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Alawad A, Sati W, Ahmed SMI, Elgassim M, Elgassim M, Balal A. Melatonin-induced symptomatic bradycardia in an otherwise healthy male: a case report. Oxf Med Case Reports 2024; 2024:omae096. [PMID: 39193480 PMCID: PMC11348002 DOI: 10.1093/omcr/omae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 04/17/2024] [Accepted: 07/03/2024] [Indexed: 08/29/2024] Open
Abstract
Melatonin, a pineal gland hormone closely associated with the circadian rhythm, has been trending over the past years as an over-the-counter medication to aid with sleep disturbances. Although generally believed to be safe, recent studies show negative inotropic and chronotropic effects on the heart rate and blood pressure in humans. Several studies suggested that melatonin induces cardiac vagal tone and affects heart rate and mean arterial pressure. Limited literature is currently available on the effects of melatonin beyond its sleep function. We present a case of a healthy 22-year-old male who visited the emergency department reporting palpitations and dizziness following the ingestion of 20 mg of melatonin. Subsequent examinations revealed marked bradycardia. Fortunately, the patient experienced spontaneous resolution of the bradycardia without necessitating intervention after a few hours of observation, and he was observed and discharged.
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Affiliation(s)
- Asim Alawad
- Emergency Medicine Department, Hamad General Hospital, P.O. Box: 3050, Doha, Qatar
| | - Wala Sati
- Emergency Medicine Department, Hamad General Hospital, P.O. Box: 3050, Doha, Qatar
| | - Sara M I Ahmed
- Emergency Medicine Department, Hamad General Hospital, P.O. Box: 3050, Doha, Qatar
| | - Moayed Elgassim
- Emergency Medicine Department, Hamad General Hospital, P.O. Box: 3050, Doha, Qatar
| | - Mohamad Elgassim
- Emergency Medicine Department, Hamad General Hospital, P.O. Box: 3050, Doha, Qatar
| | - Abderahman Balal
- Emergency Medicine Department, Hamad General Hospital, P.O. Box: 3050, Doha, Qatar
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2
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Saelzler UG, Verhaeghen P, Panizzon MS, Moffat SD. Intact circadian rhythm despite cortisol hypersecretion in Alzheimer's disease: A meta-analysis. Psychoneuroendocrinology 2021; 132:105367. [PMID: 34340133 DOI: 10.1016/j.psyneuen.2021.105367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 12/26/2022]
Abstract
Hypersecretion of the glucocorticoid steroid hormone cortisol by individuals with Alzheimer's disease (AD) has been suspected for several decades, during which time dozens of examinations of this phenomenon have been conducted and published. The goals of this investigation were to summarize this sizeable body of literature, test whether participant and methodological characteristics modify the magnitude of the AD-associated basal cortisol hypersecretion, and examine whether cortisol circadian rhythmicity is maintained among individuals with AD. To this end, the present meta-analysis and systematic review examined over 300 comparisons of indices of basal HPA-axis functioning between individuals with AD and cognitively normal older adults. AD was associated with basal cortisol elevations (g = 0.45) but the magnitude of the effect was not systematically impacted by any of the participant characteristics considered or the time-of-day of the cortisol sampling. Further, there was no evidence of group differences among direct indices of circadian rhythmicity such as the cortisol awakening response or the diurnal cortisol slope. These results suggest that basal hypersecretion of cortisol, but not circadian dysrhythmia, is characteristic of individuals with AD. Mechanistically, the observed hypersecretion is consistent with the theorized AD-driven deterioration of the hippocampus and subsequent reduction in hypothalamic-pituitary-adrenal axis inhibition. Further investigation is warranted to elucidate the role and timing of cortisol elevations in the progression of AD.
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Affiliation(s)
- Ursula G Saelzler
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA.
| | - Paul Verhaeghen
- Department of Psychology, Georgia Institute of Technology, 648 Cherry St. NW, Atlanta GA 30313, USA.
| | - Matthew S Panizzon
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA.
| | - Scott D Moffat
- Department of Psychology, Georgia Institute of Technology, 648 Cherry St. NW, Atlanta GA 30313, USA.
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3
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Nous A, Wittens MMJ, Vermeiren Y, De Deyn PP, Van Broeckhoven C, Nagels G, Smolders I, Engelborghs S. Serum Daytime Melatonin Levels Reflect Cerebrospinal Fluid Melatonin Levels in Alzheimer's Disease but Are Not Correlated with Cognitive Decline. J Alzheimers Dis 2021; 83:693-704. [PMID: 34366353 PMCID: PMC8543270 DOI: 10.3233/jad-210562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Nocturnal cerebrospinal fluid (CSF) and blood melatonin levels are altered in Alzheimer’s disease (AD). However, literature remains inconclusive on daytime blood melatonin levels. A positive correlation between melatonin levels and Mini-Mental State Examination (MMSE) scores in AD subjects has been evidenced following cross-sectional analyses. Whereas a correlation between serum and spinal CSF melatonin has been shown in healthy volunteers, an equal investigation in AD patients still has to be undertaken. Objective: 1) To evaluate whether serum melatonin levels correlate with spinal CSF melatonin levels in AD. 2) To compare daytime CSF and serum melatonin levels between patients with AD dementia, mild cognitive impairment due to AD, and healthy controls, and to evaluate whether melatonin can affect cognitive decline in AD. Methods: Subjects with AD and healthy controls included in two existing cohorts, of whom a CSF and serum sample was available at the neurobiobank and had at least 6 months of neuropsychological follow-up, were included in the present study. Melatonin concentrations were measured with liquid chromatography-mass spectrometry. Results: Daytime serum melatonin levels correlated with spinal CSF melatonin levels in AD (r = 0.751, p < 0.001). No significant differences regarding daytime melatonin levels were found between patients and controls. No correlations were observed between daytime melatonin levels and MMSE score changes. Conclusion: Daytime serum melatonin accurately reflects CSF melatonin levels in AD, raising the possibility to assess melatonin alterations by solely performing blood sampling if also confirmed for night-time values. However, daytime melatonin levels are not associated with changes of cognitive impairment.
