate the molecular mechanisms underlying the anti-inflammatory effects of the dopamine D2 receptor in AR-induced OD.

Results

We found that AR-induced OD has a relationship with inflammatory responses in the olfactory bulb. Nasal administration of quinpirole (Quin, a dopamine D2 receptor agonist, 3 mg/kg) improved olfactory function in mice, inhibited the expression of toll-like receptor 4 (TLR4)/nuclear factor-κB (NF-κB) signalings and the levels of tumor necrosis factor-α, interleukin (IL)-1β and IL-6 in the olfactory bulb. In vitro, Quin (20 μmol/L) inhibited the release of TLR4/NF-κB signalings-dependent inflammatory cytokines in cultured microglia.

Conclusions

Activation of the dopamine D2 receptor inhibits the release of inflammatory cytokines through TLR4/NF-κB signaling in the olfactory bulb microglia, and protects olfactory function.

Guilt, shame and their associations with chronic diseases in Czech adults

The interest in the association between feelings of guilt and shame and psychological health is growing. However, less attention so far has been paid to the associations with chronic disease. Therefore, the aim of this study was to explore whether feelings of guilt and shame are related to physical health in chronic disease and in selected ones. A nationally representative sample of Czech adults (n = 1000, age = 46.0 ± 17.3 years, 48.6% men) participated in the survey. Feelings of guilt and shame (items from The Positive and Negative Affect Schedule) and health problems in selected chronic diseases were measured. Respondents with higher feelings of guilt - but not of shame - were more likely to suffer from a chronic disease; we found this in arthritis, back pain, cardiovascular disease, asthma, cancer and depression or anxiety. The association was strongest in the case of cancer with odds ratios (OR) 5.83 (95% confidence interval (CI) 2.27-16.69). There were no significant associations in case of diabetes and stroke. Feelings of shame were not related to chronic diseases. Our findings suggest that feelings of guilt are associated with worse physical health. Further research is needed in this area.

Coupling of spatial and directional functional network connectivity reveals a physiological basis for salience network hubs in asthma

Research findings have consistently indicated that asthma might be correlated with neural activity in brain circuits, especially the insular and anterior cingulate cortex (ACC), which are primary nodes of the salience network (SN). However, little is known about the relationships between the SN and other brain regions that are affected by asthma. Therefore, we explored the role of the SN to determine whether its neural activity was disrupted by asthma. Forty asthmatic patients and 40 well-matched healthy controls (HCs) underwent functional magnetic resonance imaging scanning and clinical assessments, including the asthma control test and 17-item Hamilton depression scale (HAMD). Altered spatial, network and temporal connections of the SN were investigated. Compared to HCs, patients showed increased functional connectivity (FC) between the dorsal ACC (dACC) and left middle frontal gyrus. In addition, network FC analysis suggested that the SN has increased connections with both the default mode network (DMN) and executive control network (ECN), which are both related to asthma. Asthma decreased the network connections between the DMN and ECN. Furthermore, Granger causality (GC) strengths from both the DMN and ECN to the bilateral anterior insula were increased in asthmatic patients. A positive correlation was found between GC strengths from the left parietal cortex to the right anterior insula and HAMD scores in asthmatic patients (r = 0.434, P = 0.005). The findings from this study suggested that the SN plays an important role in asthma. The aberrant spatial FC of the SN and its directional network connections with the DMN and ECN may contribute to the potential neural underpinnings of asthma.

Allergic rhinitis impairs working memory in association with drop of hippocampal - Prefrontal coupling

Allergic rhinitis (AR) is a chronic inflammatory disease frequently associated with a deficit in learning and memory. Working memory is an important system for decision making and guidance, which depends on interactions between the ventral hippocampus (vHipp) and the prelimbic prefrontal cortex (plPFC). It is still unclear whether AR influences the activity and coupling of these brain areas, which consequently may impair working memory. The current study aimed to examine alterations of the vHipp-plPFC circuit in a rat model of AR. Our results show decreased working memory performance in AR animals, accompanied by a reduction of theta and gamma oscillations in plPFC. Also, AR reduces coherence between vHipp and plPFC in both theta and gamma frequency bands. Cross-frequency coupling analyses confirmed a reduced interaction between hippocampal theta and plPFC gamma oscillations. Granger causality analysis revealed a reduction in the causal effects of vHipp activity on plPFC oscillations and vice versa. A significant correlation was found between working memory performance with disruption of functional connectivity in AR animals. In summary, our data show that in AR, there is a deficit of functional coupling between hippocampal and prefrontal network, and suggest that this mechanism might contribute to working memory impairment in individuals with AR.

