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Sandler CX, Cvejic E, Valencia BM, Li H, Hickie IB, Lloyd AR. Predictors of Chronic Fatigue Syndrome and Mood Disturbance After Acute Infection. Front Neurol 2022; 13:935442. [PMID: 35959390 PMCID: PMC9359311 DOI: 10.3389/fneur.2022.935442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Prospective cohort studies following individuals from acute infections have documented a prevalent post-infective fatigue state meeting diagnostic criteria for chronic fatigue syndrome (CFS) – that is, a post-infective fatigue syndrome (PIFS). The Dubbo Infection Outcomes Study (DIOS) was a prospective cohort following individuals from acute infection with Epstein-Barr virus (EBV), Ross River virus (RRV), or Q fever through to assessment of caseness for CFS designated by physician and psychiatrist assessments at 6 months. Previous studies in DIOS have revealed that functional genetic polymorphisms in both immunological (pro- and anti-inflammatory cytokines) and neurological (the purinergic receptor, P2X7) genes are associated with both the severity of the acute infection and subsequent prolonged illness. Principal components analysis was applied to self-report data from DIOS to describe the severity and course of both the overall illness and concurrent mood disturbance. Associations between demographics and acute infection characteristics, with prolonged illness course as well as the PIFS outcome were examined using multivariable statistics. Genetic haplotype-driven functional variations in the neuropeptide Y (NPY) gene previously shown to be associated with brain responses to stress, and to trait anxiety were also examined as predictors. The sample included 484 subjects (51% female, median age 32, IQR 19–44), of whom 90 (19%) met diagnostic criteria for CFS at 6 months. Participants with greater overall illness severity and concurrent mood disturbance in the acute illness had a more prolonged illness severity (HR = 0.39, 95% CI: 0.34–0.46, p < 0.001) and mood disturbance (HR = 0.36, 95% CI: 0.30–0.42, p < 0.001), respectively. Baseline illness severity and RRV infection were associated with delayed recovery. Female gender and mood disturbance in the acute illness were associated with prolonged mood disturbance. Logistic regression showed that the odds of an individual being diagnosed with PIFS increased with greater baseline illness severity (OR = 2.24, 95% CI: 1.71–2.94, p < 0.001). There was no association between the NPY haplotypes with overall illness severity or mood disturbance either during the acute illness phase or with prolonged illness (p > 0.05). Severe acute infective illnesses predicted prolonged illness, prolonged mood disturbance and PIFS. These factors may facilitate early intervention to manage both PIFS and mood disturbances.
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Affiliation(s)
- Carolina X. Sandler
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
- Sport and Exercise Science, School of Health Science, Western Sydney University, Sydney, NSW, Australia
- Menzies Health Institute Queensland, Griffith University Brisbane, Queensland, QLD, Australia
| | - Erin Cvejic
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW, Australia
| | - Braulio M. Valencia
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
| | - Hui Li
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
| | - Ian B. Hickie
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
| | - Andrew R. Lloyd
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
- *Correspondence: Andrew R. Lloyd
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Li K, Schön M, Naviaux JC, Monk JM, Alchus-Laiferová N, Wang L, Straka I, Matejička P, Valkovič P, Ukropec J, Tarnopolsky MA, Naviaux RK, Ukropcová B. Cerebrospinal fluid and plasma metabolomics of acute endurance exercise. FASEB J 2022; 36:e22408. [PMID: 35713567 DOI: 10.1096/fj.202200509r] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/05/2022] [Accepted: 05/28/2022] [Indexed: 11/11/2022]
Abstract
Metabolomics has emerged as a powerful new tool in precision medicine. No studies have yet been published on the metabolomic changes in cerebrospinal fluid (CSF) produced by acute endurance exercise. CSF and plasma were collected from 19 young active adults (13 males and 6 females) before and 60 min after a 90-min monitored outdoor run. The median age, BMI, and VO2 max of subjects was 25 years (IQR 22-31), 23.2 kg/m2 (IQR 21.7-24.5), and 47 ml/kg/min (IQR 38-51), respectively. Targeted, broad-spectrum metabolomics was performed by liquid chromatography, tandem mass spectrometry (LC-MS/MS). In the CSF, purines and pyrimidines accounted for 32% of the metabolic impact after acute endurance exercise. Branch chain amino acids, amino acid neurotransmitters, fatty acid oxidation, phospholipids, and Krebs cycle metabolites traceable to mitochondrial function accounted for another 52% of the changes. A narrow but important channel of metabolic communication was identified between the brain and body by correlation network analysis. By comparing these results to previous work in experimental animal models, we found that over 80% of the changes in the CSF correlated with a cascade of mitochondrial and metabolic changes produced by ATP signaling. ATP is released as a co-neurotransmitter and neuromodulator at every synapse studied to date. By regulating brain mitochondrial function, ATP release was identified as an early step in the kinetic cascade of layered benefits produced by endurance exercise.
