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James LM, Tsilibary EP, Wanberg EJ, Georgopoulos AP. Negative Association of Cognitive Performance With Blood Serum Neurotoxicity and Its Modulation by Human Herpes Virus 5 (HHV5) Seropositivity in Healthy Women. Neurosci Insights 2024; 19:26331055241258436. [PMID: 38827247 PMCID: PMC11143810 DOI: 10.1177/26331055241258436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/15/2024] [Indexed: 06/04/2024] Open
Abstract
Identification of early influences on cognitive decline is of paramount importance in order to stem the impacts of decrements in cognitive functioning and to potentially intervene. Thus, here we focused on 132 healthy adult women (age range 26-98 years) to (a) determine whether factors circulating in serum may exert neurotoxic effects in vitro, (b) evaluate associations between serum neurotoxicity and cognitive performance, and (c) assess the influence of human herpes virus (HHV) seroprevalence and other factors on apoptosis and cognitive performance. The results documented that the addition of serum from healthy adult women to neural cell cultures resulted in apoptosis, indicating the presence of circulating neurotoxic factors in the serum. Furthermore, apoptosis increased with age, and was associated with decreased cognitive performance. Stepwise regression evaluating the influence of 6 HHVs on apoptosis and cognitive function revealed that only HHV5 (cytomegalovirus; CMV) seropositivity was significantly associated with apoptosis and cognitive decline, controlling for age. These findings document neurotoxic effects of serum from healthy women across the adult lifespan and suggest a unique detrimental influence associated with CMV seropositivity.
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Affiliation(s)
- Lisa M James
- The Healthy Brain Aging Group, Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Effie-Photini Tsilibary
- The Healthy Brain Aging Group, Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Erik J Wanberg
- The Healthy Brain Aging Group, Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Apostolos P Georgopoulos
- The Healthy Brain Aging Group, Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA
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Gale SD, Farrer TJ, Erbstoesser R, MacLean S, Hedges DW. Human Cytomegalovirus Infection and Neurocognitive and Neuropsychiatric Health. Pathogens 2024; 13:417. [PMID: 38787269 PMCID: PMC11123947 DOI: 10.3390/pathogens13050417] [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: 04/23/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
A common infection, human cytomegalovirus (HCMV) has been associated with a variety of human diseases, including cardiovascular disease and possibly certain cancers. HCMV has also been associated with cognitive, psychiatric, and neurological conditions. Children with congenital or early-life HCMV are at risk for microcephaly, cerebral palsy, and sensorineural hearing loss, although in many cases sensorineural loss may resolve. In addition, HCMV can be associated with neurodevelopmental impairment, which may improve with time. In young, middle-aged, and older adults, HCMV has been adversely associated with cognitive function in some but not in all studies. Research has linked HCMV to Alzheimer's and vascular dementia, but again not all findings consistently support these associations. In addition, HCMV has been associated with depressive disorder, bipolar disorder, anxiety, and autism-spectrum disorder, although the available findings are likewise inconsistent. Given associations between HCMV and a variety of neurocognitive and neuropsychiatric disorders, additional research investigating reasons for the considerable inconsistencies in the currently available findings is needed. Additional meta-analyses and more longitudinal studies are needed as well. Research into the effects of antiviral medication on cognitive and neurological outcomes and continued efforts in vaccine development have potential to lower the neurocognitive, neuropsychiatric, and neurological burden of HCMV infection.
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Affiliation(s)
- Shawn D. Gale
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (S.M.); (D.W.H.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
| | - Thomas J. Farrer
- Idaho WWAMI Medical Education Program, University of Idaho, Moscow, ID 83844, USA;
| | - Reagan Erbstoesser
- The Department of Biology, Brigham Young University, Provo, UT 84602, USA;
| | - Scott MacLean
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (S.M.); (D.W.H.)
| | - Dawson W. Hedges
- The Department of Psychology, Brigham Young University, Provo, UT 84602, USA; (S.M.); (D.W.H.)
- The Neuroscience Center, Brigham Young University, Provo, UT 84602, USA
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Flegr J, Chvátalová V, Příplatová L, Tureček P, Kodym P, Šebánková B, Kaňková Š. Cognitive Effects of Toxoplasma and CMV Infections: A Cross-Sectional Study of 557 Young Adults Considering Modulation by Sex and Rh Factor. Pathogens 2024; 13:363. [PMID: 38787216 PMCID: PMC11124290 DOI: 10.3390/pathogens13050363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
One-third of humanity harbors a lifelong infection with Toxoplasma gondii, and probably about 80% are infected with human cytomegalovirus (CMV). This study aims to delineate the associations between toxoplasmosis and cognitive abilities and compare these to the associations with CMV. We evaluated the cognitive performance of 557 students, who had been examined for Toxoplasma and CMV infections, using intelligence, memory, and psychomotor tests. The results indicated cognitive impairments in seropositive individuals for both pathogens, with variations in cognitive impact related to sex and the Rh factor. Specifically, Toxoplasma infection was associated with lower IQ in men, whereas CMV was predominantly associated with worse performance by women when testing memory and reaction speeds. Analysis of the antibody concentrations indicated that certain Toxoplasma-associated cognitive detrimental effects may wane (impaired intelligence) or worsen (impaired reaction times) over time following infection. The findings imply that the cognitive impairments caused by both neurotropic pathogens are likely due to pathological changes in the brain rather than from direct manipulative action by the parasites.