Serum Levels of Interleukin-6 and Tumor Necrosis Factor Alpha in Children With Attention-Deficit Hyperactivity Disorder

Background:

Attention-deficit hyperactivity disorder (ADHD) is a common disorder in children, but its etiology and pathogenesis are still unclear.

Aims:

The aims of this study were to measure the level of serum interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) as markers of immune system involvement in children with ADHD, and to study their correlation with symptoms severity of ADHD.

Materials and Methods:

The study was conducted on 80 children diagnosed as ADHD based on the criteria adapted from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Eighty healthy children of matched age and sex served as a control group. All children enrolled in the study were subjected to history taking, clinical examination, and psychometric tests. Assay for serum IL-6 and TNF-α for all patients and controls was performed using enzyme-linked immunosorbent assay.

Results:

The mean serum level of IL-6 was 26.11 ± 11.14 and 6.23 ± 2.52 in children with ADHD and controls, respectively. Children with ADHD showed significantly higher serum IL-6 levels than the control group (P = 0.001). Serum IL-6 showed no significant correlation with the intelligence quotient (IQ) or the Abbreviated Conners’ Rating Scale scores for parents. However, TNF-α showed no significant differences between the two groups and no significant correlation with the IQ or the Abbreviated Conners’ Rating Scale scores for parents.

Conclusion:

Serum IL-6 levels were significantly higher in children with ADHD compared to controls; however, the IL-6 levels did not correlate with ADHD symptoms severity. Increased IL-6 levels may contribute to the etiology of ADHD.

TAK-242 ameliorates olfactory dysfunction in a mouse model of allergic rhinitis by inhibiting neuroinflammation in the olfactory bulb

OBJECTIVE

Olfactory dysfunction (OD) is a common symptom of allergic rhinitis (AR) that can seriously affect patient quality of life; however, the associated pathogenesis remains unclear. This study aimed to explore the relationship between OD and damage of the olfactory bulb (OB) in allergic rhinitis (AR). The therapeutic potential of TAK-242, a selective TLR4 inhibitor, was evaluated for OD.

METHOD

An AR mouse model was established with ovalbumin (OVA) to test the olfactory function of AR mice using the buried food pellet test (BFPT). Mice with OD were intraperitoneally injected with TAK-242 or 1% DMSO (vehicle). Immunohistochemistry was used to detect microglia and astrocyte activation in the OB. TUNNEL staining was performed to detect apoptosis in the OB. Proteins in the TLR4 signaling pathway were detected by Western blot. The level of proinflammatory factor mRNA in the OB was determined by RT-PCR.

RESULT

Neuroinflammation was observed in the OB of the OD group, as evidenced by glial cell activation and increased proinflammatory factor expression. The number of apoptotic cells was significantly increased in the OB of the OD group. The expression of TLR4, MyD88, and p-NF-κBp65 was significantly up-regulated in the OB of the OD group. TAK-242 treatment significantly reduced the level of IL-1β, IL-6, and TNF-α mRNA expression, as well as activation of microglia and astrocytes in the OB tissues.

CONCLUSION

TAK-242 improve olfactory function in AR mice mainly by reducing neuroinflammation and apoptosis in the OB, which may be related to blocking the TLR4/MyD88/NF-κB signaling pathway.

Neuronal regulation of immunity: why, how and where?