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Affiliation(s)
- Kefeng Li
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, California, USA.,Department of Medicine, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Martin Schön
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jane C Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, California, USA.,Department of Neurosciences, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Jonathan M Monk
- Department of Bioengineering, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Nikoleta Alchus-Laiferová
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lin Wang
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, California, USA.,Department of Medicine, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Igor Straka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Matejička
- 2nd Department of Neurology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Valkovič
- 2nd Department of Neurology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia.,Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jozef Ukropec
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Mark A Tarnopolsky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Robert K Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, California, USA.,Department of Medicine, University of California, San Diego School of Medicine, San Diego, California, USA.,Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California, USA.,Department of Pathology, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Barbara Ukropcová
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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Gonçalves MCB, Andrejew R, Gubert C. The Purinergic System as a Target for the Development of Treatments for Bipolar Disorder. CNS Drugs 2022; 36:787-801. [PMID: 35829960 PMCID: PMC9345801 DOI: 10.1007/s40263-022-00934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/27/2022]
Abstract
The neurobiological and neurochemical mechanisms underlying the pathophysiology of bipolar disorder are complex and not yet fully understood. From circadian disruption to neuroinflammation, many pathways and signaling molecules are important contributors to bipolar disorder development, some specific to a disease subtype or a cycling episode. Pharmacological agents for bipolar disorder have shown only partial efficacy, including mood stabilizers and antipsychotics. The purinergic hypothesis for bipolar disorder emerges in this scenario as a promising target for further research and drug development, given its role in neurotransmission and neuroinflammation that results in behavioral and mood regulation. Here, we review the basic concepts of purinergic signaling in the central nervous system and its contribution to bipolar disorder pathophysiology. Allopurinol and novel P2X7 receptor antagonists are promising candidates for treating bipolar disorder. We further explore currently available pharmacotherapies and the emerging new purinergic targets for drug development in bipolar disorder.
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Affiliation(s)
| | - Roberta Andrejew
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | - Carolina Gubert
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, 30 Royal Parade, Parkville, VIC, 3032, Australia.
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Zolkipli-Cunningham Z, Naviaux JC, Nakayama T, Hirsch CM, Monk JM, Li K, Wang L, Le TP, Meinardi S, Blake DR, Naviaux RK. Metabolic and behavioral features of acute hyperpurinergia and the maternal immune activation mouse model of autism spectrum disorder. PLoS One 2021; 16:e0248771. [PMID: 33735311 PMCID: PMC7971557 DOI: 10.1371/journal.pone.0248771] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/05/2021] [Indexed: 12/11/2022] Open
Abstract
Since 2012, studies in mice, rats, and humans have suggested that abnormalities in purinergic signaling may be a final common pathway for many genetic and environmental causes of autism spectrum disorder (ASD). The current study in mice was conducted to characterize the bioenergetic, metabolomic, breathomic, and behavioral features of acute hyperpurinergia triggered by systemic injection of the purinergic agonist and danger signal, extracellular ATP (eATP). Responses were studied in C57BL/6J mice in the maternal immune activation (MIA) model and controls. Basal metabolic rates and locomotor activity were measured in CLAMS cages. Plasma metabolomics measured 401 metabolites. Breathomics measured 98 volatile organic compounds. Intraperitoneal eATP dropped basal metabolic rate measured by whole body oxygen consumption by 74% ± 6% (mean ± SEM) and rectal temperature by 6.2˚ ± 0.3˚C in 30 minutes. Over 200 metabolites from 37 different biochemical pathways where changed. Breathomics showed an increase in exhaled carbon monoxide, dimethylsulfide, and isoprene. Metabolomics revealed an acute increase in lactate, citrate, purines, urea, dopamine, eicosanoids, microbiome metabolites, oxidized glutathione, thiamine, niacinamide, and pyridoxic acid, and decreased folate-methylation-1-carbon intermediates, amino acids, short and medium chain acyl-carnitines, phospholipids, ceramides, sphingomyelins, cholesterol, bile acids, and vitamin D similar to some children with ASD. MIA animals were hypersensitive to postnatal exposure to eATP or poly(IC), which produced a rebound increase in body temperature that lasted several weeks before returning to baseline. Acute hyperpurinergia produced metabolic and behavioral changes in mice. The behaviors and metabolic changes produced by ATP injection were associated with mitochondrial functional changes that were profound but reversible.
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Affiliation(s)
- Zarazuela Zolkipli-Cunningham
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Neurosciences, University of California, San Diego School of Medicine, San Diego, CA, United States of America
| | - Jane C. Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Neurosciences, University of California, San Diego School of Medicine, San Diego, CA, United States of America
| | - Tomohiro Nakayama
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Neurosciences, University of California, San Diego School of Medicine, San Diego, CA, United States of America
| | - Charlotte M. Hirsch
- Department of Chemistry, University of California, Irvine (UCI), Irvine, CA, United States of America
| | - Jonathan M. Monk
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, United States of America
| | - Kefeng Li
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, United States of America
| | - Lin Wang
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, United States of America
| | - Thuy P. Le
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Neurosciences, University of California, San Diego School of Medicine, San Diego, CA, United States of America
| | - Simone Meinardi
- Department of Chemistry, University of California, Irvine (UCI), Irvine, CA, United States of America
| | - Donald R. Blake
- Department of Chemistry, University of California, Irvine (UCI), Irvine, CA, United States of America
| | - Robert K. Naviaux
- The Mitochondrial and Metabolic Disease Center, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, CA, United States of America
- Department of Pathology, University of California, San Diego School of Medicine, San Diego, CA, United States of America
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