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Affiliation(s)
- Jaroslav Flegr
- Laboratory of Evolutionary Biology, Department of Philosophy and History of Sciences, Faculty of Science, Charles University, Viničná 7, 128 00 Prague, Czech Republic (P.T.); (B.Š.); (Š.K.)
| | - Veronika Chvátalová
- Laboratory of Evolutionary Biology, Department of Philosophy and History of Sciences, Faculty of Science, Charles University, Viničná 7, 128 00 Prague, Czech Republic (P.T.); (B.Š.); (Š.K.)
| | - Lenka Příplatová
- Laboratory of Evolutionary Biology, Department of Philosophy and History of Sciences, Faculty of Science, Charles University, Viničná 7, 128 00 Prague, Czech Republic (P.T.); (B.Š.); (Š.K.)
| | - Petr Tureček
- Laboratory of Evolutionary Biology, Department of Philosophy and History of Sciences, Faculty of Science, Charles University, Viničná 7, 128 00 Prague, Czech Republic (P.T.); (B.Š.); (Š.K.)
| | - Petr Kodym
- National Reference Laboratory for Toxoplasmosis, Šrobárova 48, 100 42 Prague, Czech Republic
| | - Blanka Šebánková
- Laboratory of Evolutionary Biology, Department of Philosophy and History of Sciences, Faculty of Science, Charles University, Viničná 7, 128 00 Prague, Czech Republic (P.T.); (B.Š.); (Š.K.)
| | - Šárka Kaňková
- Laboratory of Evolutionary Biology, Department of Philosophy and History of Sciences, Faculty of Science, Charles University, Viničná 7, 128 00 Prague, Czech Republic (P.T.); (B.Š.); (Š.K.)
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Müller L, Di Benedetto S. Immunosenescence and Cytomegalovirus: Exploring Their Connection in the Context of Aging, Health, and Disease. Int J Mol Sci 2024; 25:753. [PMID: 38255826 PMCID: PMC10815036 DOI: 10.3390/ijms25020753] [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: 11/18/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Aging induces numerous physiological alterations, with immunosenescence emerging as a pivotal factor. This phenomenon has attracted both researchers and clinicians, prompting profound questions about its implications for health and disease. Among the contributing factors, one intriguing actor in this complex interplay is human cytomegalovirus (CMV), a member of the herpesvirus family. Latent CMV infection exerts a profound influence on the aging immune system, potentially contributing to age-related diseases. This review delves into the intricate relationship between immunosenescence and CMV, revealing how chronic viral infection impacts the aging immune landscape. We explore the mechanisms through which CMV can impact both the composition and functionality of immune cell populations and induce shifts in inflammatory profiles with aging. Moreover, we examine the potential role of CMV in pathologies such as cardiovascular diseases, cancer, neurodegenerative disorders, COVID-19, and Long COVID. This review underlines the importance of understanding the complex interplay between immunosenescence and CMV. It offers insights into the pathophysiology of aging and age-associated diseases, as well as COVID-19 outcomes among the elderly. By unraveling the connections between immunosenescence and CMV, we gain a deeper understanding of aging's remarkable journey and the profound role that viral infections play in transforming the human immune system.
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Affiliation(s)
- Ludmila Müller
- Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
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Parker DC, Whitson HE, Smith PJ, Kraus VB, Huebner JL, North R, Kraus WE, Cohen HJ, Huffman KM. Anti-CMV IgG Seropositivity is Associated with Plasma Biomarker Evidence of Amyloid-β Accumulation. J Alzheimers Dis 2024; 98:593-600. [PMID: 38393897 PMCID: PMC10960581 DOI: 10.3233/jad-230220] [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] [Indexed: 02/25/2024]
Abstract
Background Some human studies have identified infection with cytomegalovirus (CMV), a member of the alpha herpesvirus family, as a risk factor for Alzheimer's disease and related dementias (ADRD). To our knowledge, no studies have evaluated associations of CMV seropositivity with plasma biomarkers of ADRD risk in middle-aged adults. Objective In participants recruited for an exercise study, we evaluated cross-sectional associations of CMV seropositivity with: Aβ42/Aβ40 ratio, a low ratio suggestive of central nervous system Aβ accumulation; glial fibrillary acidic protein (GFAP), a measure of neuroinflammation; and neurofilament light (NfL), a measure of neurodegeneration. Methods Anti-CMV IgG was quantified by ELISA. Plasma ADRD biomarkers were quantified using the ultrasensitive SIMOA assay. We used linear regression to evaluate associations of CMV seropositivity with the ADRD biomarkers, adjusting for age, sex, and race (n = 303; Age = 55.7±9.2 years). For ADRD biomarkers significantly associated with CMV seropositivity, we evaluated continuous associations of anti-CMV IgG levels with the ADRD biomarkers, excluding CMV seronegative participants. Results 53% of participants were CMV seropositive. CMV seropositivity was associated with a lesser Aβ42/Aβ40 ratio (β=-3.02e-03 95% CI [-5.97e-03, -7.18e-05]; p = 0.045). In CMV seropositive participants, greater anti-CMV IgG levels were associated with a lesser Aβ42/Aβ40 ratio (β=-4.85e-05 95% CI[-8.45e-05, -1.25e-05]; p = 0.009). CMV seropositivity was not associated with plasma GFAP or NfL in adjusted analyses. Conclusions CMV seropositivity was associated with a lesser plasma Aβ42/Aβ40 ratio. This association may be direct and causally related to CMV neuro-cytotoxicity or may be indirect and mediated by inflammatory factors resulting from CMV infection burden and/or the immune response.