Neuroimmunology is one of the fastest-growing fields in the life sciences, and for good reason; it fills the gap between two principal systems of the organism, the nervous system and the immune system. Although both systems affect each other through bidirectional interactions, we focus here on one direction - the effects of the nervous system on immunity. First, we ask why is it beneficial to allow the nervous system any control over immunity? We evaluate the potential benefits to the immune system that arise by taking advantage of some of the brain's unique features, such as its capacity to integrate and synchronize physiological functions, its predictive capacity and its speed of response. Second, we explore how the brain communicates with the peripheral immune system, with a focus on the endocrine, sympathetic, parasympathetic, sensory and meningeal lymphatic systems. Finally, we examine where in the brain this immune information is processed and regulated. We chart a partial map of brain regions that may be relevant for brain-immune system communication, our goal being to introduce a conceptual framework for formulating new hypotheses to study these interactions.

Functional abdominal pain disorders and asthma: two disorders, but similar pathophysiology?

INTRODUCTION

Functional abdominal pain disorders (FAPDs) and asthma are common ailments affecting both children and adults worldwide. Multiple studies have demonstrated an association between these two disorders. However, the exact reason for this observed association is not apparent.

AREAS COVERED

The current review has explored available literature and outlined multiple underlying pathophysiological mechanisms, common to both asthma and FAPDs, as possible reasons for this association.

EXPERT OPINION

Smooth muscle dysfunction, hypersensitivity and hyper-responsiveness, mucosal inflammation, and barrier dysfunction involving gastrointestinal and respiratory tracts are the main underlying pathophysiological mechanisms described for the generation of symptoms in FAPDs and asthma. In addition, alterations in neuroendocrine regulatory functions, immunological dysfunction, and microbial dysbiosis have been described in both disorders. We believe that the pathophysiological processes that were explored in this article would be able to expand the mechanisms of the association. The in-depth knowledge is needed to be converted to therapeutic and preventive strategies to improve the quality of care of children suffering from FAPDs and asthma.

Predicting Response to Group Cognitive Behavioral Therapy in Asthma by a Small Number of Abnormal Resting-State Functional Connections

Group cognitive behavioral therapy (GCBT) is a successful psychotherapy for asthma. However, response varies considerably among individuals, and identifying biomarkers of GCBT has been challenging. Thus, the aim of this study was to predict an individual's potential response by using machine learning algorithms and functional connectivity (FC) and to improve the personalized treatment of GCBT. We use the lasso method to make the feature selection in the functional connections between brain regions, and we utilize t-test method to test the significant difference of these selected features. The feature selections are performed between controls (size = 20) and pre-GCBT patients (size = 20), pre-GCBT patients (size = 10) and post-GCBT patients (size = 10), and post-GCBT patients (size = 10) and controls (size = 10). Depending on these features, support vector classification was used to classify controls and pre- and post-GCBT patients. Pearson correlation analysis was employed to analyze the associations between clinical symptoms and the selected discriminated FCs in post-GCBT patients. At last, linear support vector regression was applied to predict the therapeutic effect of GCBT. After feature selection and significant analysis, five discriminated FC regarding neuroimaging biomarkers of GCBT were discovered, which are also correlated with clinical symptoms. Using these discriminated functional connections, we could accurately classify the patients before and after GCBT (classification accuracy, 80%) and predict the therapeutic effect of GCBT in asthma (predicted accuracy, 67.8%). The findings in this study would provide a novel sight toward GCBT response prediction and further confirm neural underpinnings of asthma. Moreover, our findings had clinical implications for personalized treatment by identifying asthmatic patients who will be appropriate for GCBT.

CLINICAL TRIAL REGISTRATION

The brain mechanisms of group cognitive behavioral therapy to improve the symptoms of asthma (Registration number: Chi-CTR-15007442, http://www.chictr.org.cn/index.aspx).

Anti-Yo Antibodies in Children With ADHD: First Results About Serum Cytokines

Objective: We investigated whether ADHD children who are positive to Purkinje cell antibodies display pro-inflammatory activity associated with high cytokine serum levels. Method: Fifty-eight ADHD outpatients were compared with 36 healthy, age- and sex-matched children. Forty-five of the ADHD children were positive to anti-Yo antibodies, whereas 34 of the control children were negative. Interleukin 4 (IL-4), IL-6, IL-10, IL-17, tumor necrosis factor alpha (TNFα), and interferon gamma (IFNγ) cytokine serum levels were tested in ADHD children who were positive to anti-Yo antibodies and in the control children who were negative. Results: Anti-Yo antibodies were present to a greater extent in the ADHD group: 77.58% versus 22.42%. Significant differences emerged between the two groups in IL-6 and IL-10, with higher cytokine levels being detected in ADHD children than in controls. Conclusion: Immune processes in ADHD are likely to be associated with mediators of inflammation, such as cytokines. These results contribute to our understanding of action of neural antibodies and cytokines in ADHD.

The Relationship Between Cough Reflex Sensitivity and Exacerbation Frequency in Chronic Obstructive Pulmonary Disease

BACKGROUND

Cough is predictive of exacerbations of chronic obstructive pulmonary disease (COPD). Little is known about cough reflex sensitivity during exacerbation of COPD and whether it is associated with exacerbation frequency. This pilot study aimed to investigate cough reflex sensitivity during and following recovery from exacerbation of COPD, and its association with the frequency of future exacerbations. In addition, the repeatability of cough reflex sensitivity in stable COPD was investigated.

METHODS

Twenty participants hospitalised with exacerbation of COPD underwent inhaled capsaicin challenge during exacerbation and after 6 weeks of recovery. The frequency of future exacerbations was monitored for 12 months. The repeatability of cough reflex sensitivity was assessed in separate participants with stable COPD, who underwent 2 capsaicin challenge tests, 6 weeks apart.

RESULTS

Cough reflex sensitivity was heightened during exacerbation of COPD. Geometric mean (SD) capsaicin concentration thresholds to elicit 5 coughs (C5) during exacerbation and after 6 weeks of recovery were 1.76 (3.73) vs. 8.09 (6.25) μmol L^-1, respectively (p < 0.001). The change in C5 from exacerbation to 6-week recovery was associated with the frequency of future exacerbations (ρ = - 0.687, p = 0.003). C5 was highly repeatable over 6 weeks in stable COPD, and intraclass correlation coefficient was 0.85.

CONCLUSION

Cough reflex sensitivity is heightened during exacerbation of COPD and reduces after recovery. The persistence of cough reflex hypersensitivity at recovery was associated with the frequency of future exacerbations.

Effect of acupuncture and its influence on cerebral activity in patients with persistent asthma: study protocol for a randomized controlled clinical trial

Background

Previous studies suggested that acupuncture was a promising adjunctive treatment for asthma. However, the underlying mechanism of acupuncture for asthma remains unclear. The aim of the present trial is to explore whether and how specific meridian acupuncture works in quality of life and symptomatic improvement by modulating brain function in patients with asthma.

Methods/design

This is a randomized controlled functional brain imaging trial currently being conducted in Sichuan, China. In total, 48 patients with mild to moderate persistent asthma will be recruited randomly and allocated to either of two acupuncture groups: acupuncture at the lung meridian or acupuncture at the heart meridian. The treatment period will last 4 weeks. The Asthma Quality of Life Questionnaire is the primary outcome. The Asthma Control Test, peak expiratory flow rate, forced expiratory volume in 1 s, Montreal Cognitive Assessment, Zung Self-rating Anxiety Scale, and Zung Self-rating Depression Scale will also be used to assess the clinical efficacy of different interventions. Functional magnetic resonance imaging (fMRI) will be performed to detect cerebral activity changes in each group. The clinical data and fMRI data will be analyzed between groups, then, the Pearson correlation analysis will be used to assess the association between the changes of cerebral activity features and the improvement of clinical outcomes in each group.

Discussion

The present study has been established on the basis of the “meridian–viscera relationship” theory of traditional Chinese medicine and the modern central mechanism of acupuncture. The results of this trial would be useful to identify the efficiency of the specific meridian acupuncture for asthma. The investigation of its central mechanism would further expand knowledge of acupuncture for asthma.

Trial registration

Chinese Clinical Trial Registry, ChiCTR1900027478. Registered on 15 November 2019.