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Affiliation(s)
- Daniel C. Parker
- Duke University School of Medicine, Division of Geriatrics, Durham, NC, USA
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
| | - Heather E. Whitson
- Duke University School of Medicine, Division of Geriatrics, Durham, NC, USA
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Durham VA Geriatrics Research Education and Clinical Center (GRECC), Durham, NC USA
| | - Patrick J. Smith
- University of North Carolina, Chapel Hill, Department of Psychiatry, Chapel Hill, NC, USA
| | - Virginia B. Kraus
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Division of Rheumatology and Immunology, Durham, NC, USA
| | - Janet L. Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca North
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
| | - William E. Kraus
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Division of Cardiology, Durham, NC, USA
| | - Harvey Jay Cohen
- Duke University School of Medicine, Division of Geriatrics, Durham, NC, USA
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
| | - Kim M. Huffman
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Division of Rheumatology and Immunology, Durham, NC, USA
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Fu J, Wei Q, Chen X, Lai X, Shang H. Analysis of the Association Between Pathogen Exposure and the Risk of Dementia. J Alzheimers Dis 2024; 100:961-972. [PMID: 38995782 DOI: 10.3233/jad-240073] [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] [Indexed: 07/14/2024]
Abstract
Background Previous research has suggested that pathogen infections may serve as potential contributors to dementia. Objective Consequently, the study aimed to evaluate whether pathogen exposure heightens the risk of dementia. Methods Between 2006 and 2010, a total of 8,144 individuals from the UK Biobank had data on pathogen antibodies and were included in the baseline assessment. Cox proportional hazard models were employed for the analysis. Results Out of the 8,144 participants, 107 eventually developed dementia, while 55 participants were diagnosed with Alzheimer's disease (AD). Multivariate Cox regression analysis revealed that the levels of pathogen antibody titers of EBV and C. trachomatis were associated with an increased risk of dementia/AD. The highest quartile of EBV EBNA-1 and EBV VCA p18, and the second quartile of H. pylori VacA significantly increased the risk of dementia compared lower quartile (EBV EBNA-1: HR = 1.938, p = 0.018; EBV VCA p18: HR = 1.824, p = 0.040; H. pylori VacA: HR = 1.890, p = 0.033). Besides, the highest quartile of EBV VCA p18 had a higher risk of AD compared lower quartile (HR = 2.755, p = 0.029). Conclusions The study demonstrated that exposure to EBV, H. pylori, and C. trachomatis substantially elevated the risk of dementia/AD. Despite the relatively widespread occurrence of EBV infection in the population, elevated pathogen antibody titers were still found to increase the risk of dementia/AD. Besides, since C. trachomatis and C. pneumoniae are quite homologous, this study found that trachomatis (C. trachomatis/C. pneumoniae) may be significantly associated with the risk of AD/dementia.
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Affiliation(s)
- Jiajia Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Rare Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Rare Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Rare Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohui Lai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Rare Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Swilley-Martinez ME, Coles SA, Miller VE, Alam IZ, Fitch KV, Cruz TH, Hohl B, Murray R, Ranapurwala SI. "We adjusted for race": now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020-2021. Epidemiol Rev 2023; 45:15-31. [PMID: 37789703 DOI: 10.1093/epirev/mxad010] [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: 05/16/2022] [Revised: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
Race is a social construct, commonly used in epidemiologic research to adjust for confounding. However, adjustment of race may mask racial disparities, thereby perpetuating structural racism. We conducted a systematic review of articles published in Epidemiology and American Journal of Epidemiology between 2020 and 2021 to (1) understand how race, ethnicity, and similar social constructs were operationalized, used, and reported; and (2) characterize good and poor practices of utilization and reporting of race data on the basis of the extent to which they reveal or mask systemic racism. Original research articles were considered for full review and data extraction if race data were used in the study analysis. We extracted how race was categorized, used-as a descriptor, confounder, or for effect measure modification (EMM)-and reported if the authors discussed racial disparities and systemic bias-related mechanisms responsible for perpetuating the disparities. Of the 561 articles, 299 had race data available and 192 (34.2%) used race data in analyses. Among the 160 US-based studies, 81 different racial categorizations were used. Race was most often used as a confounder (52%), followed by effect measure modifier (33%), and descriptive variable (12%). Fewer than 1 in 4 articles (22.9%) exhibited good practices (EMM along with discussing disparities and mechanisms), 63.5% of the articles exhibited poor practices (confounding only or not discussing mechanisms), and 13.5% were considered neither poor nor good practices. We discuss implications and provide 13 recommendations for operationalization, utilization, and reporting of race in epidemiologic and public health research.