Cerebral regional and network characteristics in asthma patients: a resting-state fMRI study

Asthma is a serious health problem that involves not only the respiratory system but also the central nervous system. Previous studies identified either regional or network alterations in patients with asthma, but inconsistent results were obtained. A key question remains unclear: are the regional and neural network deficits related or are they two independent characteristics in asthma? Answering this question is the aim of this study. By collecting resting-state functional magnetic resonance imaging from 39 patients with asthma and 40 matched health controls, brain functional measures including regional activity (amplitude of low-frequency fluctuations) and neural network function (degree centrality (DC) and functional connectivity) were calculated to systematically characterize the functional alterations. Patients exhibited regional abnormities in the left angular gyrus, right precuneus, and inferior temporal gyrus within the default mode network. Network abnormalities involved both the sensorimotor network and visual network with key regions including the superior frontal gyrus and occipital lobes. Altered DC in the lingual gyrus was correlated with the degree of airway obstruction. This study elucidated different patterns of regional and network changes, thereby suggesting that the two parameters reflect different brain characteristics of asthma. These findings provide evidence for further understanding the potential cerebral alterations in the pathophysiology of asthma.

Association of atopic dermatitis with suicide risk among 788,411 adolescents: A Korean cross-sectional study

BACKGROUND

Atopic dermatitis (AD) is known to negatively influence the mental health of patients. However, only a few studies have explored the influencing factors for psychiatric problems among adolescents with AD.

OBJECTIVE

To assess the association of AD and suicidal behaviors among adolescents by analyzing data from the 3rd through the 13th annual Korean Youth Risk Behavior Web-based Surveys (completed from 2007 to 2017).

METHODS

Survey data were obtained from a stratified, multistage, clustered sample. Students self-reported AD if they had received a diagnosis of AD by a physician. Influencing factors for suicidal behaviors were tested by logistic regression models.

RESULTS

A total of 788,411 adolescents completed the survey. The proportion of participants with AD was 22.2%. Those reporting suicide ideation and suicide attempts were 19.0%, and 4.5%, respectively. Compared with adolescents without AD, those with AD were more likely to be female, to skip breakfast less frequently, to exercise less frequently, to drink less alcohol, and to not be current smokers and were statistically significantly more likely to have negative mental health states. In the multivariable model, perceived unhappiness and suicidal ideation were the strongest influencing factors for suicidal ideation (adjusted odds ratio, 4.90; 95% CI, 4.31-5.57) and for suicidal attempts (adjusted odds ratio, 48.01; 95% CI, 42.69-53.09), respectively.

CONCLUSION

Adolescents with AD had a meaningful prevalence of suicidal behaviors. Although further research is needed to clarify this association, adolescents with AD with influencing factors for negative mental health state may need intervention from practitioners who use a multidisciplinary team approach to prevent suicide.

Antioxidants as a Potential Target against Inflammation and Oxidative Stress in Attention-Deficit/Hyperactivity Disorder

Psychostimulants and non-psychostimulants are the medications prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD). However, several adverse results have been linked with an increased risk of substance use and side effects. The pathophysiology of ADHD is not completely known, although it has been associated with an increase in inflammation and oxidative stress. This review presents an overview of findings following antioxidant treatment for ADHD and describes the potential amelioration of inflammation and oxidative stress using antioxidants that might have a future as multi-target adjuvant therapy in ADHD. The use of antioxidants against inflammation and oxidative conditions is an emerging field in the management of several neurodegenerative and neuropsychiatric disorders. Thus, antioxidants could be promising as an adjuvant ADHD therapy.

Peanut Sensitivity and Allergic Rhinitis in Young Children are Associated with Attention-Deficit Hyperactivity Disorder Symptoms in Adolescence

OBJECTIVE

Although childhood allergic diseases have been found to be associated with symptoms of attention-deficit hyperactivity disorder, the temporal relationship between these diseases remains unclear. In this study of 97 children, clinical examination and blood samples for total and specific IgE were collected at 6 and 12 years old.

PATIENTS AND METHODS

We followed a total of 97 children from 6 to 12 years old. Clinical examination and blood samples for total and specific IgE were collected at 6 and 12 years old. Attention-deficit hyperactivity disorder and oppositional defiant disorder symptoms at 12 years old were evaluated using the Swanson, Nolan, and Pelham, Version IV Scale Parent Form.