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Affiliation(s)
- Monica E Swilley-Martinez
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Serita A Coles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7440, United States
| | - Vanessa E Miller
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Ishrat Z Alam
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Kate Vinita Fitch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Theresa H Cruz
- Prevention Research Center, Department of Pediatrics, Health Sciences Center, University of New Mexico, Albuquerque, NM 87131, United States
| | - Bernadette Hohl
- Penn Injury Science Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6021, United States
| | - Regan Murray
- Center for Public Health and Technology, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, United States
| | - Shabbar I Ranapurwala
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
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Vogel RI, Stenzel AE, Lee H, Hunter-Schlichting D, Wesley E, Uppendahl LD, Geller MA, Nelson HH. Prevalence of active cytomegalovirus infection at diagnosis of ovarian cancer and during chemotherapy and subsequent changes in cognitive functioning. BMC Cancer 2023; 23:1057. [PMID: 37923995 PMCID: PMC10623703 DOI: 10.1186/s12885-023-11566-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
PURPOSE One of the most frequently reported effects of cancer and its treatments is cancer-related cognitive impairment (CRCI). Viral infections may affect inflammation and immune function and therefore may influence patient symptoms, including CRCI. The goal of this study was to describe the prevalence of cytomegalovirus (CMV) infections at diagnosis, during, and after chemotherapy in individuals with ovarian cancer and explore CMV infection at diagnosis with cancer-related cognitive impairment (CRCI) following chemotherapy. METHODS We recruited adults newly diagnosed with ovarian, primary peritoneal or fallopian tube cancer at a single academic cancer center into two prospective studies. In Study 1 (N = 71), participants provided blood samples at diagnosis. In Study 2 (N = 18), participants provided blood samples and completed symptom surveys before, during and after front-line adjuvant chemotherapy. Serum CMV DNA levels were assessed using digital PCR; >100 copies/mL of serum was considered positive for active CMV infection (CMV+). CRCI was measured using the Functional Assessment of Cancer Therapy - Cognitive Function (FACT-Cog) questionnaire. Changes in FACT-Cog scores were compared by CMV status at diagnosis using t-tests at each time point. RESULTS At diagnosis, 29.2% were CMV+ (28.2% in Study 1, 33.3% in Study 2). Following three cycles of chemotherapy (Study 2), CMV positivity rose to 60.0% and then back down to 31.3% after chemotherapy. We observed significant differences in CRCI following chemotherapy by CMV status at diagnosis. CONCLUSION Our data suggest that active CMV infection is common among patients undergoing treatment for ovarian cancer and may contribute to symptoms of CRCI.
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Affiliation(s)
- Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 420 Delaware Street SE, MMC 395, Minneapolis, MN, 55455, USA.
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
| | - Ashley E Stenzel
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 420 Delaware Street SE, MMC 395, Minneapolis, MN, 55455, USA
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Heewon Lee
- Genetics, Cell Biology and Development, University of Minnesota, Minneapolis, MN, USA
| | - DeVon Hunter-Schlichting
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Erin Wesley
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 420 Delaware Street SE, MMC 395, Minneapolis, MN, 55455, USA
| | - Locke D Uppendahl
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 420 Delaware Street SE, MMC 395, Minneapolis, MN, 55455, USA
| | - Melissa A Geller
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 420 Delaware Street SE, MMC 395, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Heather H Nelson
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Monfared AAT, Hummel N, Chandak A, Khachatryan A, Zhang Q. Assessing out-of-pocket expenses and indirect costs for the Alzheimer disease continuum in the United States. J Manag Care Spec Pharm 2023; 29:1065-1077. [PMID: 37307097 PMCID: PMC10510674 DOI: 10.18553/jmcp.2023.23013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND: The societal costs of Alzheimer disease (AD) are considerable. Cost data stratified by cost category (direct and indirect) and AD severity in the United States are limited. OBJECTIVE: To describe out-of-pocket (OOP) expenses and indirect costs from unpaid caregiving and work impairment among patients with AD by severity and among patients with mild cognitive impairment (MCI) in a representative sample of the US population. METHODS: Data from the Health and Retirement Study (HRS) were used. HRS respondents were included if they reported an AD diagnosis or were considered as having MCI based on their cognitive performance. MCI and AD severity staging was performed using a crosswalk from results of the modified Telephone Interview of Cognitive Status to the Mini-Mental State Examination. OOP expenses were assessed along with indirect costs (costs to caregivers from providing unpaid help and costs to employers). Sensitivity analyses were performed by varying assumptions of caregiver employment, missed workdays, and early retirement. Patients with AD were stratified by nursing home status, type of insurance, and income level. All cost calculations applied sampling weights. RESULTS: A total of 18,786 patients were analyzed. Patients with MCI (n = 17,885) and AD (n = 901) were aged 67.8 ± 10.7 and 80.9 ± 9.3 years, were 55.7% and 63.3% female, and were 28.3% and 0.9% employed, respectively. OOP expenses per patient per month increased with AD severity, ranging from $420 in mild to $903 in severe AD but were higher in MCI ($554) than in mild AD. Indirect costs to employers were similar across the AD continuum ($197-$242). Costs from unpaid caregiving generally increased by disease severity, from $72 (MCI) to $1,298 (severe AD). Total OOP and indirect costs increased by disease severity, from $869 (MCI) to $2,398 (severe AD). Sensitivity analysis assuming nonworking caregivers and zero costs to employers decreased the total OOP and indirect costs by 32%-53%. OOP expenses were higher for patients with AD who had private insurance (P < 0.01), had higher incomes (P < 0.01), or were in nursing homes (P < 0.01). Indirect costs to caregivers were lower for patients with AD in nursing homes ($600 vs $1,372, P < 0.01). Total indirect costs were higher for patients with AD with lower incomes ($1,498 vs $1,136, P < 0.01) and for those not in nursing homes ($1,571 vs $799, P < 0.01). CONCLUSIONS: This study shows that OOP expenses and indirect costs increase with AD severity, OOP expenses increase with higher income, subscription of private insurance, and nursing home residency, and total indirect costs decrease with higher income and nursing home residency in the United States. DISCLOSURES This study was financially sponsored by Eisai. Drs Zhang and Tahami are employees of Eisai. Drs Chandak, Khachatryan, and Hummel are employees of Certara; Certara is a paid consultant to Eisai. The views expressed here are those of the authors and are not to be attributed to their respective affiliations. Laura De Benedetti, BSc, provided medical writing support to the manuscript; she is an employee of Certara.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai Inc., Nutley, NJ
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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10
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Packer A, Corbett A, Arathimos R, Ballard C, Aarsland D, Hampshire A, Dima D, Creese B, Malanchini M, Powell TR. Limited evidence of a shared genetic relationship between C-reactive protein levels and cognitive function in older UK adults of European ancestry. FRONTIERS IN DEMENTIA 2023; 2:1093223. [PMID: 39081969 PMCID: PMC11285585 DOI: 10.3389/frdem.2023.1093223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2024]
Abstract
Introduction Previous studies have shown associations between cognitive function and C-reactive protein (CRP) levels in older adults. Few studies have considered the extent to which a genetic predisposition for higher CRP levels contributes to this association. Methods Data was analyzed from 7,817 UK participants aged >50 years as part of the PROTECT study, within which adults without dementia completed a comprehensive neuropsychological battery. We constructed a polygenic risk score (PRS-CRP) that explained 9.61% of the variance in serum CRP levels (p = 2.362 × 10-7) in an independent cohort. Regressions were used to explore the relationship between PRS-CRP and cognitive outcomes. Results We found no significant associations between PRS-CRP and any cognitive measures in the sample overall. In older participants (>62 years), we observed a significant positive association between PRS-CRP and self-ordered search score (i.e., spatial working memory). Conclusion Whilst our results indicate a weak positive relationship between PRS-CRP and spatial working memory that is specific to older adults, overall, there appears to be no strong effects of PRS-CRP on cognitive function.
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Affiliation(s)
- Amy Packer
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Anne Corbett
- College of Medicine & Health, St Luke's, University of Exeter, Exeter, United Kingdom
| | - Ryan Arathimos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Clive Ballard
- College of Medicine & Health, St Luke's, University of Exeter, Exeter, United Kingdom
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Danai Dima
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Psychology, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Byron Creese
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Margherita Malanchini
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, United Kingdom
| | - Timothy R. Powell
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
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11
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Müller L, Di Benedetto S. Aged brain and neuroimmune responses to COVID-19: post-acute sequelae and modulatory effects of behavioral and nutritional interventions. Immun Ageing 2023; 20:17. [PMID: 37046272 PMCID: PMC10090758 DOI: 10.1186/s12979-023-00341-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
Advanced age is one of the significant risk determinants for coronavirus disease 2019 (COVID-19)-related mortality and for long COVID complications. The contributing factors may include the age-related dynamical remodeling of the immune system, known as immunosenescence and chronic low-grade systemic inflammation. Both of these factors may induce an inflammatory milieu in the aged brain and drive the changes in the microenvironment of neurons and microglia, which are characterized by a general condition of chronic inflammation, so-called neuroinflammation. Emerging evidence reveals that the immune privilege in the aging brain may be compromised. Resident brain cells, such as astrocytes, neurons, oligodendrocytes and microglia, but also infiltrating immune cells, such as monocytes, T cells and macrophages participate in the complex intercellular networks and multiple reciprocal interactions. Especially changes in microglia playing a regulatory role in inflammation, contribute to disturbing of the brain homeostasis and to impairments of the neuroimmune responses. Neuroinflammation may trigger structural damage, diminish regeneration, induce neuronal cell death, modulate synaptic remodeling and in this manner negatively interfere with the brain functions.In this review article, we give insights into neuroimmune interactions in the aged brain and highlight the impact of COVID-19 on the functional systems already modulated by immunosenescence and neuroinflammation. We discuss the potential ways of these interactions with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and review proposed neuroimmune mechanisms and biological factors that may contribute to the development of persisting long COVID conditions. We summarize the potential mechanisms responsible for long COVID, including inflammation, autoimmunity, direct virus-mediated cytotoxicity, hypercoagulation, mitochondrial failure, dysbiosis, and the reactivation of other persisting viruses, such as the Cytomegalovirus (CMV). Finally, we discuss the effects of various interventional options that can decrease the propagation of biological, physiological, and psychosocial stressors that are responsible for neuroimmune activation and which may inhibit the triggering of unbalanced inflammatory responses. We highlight the modulatory effects of bioactive nutritional compounds along with the multimodal benefits of behavioral interventions and moderate exercise, which can be applied as postinfectious interventions in order to improve brain health.