RESULTS

After accounting for the affect of confounding variables, we found that allergic rhinitis at 6 years old was associated with higher inattention score at 12 years old (β-coefficient 0.356, 95% CI 0.104-0.609, p = 0.006). In addition, higher specific IgE levels for peanuts at 6 years of age were correlated with higher hyperactivity/impulsivity scores (β-coefficient 0.088, 95% CI 0.049-0.126, p < 0.001), and higher specific IgE for peanuts at 12 years of age were correlated with higher opposition/defiance scores (β-coefficient 0.054, 95% CI 0.012-0.096, p = 0.012) at 12 years old in our final linear regression models.

CONCLUSION

Allergic rhinitis and peanut sensitization in childhood may be associated with more symptoms of attention-deficit hyperactivity and oppositional defiant disorder in adolescence.

Headliner in Physiology and Management of Childhood Asthma: Hypothalamic-Pituitary-Adrenal Axis

Asthma is the most common chronic inflammatory disease of children. Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy which are the most effective, commonly used treatment of persistent asthma. Mostly, studies on the relationship between asthma and cortisol have focused on side effects of treatment. Recently, asthmatic patients not treated with ICS have been reported to have an attenuated activity and/or responsiveness of their Hypothalamic-Pituitary- Adrenal (HPA) axis. Moreover, it has been proposed that asthma worsening with stress may be due to a dysfunctional HPA axis, or cortisol insensitivity due to chronic psychological stress through impaired glucocorticoid receptor expression or function. Although long-term ICS treatment might produce adrenal suppression or iatrogenic Cushing syndrome, improvement of adrenal function has also been detected in some of asthmatic cases. Thus, the response scheme of HPA axis still contains undiscovered features in asthma. The management of asthma can be improved by increasing knowledge on the role of HPA axis in asthma pathophysiology. The risk for side effects of ICS can be minimized through increased awareness, early recognition of at-risk patients and regular patient follow-up. This review was written to draw attention to the role of HPA axis in both asthma and its treatment and to illustrate a follow up algorithm of HPA axis in the management of asthma.

Allergen-induced anxiety-like behavior is associated with disruption of medial prefrontal cortex - amygdala circuit

Anxiety is prevalent in asthma, and is associated with disease severity and poor quality of life. However, no study to date provides direct experimental evidence for the effect of allergic inflammation on the structure and function of medial prefrontal cortex (mPFC) and amygdala, which are essential regions for modulating anxiety and its behavioral expression. We assessed the impact of ovalbumin (OVA)-induced allergic inflammation on the appearance of anxiety-like behavior, mPFC and amygdala volumes using MRI, and the mPFC-amygdala circuit activity in sensitized rats. Our findings exhibited that the OVA challenge in sensitized rats induced anxiety-like behavior, and led to more activated microglia and astrocytes in the mPFC and amygdala. We also found a negative correlation between anxiety-like behavior and amygdala volume. Moreover, OVA challenge in sensitized rats was associated with increases in mPFC and amygdala activity, elevation of amygdala delta-gamma coupling, and the enhancement of functional connectivity within mPFC-amygdala circuit – accompanied by an inverted direction of information transferred from the amygdala to the mPFC. We indicated that disrupting the dynamic interactions of the mPFC-amygdala circuit may contribute to the induction of anxiety-related behaviors with asthma. These findings could provide new insight to clarify the underlying mechanisms of allergic inflammation-induced psychiatric disorders related to asthma.

Risk factors analysis of attention deficit/hyperactivity disorder and allergic rhinitis in children: a cross-sectional study

BACKGROUND

To investigate the relationship between symptom of attention-deficit/hyperactivity disorder (ADHD) and allergic rhinitis (AR) in AR children of different genders and ages.

METHODS

Four hundred and sixty-five allergic rhinitis children aged 6-12 years old were recruited in this study. Skin-prick test, Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), Total Nasal Symptoms Score (TNSS) and the Swanson, Nolan, and Pelham version IV scale (SNAP-IV) were recorded. Patients were divided into AR with ADHD and AR without ADHD, according to the SNAP-IV scale results.