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Affiliation(s)
- Ludmila Müller
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany.
| | - Svetlana Di Benedetto
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany
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12
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Warren‐Gash C, Cadogan SL, Nicholas JM, Breuer JM, Shah D, Pearce N, Shiekh S, Smeeth L, Farlow MR, Mori H, Gordon BA, Nuebling G, McDade E, Bateman RJ, Schofield PR, Lee J, Morris JC, Cash DM, Fox NC, Ridha BH, Rossor MN. Herpes simplex virus and rates of cognitive decline or whole brain atrophy in the Dominantly Inherited Alzheimer Network. Ann Clin Transl Neurol 2022; 9:1727-1738. [PMID: 36189728 PMCID: PMC9639627 DOI: 10.1002/acn3.51669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To investigate whether herpes simplex virus type 1 (HSV-1) infection was associated with rates of cognitive decline or whole brain atrophy among individuals from the Dominantly Inherited Alzheimer Network (DIAN). METHODS Among two subsets of the DIAN cohort (age range 19.6-66.6 years; median follow-up 3.0 years) we examined (i) rate of cognitive decline (N = 164) using change in mini-mental state examination (MMSE) score, (ii) rate of whole brain atrophy (N = 149), derived from serial MR imaging, calculated using the boundary shift integral (BSI) method. HSV-1 antibodies were assayed in baseline sera collected from 2009-2015. Linear mixed-effects models were used to compare outcomes by HSV-1 seropositivity and high HSV-1 IgG titres/IgM status. RESULTS There was no association between baseline HSV-1 seropositivity and rates of cognitive decline or whole brain atrophy. Having high HSV-1 IgG titres/IgM was associated with a slightly greater decline in MMSE points per year (difference in slope - 0.365, 95% CI: -0.958 to -0.072), but not with rate of whole brain atrophy. Symptomatic mutation carriers declined fastest on both MMSE and BSI measures, however, this was not influenced by HSV-1. Among asymptomatic mutation carriers, rates of decline on MMSE and BSI were slightly greater among those who were HSV-1 seronegative. Among mutation-negative individuals, no differences were seen by HSV-1. Stratifying by APOE4 status yielded inconsistent results. INTERPRETATION We found no evidence for a major role of HSV-1, measured by serum antibodies, in cognitive decline or whole brain atrophy among individuals at high risk of early-onset AD.
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Affiliation(s)
- Charlotte Warren‐Gash
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Sharon L. Cadogan
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Jennifer M. Nicholas
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Judith M. Breuer
- Institute of Child HealthUniversity College LondonGower StreetLondonWC1E 6BTUnited Kingdom
- Virology DepartmentGreat Ormond Street HospitalLondonUnited Kingdom
| | - Divya Shah
- Virology DepartmentGreat Ormond Street HospitalLondonUnited Kingdom
| | - Neil Pearce
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Suhail Shiekh
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Liam Smeeth
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | | | - Hiroshi Mori
- Department of Clinical NeuroscienceOsaka Metropolitan University Medical School, Sutoku UniversityOsakaJapan
| | - Brian A. Gordon
- Department of RadiologyWashington University School of Medicine in St LouisMissouriUSA
| | - Georg Nuebling
- German Center for Neurodegenerative DiseasesSite MunichGermany
- Department of NeurologyLudwig‐Maximilians UniversityMunichGermany
| | - Eric McDade
- Department of NeurologyWashington University School of MedicineSt. LouisUSA
| | - Randall J. Bateman
- Department of NeurologyWashington University School of MedicineSt. LouisUSA
| | - Peter R. Schofield
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jae‐Hong Lee
- Department of NeurologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
| | - John C. Morris
- Department of NeurologyWashington University School of MedicineSt. LouisUSA
| | - David M. Cash
- UK Dementia Research InstituteUniversity College LondonLondonUnited Kingdom
- Dementia Research Centre, Institute of NeurologyUniversity College LondonQueen SquareLondonUnited Kingdom
| | - Nick C. Fox
- Dementia Research Centre, Institute of NeurologyUniversity College LondonQueen SquareLondonUnited Kingdom
- NIHR University College London Hospitals Biomedical Research CentreLondonUnited Kingdom
| | - Basil H. Ridha
- Dementia Research Centre, Institute of NeurologyUniversity College LondonQueen SquareLondonUnited Kingdom
- NIHR University College London Hospitals Biomedical Research CentreLondonUnited Kingdom
| | - Martin N. Rossor
- Dementia Research Centre, Institute of NeurologyUniversity College LondonQueen SquareLondonUnited Kingdom
- NIHR University College London Hospitals Biomedical Research CentreLondonUnited Kingdom
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13
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New Insights into the Molecular Interplay between Human Herpesviruses and Alzheimer’s Disease—A Narrative Review. Brain Sci 2022; 12:brainsci12081010. [PMID: 36009073 PMCID: PMC9406069 DOI: 10.3390/brainsci12081010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 12/15/2022] Open
Abstract