RESULTS

Children with the inattention/hyperactivity scale (IHS) > 1.25 accounted for 26.4% of all children with AR. The TNSS with IHS > 1.25 group were significantly higher than the IHS ≤ 1.25 group. Univariate analysis showed that age, gender, duration of AR symptoms, skin index, and PRQLQ subscales were associated with symptoms of hyperactivity and attention deficit (IHS > 1.25). After normalizing the age and gender factors, duration of AR symptoms and skin index correlated with IHS > 1.25. After stratifying age and gender, the correlation between IHS > 1.25 and skin index and PRQLQ subscales was mainly found in male children, and the association between the duration of AR symptoms and IHS > 1.25 was reflected in each group.

CONCLUSIONS

ADHD in children with AR is associated with severity, duration, and skin index of AR, and this association is more pronounced in male children.

Altered brain network integrity in patients with asthma: A structural connectomic diffusion tensor imaging study

Brain functional deficits had been reported in asthma patients. These deficits may be related to treatment resistance, inaccurate self-assessment and poor self-management. However, changes of the structural brain network in asthma patients remain largely unclear. Diffusion tensor imaging were acquired from 54 asthmatic patients and 44 controls. Then we calculated all the participants' structural network metrics. All the participants underwent the test of Hamilton Rating Scale for Depression and Anxiety as well as a lung function. Multiple linear correlation analyses were conducted. At the global level, asthma patients had a higher path length and lower global efficiency than controls, implying a shift toward regular networks. At the local level, asthma patients exhibited abnormal nodal connectivity with other nodes involved the fronto-limbic regions. Our findings highlight more locally segregated but less efficiently integrated structural networks, particularly involving frontal-limbic networks, in asthmatic patients. These findings provide important evidence to support the role of brain networks in the pathophysiology of asthma.

The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in adolescent obsessive-compulsive disorder: Does comorbid anxiety disorder affect inflammatory response?

Recent adult etiologic studies indicated evidence linking increased inflammatory parameters with psychiatric disorders. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are easily obtainable clinical markers of inflammation and have been found to be increased in various medical and mental disorders. In this study, we aimed to investigate the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in adolescents with obsessive-compulsive disorder (OCD). Secondarily, the effect of comorbid anxiety disorder with OCD on the inflammatory response was investigated. Sixty drug-naïve adolescents with OCD aged 12 to 18 years were enrolled in the patient group. Twenty-three of the OCD group had comorbid anxiety disorder (AD) and 37 had no comorbidities. One hundred twenty-eight adolescents in the same age range with no psychiatric disorders were recruited as the healthy control group. The severity of OCD symptoms was evaluated using the Children's Yale-Brown Obsessive Compulsive Scale. There were statistically significant differences in the neutrophil-lymphocyte ratio, white blood cell, neutrophil, and platelet counts among the three groups, even after adjusting for age and sex. The adolescents with OCD and AD had the highest neutrophil-lymphocyte ratio and white blood cell counts. A comorbid anxiety disorder diagnosis in addition to obsessive-compulsive disorder may increase the inflammatory response.

The Physical Burden of Immunoperception

The previous chapter introduced the ImmunoEmotional Regulatory System (IMMERS). Also, there was a brief discussion about psychological states/psychiatric disorders that so far have been linked to the IMMERS. The present chapter considers another aspect of the IMMERS in which physiological states/physical diseases can be fit to the IMMERS.

Exposure to formaldehyde and diisononyl phthalate exacerbate neuroinflammation through NF-κB activation in a mouse asthma model

Diisononyl phthalate (DINP) and formaldehyde both are associated with asthma and allergies. However, it is unclear about the adverse effect of DINP and formaldehyde exposure on the brain for asthma patients. Here, we determined the effect of DINP and/or formaldehyde exposure on neuroinflammation in brain by a murine asthma model and investigated the underlying mechanisms. Mice were exposed to formaldehyde and/or DINP and sensitization with ovalbumin. The results show that exposure to formaldehyde and/or DINP not only exacerbated allergic asthma-like symptoms, but also promoted neuroinflammation in brain. The incrassation of the airway wall and exacerbation of neuroinflammation were more obviously when mice were subjected to a combined exposure to DINP and formaldehyde. Exposure to DINP and/or formaldehyde enhances oxidative stress and the activation of NF-κB in the prefrontal cortex of mouse asthma model. Exposure to DINP and/or formaldehyde also induced an increase in IL-1β, IL-17, and NGF. Blocking oxidative stress by administering melatonin or inhibiting NF-κB activation by treatment with Dehydroxymethylepoxyquinomicin effectively prevented increasing the levels IL-1β, IL-17 and nerve growth factor. The data indicated that DINP and/or formaldehyde exposure promoted neuroinflammation in the brain through enhanced oxidative stress and activation of NF-κB in a mouse asthma model.