Human herpesviruses (HHVs) have been implicated as possible risk factors in Alzheimer’s disease (AD) pathogenesis. Persistent lifelong HHVs infections may directly or indirectly contribute to the generation of AD hallmarks: amyloid beta (Aβ) plaques, neurofibrillary tangles composed of hyperphosphorylated tau proteins, and synaptic loss. The present review focuses on summarizing current knowledge on the molecular mechanistic links between HHVs and AD that include processes involved in Aβ accumulation, tau protein hyperphosphorylation, autophagy, oxidative stress, and neuroinflammation. A PubMed search was performed to collect all the available research data regarding the above mentioned mechanistic links between HHVs and AD pathology. The vast majority of research articles referred to the different pathways exploited by Herpes Simplex Virus 1 that could lead to AD pathology, while a few studies highlighted the emerging role of HHV 6, cytomegalovirus, and Epstein–Barr Virus. The elucidation of such potential links may guide the development of novel diagnostics and therapeutics to counter this devastating neurological disorder that until now remains incurable.
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14
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Segerstrom SC, Reed RG, Karr JE. Cytomegalovirus and Toxoplasma Gondii Serostatus Prospectively Correlated With Problems in Self-Regulation but not Executive Function Among Older Adults. Psychosom Med 2022; 84:603-611. [PMID: 35420585 PMCID: PMC9167754 DOI: 10.1097/psy.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cytomegalovirus (CMV) and Toxoplasma gondii are organisms that may infect the brain and have cognitive and behavioral consequences. We hypothesized that these latent infections would be prospectively associated with poorer cognition and more problems in self-regulation among older adults. METHODS Older adults (n = 138, mean age = 75.5 years, 59% women) had CMV and T. gondii serostatus tested, crystallized intelligence estimated (North American Adult Reading Test), and executive function (EF; e.g., Trail Making Test) and self-regulation (Behavior Regulation Inventory of Executive Function-Adult) assessed in visits occurring every 6 months (mean visits = 16). RESULTS CMV+ people (79%) had significantly poorer self-regulation versus CMV- people (21%; behavioral regulation: γ = 0.108, 95% confidence interval [CI] = 0.009-0.206; metacognition: γ = 0.117, 95% CI = 0.005-0.229), but not intelligence or EF. T. gondii+ people (24%) were not significantly different from T. gondii- people (76%) on any outcome. However, T. gondii+ men had better self-regulation versus T. gondii- men, and the opposite was true of women (behavioral regulation interaction: γ = 0.267, 95% CI = 0.093-0.441). CONCLUSIONS CMV latent infection was associated with more problems in self-regulation, and the magnitude of this difference was clinically significant. T. gondii latent infection was associated with more problems, but only for women. Latent infection might associate with self-regulation but not EF because of factors influencing self-regulation but not neuropsychological test performance, such as values and emotion. Efforts to link latent infection with EFs might, in the future, include the application of those functions to self-regulation in daily life.
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15
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Gale SD, Erickson LD, Brown BL, Hedges DW. Cytomegalovirus is not associated with cognitive function in UK adults aged 40 to 70 years. Psychiatry Res 2022; 309:114410. [PMID: 35091160 DOI: 10.1016/j.psychres.2022.114410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 01/15/2022] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Abstract
Infecting much of the world's population, the herpesviridae virus cytomegalovirus has been associated with lower cognitive function in some but not all studies. In this study, we further investigate associations between cytomegalovirus and cognitive function in a community-based sample of adults aged 40 to 70 years (M = 55.3; SD = 8.1) from the United Kingdom. Adjusted multiple-regression modeling showed no significant associations between cytomegalovirus and performance on nine cognitive tasks. Further, in adjusted interaction models, age, sex, educational attainment, and income did not moderate associations between cytomegalovirus and cognitive function. In this community-based adult sample, cytomegalovirus was not associated with cognitive function.
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Affiliation(s)
- Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Center, Brigham Young University, Provo, UT, United States.
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, UT, United States
| | - Bruce L Brown
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, UT, United States; The Neuroscience Center, Brigham Young University, Provo, UT, United States
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16
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Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors. Cancer Causes Control 2021; 33:81-90. [PMID: 34637066 DOI: 10.1007/s10552-021-01504-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia. METHODS Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters. RESULTS CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95% CI [6.1, 56.1]). CONCLUSION The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors.
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Takada N, Nakamura Y, Ikeda K, Takaoka N, Hisaoka-Nakashima K, Sanoh S, Kotake Y, Nakata Y, Morioka N. Treatment with Histone Deacetylase Inhibitor Attenuates Peripheral Inflammation-Induced Cognitive Dysfunction and Microglial Activation: The Effect of SAHA as a Peripheral HDAC Inhibitor. Neurochem Res 2021; 46:2285-2296. [PMID: 34081246 DOI: 10.1007/s11064-021-03367-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/09/2021] [Accepted: 05/28/2021] [Indexed: 12/22/2022]
Abstract
It has been demonstrated that peripheral inflammation induces cognitive dysfunction. Several histone deacetylase (HDAC) inhibitors ameliorate cognitive dysfunction in animal models of not only peripheral inflammation but also Alzheimer's disease. However, it is not clear which HDAC expressed in the central nervous system or peripheral tissues is involved in the therapeutic effect of HDAC inhibition on cognitive dysfunction. Hence, the present study investigated the effect of peripheral HDAC inhibition on peripheral inflammation-induced cognitive dysfunction. Suberoylanilide hydroxamic acid (SAHA), a pan-HDAC inhibitor that is mainly distributed in peripheral tissues after intraperitoneal administration, was found to prevent peripheral inflammation-induced cognitive dysfunction. Moreover, pretreatment with SAHA dramatically increased mRNA expression of interleukin-10, an anti-inflammatory cytokine, in peripheral and central tissues and attenuated peripheral inflammation-induced microglial activation in the CA3 region of the hippocampus. Minocycline, a macrophage/microglia inhibitor, also ameliorated cognitive dysfunction. Furthermore, as a result of treatment with liposomal clodronate, depletion of peripheral macrophages partially ameliorated the peripheral inflammation-evoked cognitive dysfunction. Taken together, these findings demonstrate that inhibition of peripheral HDAC plays a critical role in preventing cognitive dysfunction induced by peripheral inflammation via the regulation of anti-inflammatory cytokine production and the inhibition of microglial functions in the hippocampus. Thus, these findings could provide support for inhibition of peripheral HDAC as a novel therapeutic strategy for inflammation-induced cognitive dysfunction.
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Affiliation(s)
- Naoki Takada
- Department of Pharmacology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Yoki Nakamura
- Department of Pharmacology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan.
| | - Keisuke Ikeda
- Department of Pharmacology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Naoki Takaoka
- Department of Neurochemistry and Environmental Health Sciences, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
- School of Pharmaceutical Sciences, Wakayama Medical University, 25-1 Shichibancho, Wakayama, 640-8156, Japan
| | - Kazue Hisaoka-Nakashima
- Department of Pharmacology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Seigo Sanoh
- Department of Neurochemistry and Environmental Health Sciences, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
- School of Pharmaceutical Sciences, Wakayama Medical University, 25-1 Shichibancho, Wakayama, 640-8156, Japan
| | - Yaichiro Kotake
- Department of Neurochemistry and Environmental Health Sciences, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Yoshihiro Nakata
- Department of Pharmacology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan
| | - Norimitsu Morioka
- Department of Pharmacology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8553, Japan.
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Han SH, Yoo SG, Do Han K, La Y, Kwon DE, Lee KH. The Incidence and Effect of Cytomegalovirus Disease on Mortality in Transplant Recipients and General Population: Real-world Nationwide Cohort Data. Int J Med Sci 2021; 18:3333-3341. [PMID: 34400903 PMCID: PMC8364452 DOI: 10.7150/ijms.62621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background: In addition to the conventional opportunistic infections in solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) recipients, cytomegalovirus (CMV) infection is associated with various chronic inflammatory diseases or poor outcomes in non-immunocompromised critically ill patients. To evaluate the burden or outcome of CMV replication in non-transplant individuals, we compared the incidence rates (IRs) for CMV disease and all-cause mortality between SOT recipients, HSCT recipients, and non-transplant population. Methods: The SOT (N=16,368) and HSCT (N=10,206) cohorts between 2010 and 2015 were established using the WHO ICD-10 from the whole population-based large database of the Health Insurance Review & Assessment Service (HIRA). CMV cases, defined as symptomatic disease with isolation of virus, DNA, pp65 antigen, and pathology except CMV syndrome, were extracted with the unique codes for relief of medical costs of HIRA in the same dataset. Cox's proportional hazard regression analyses and log-rank test in the Kaplan-Meier curves were performed to compare all-cause mortality between the three groups. Results: The CMV IRs adjusted by age and sex were significantly higher in the SOT (adjusted IR [95% confidence intervals], 33.1 [28.8-38.0] per 1,000 person-years) and HSCT recipients (5.1 [4.6-6.1] per 1,000 person-years) than in the whole population (0.58 [0.49-0.67] per 100,000 person-years). However, SOT recipients with CMV (18/283, 6.4%) had significantly lower all-cause mortality than non-transplant individuals with CMV (207/1,258, 16.5%) (adjusted hazard ratio [95% CI], 0.42 [0.25-0.67], log-rank P < 0.001). Conclusion: These data suggest that CMV disease in patients without transplants is associated with poor outcomes.
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Affiliation(s)
- Sang Hoon Han
- Divison of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seul Gi Yoo
- Divison of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Yeonju La
- Divison of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Da Eun Kwon
- Divison of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwa Lee
- Divison of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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