Association Between Asthma and Depression: A National Cohort Study

BACKGROUND

Patients with asthma often suffer from depression and vice versa. However, the temporal relationship between the 2 diseases has remained elusive.

OBJECTIVE

The aim of this study was to determine the bidirectional relationship between asthma and depression in adults, using national cohort samples in Korea.

METHODS

Using the national cohort from the study by the Korean Health Insurance Review and Assessment Service, patients with asthma and control participants were selected and matched by age group, sex, income group, region of residence, and medical histories. A stratified Cox proportional hazards model was used to analyze the hazard ratio (HR) of asthma with depression (study 1) and depression with asthma (study 2).

RESULTS

In study 1, the HR of depressive disorders was significantly higher in patients with asthma than in patients without asthma (HR, 1.35; 95% CI, 1.31-1.40). In study 2, the HR of asthma in patients with depression was significantly higher than that in patients without depression (HR, 1.25; 95% CI, 1.21-1.29).

CONCLUSION

A bidirectional association between asthma and depression was observed in this study.

Resting-state connectivity and spontaneous activity of ventromedial prefrontal cortex predict depressive symptomology and peripheral inflammation in HIV

Depression and chronic inflammation are common in persons infected with the human immunodeficiency virus (HIV+). Although depression and response to inflammatory challenge are shown to reflect activity in common neural networks, little is known regarding sub-clinical presentation in persons chronically infected with HIV. The relationship of resting-state functional connectivity (rsFC) between the subgenual anterior cingulate cortex (sgACC) and bilateral amygdala to Beck Depression Inventory-1 (BDI) scores were compared within a group of 23 HIV+ and 23 HIV-negative comparison adults. An interaction was found wherein lower rsFC between the sgACC and both right and left amygdala was associated with higher BDI scores in HIV+ individuals. Total BDI scores and plasma levels of IL-6, IL-8, TNF-α, and IL-10 made available from 10 of the HIV+ patients were regressed upon an index of spontaneous whole-brain activity at rest; i.e., the amplitude of low-frequency fluctuations (ALFFs). Elevated levels of depression and IL-6 were associated with increased ALFF in a cluster of voxels on the medial portion of the ventral surface of the frontal lobe (Brodmann Area 11). Within this sample of HIV+ individuals lower rsFC of the sgACC with subcortical limbic regions predicts greater burden of depressive symptomology whereas elevated activity in the adjacent BA 11 may reflect sickness, indexed by elevated IL-6, and associated depressive behaviors.

The neurobiology of interoception in health and disease

Interoception is the sensing of internal bodily sensations. Interoception is an umbrella term that encompasses (1) the afferent (body-to-brain) signaling through distinct neural and humoral (including immune and endocrine) channels; (2) the neural encoding, representation, and integration of this information concerning internal bodily state; (3) the influence of such information on other perceptions, cognitions, and behaviors; (4) and the psychological expression of these representations as consciously accessible physical sensations and feelings. Interoceptive mechanisms ensure physiological health through the cerebral coordination of homeostatic reflexes and allostatic responses that include motivational behaviors and associated affective and emotional feelings. Furthermore, the conscious, unitary sense of self in time and space may be grounded in the primacy and lifelong continuity of interoception. Body-to-brain interactions influence physical and mental well-being. Consequently, we show that systematic investigation of how individual differences, and within-individual changes, in interoceptive processing can contribute to the mechanistic understanding of physical and psychological disorders. We present a neurobiological overview of interoception and describe how interoceptive impairments at different levels relate to specific physical and mental health conditions, including sickness behaviors and fatigue, depression, eating disorders, autism, and anxiety. We frame these findings in an interoceptive predictive processing framework and highlight potential new avenues for treatments.