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Affiliation(s)
- Amber Nous
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Mandy Melissa Jane Wittens
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Yannick Vermeiren
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Medicine & Health Sciences, Translational Neurosciences, University of Antwerp, Antwerp, Belgium.,Division of Human Nutrition and Health, Chair Group of Nutritional Biology, Wageningen University and Research, Wageningen, Netherlands
| | - Peter Paul De Deyn
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Christine Van Broeckhoven
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,Neurodegenerative Brain Diseases, VIB Center for Molecular Neurology, Antwerp Belgium
| | - Guy Nagels
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ilse Smolders
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sebastiaan Engelborghs
- Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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4
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Nous A, Engelborghs S, Smolders I. Melatonin levels in the Alzheimer's disease continuum: a systematic review. ALZHEIMERS RESEARCH & THERAPY 2021; 13:52. [PMID: 33622399 PMCID: PMC7903801 DOI: 10.1186/s13195-021-00788-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
Background The search for new Alzheimer’s disease (AD) cerebrospinal fluid (CSF) and blood biomarkers with potential pathophysiological and clinical relevance continues, as new biomarkers might lead to improved early and differential diagnosis, monitoring of disease progression and might even identify new druggable targets. Melatonin might be an interesting biomarker as an inverse correlation between CSF melatonin levels, and severity of the neuropathology as measured by Braak stages has been described. Melatonin can be measured in different body fluids, such as CSF, blood, saliva and urine. Objectives The aim of this systematic review was to review all available studies regarding melatonin levels in different body fluids in the AD continuum and give an extensive overview of reported outcomes. Methods We included papers comparing melatonin levels between healthy controls and human patients belonging to the AD continuum. A systematic search of PubMed and Web of Science led to inclusion of 20 full-length English papers following exclusion of duplicates. Results This systematic literature search showed that disruptions in melatonin levels occur with age, but also in AD when compared to age-matched controls. Night-time melatonin levels were found to be lower in CSF and blood of AD patients as compared to controls. Literature was not conclusive regarding alterations in blood daytime melatonin levels or regarding saliva melatonin in AD patients. Decreased total and night-time melatonin production has been described in urine of AD patients. Conclusion Our systematic review shows evidence for disruptions in (night-time) melatonin levels in AD as compared to age-matched controls. Although more studies are needed to understand the contribution of disruption of the melatonergic system to the pathophysiology of AD, the potential anti-AD effects that have been attributed to melatonin, renders research on this topic relevant for the discovery of potential future treatment effects of melatonin for AD. The use of melatonin as potential blood biomarker for disease progression should also be further investigated.
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Affiliation(s)
- Amber Nous
- Research group Experimental Pharmacology (EFAR), Department of Pharmaceutical Chemistry, Drug Analysis and Drug Information (FASC), Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Neurology, UZ Brussel, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Department of Neurology, UZ Brussel, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. .,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.
| | - Ilse Smolders
- Research group Experimental Pharmacology (EFAR), Department of Pharmaceutical Chemistry, Drug Analysis and Drug Information (FASC), Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
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5
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Ramírez-Rodríguez GB, Olvera-Hernández S, Vega-Rivera NM, Ortiz-López L. Melatonin Influences Structural Plasticity in the Axons of Granule Cells in the Dentate Gyrus of Balb/C Mice. Int J Mol Sci 2018; 20:ijms20010073. [PMID: 30585191 PMCID: PMC6337618 DOI: 10.3390/ijms20010073] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 02/07/2023] Open
Abstract
Melatonin, the main product synthesized by the pineal gland, acts as a regulator of the generation of new neurons in the dentate gyrus (DG). Newborn neurons buffer the deleterious effects of stress and are involved in learning and memory processes. Furthermore, melatonin, through the regulation of the cytoskeleton, favors dendrite maturation of newborn neurons. Moreover, newborn neurons send their axons via the mossy fiber tract to Cornu Ammonis 3 (CA3) region to form synapses with pyramidal neurons. Thus, axons of newborn cells contribute to the mossy fiber projection and their plasticity correlates with better performance in several behavioral tasks. Thus, in this study, we analyzed the impact of exogenous melatonin (8 mg/kg) administered daily for one- or six-months on the structural plasticity of infrapyramidal- and suprapyramidal mossy fiber projection of granule cells in the DG in male Balb/C mice. We analyzed the mossy fiber projection through the staining of calbindin, that is a calcium-binding protein localized in dendrites and axons. We first found an increase in the number of calbindin-positive cells in the granular cell layer in the DG (11%, 33%) after treatment. Futhermore, we found an increase in the volume of suprapyramidal (>135%, 59%) and infrapyramidal (>128%, 36%) mossy fiber projection of granule neurons in the DG after treatment. We also found an increase in the volume of CA3 region (>146%, 33%) after treatment, suggesting that melatonin modulates the structural plasticity of the mossy fiber projection to establish functional synapses in the hippocampus. Together, the data suggest that, in addition to the previously reported effects of melatonin on the generation of new neurons and its antidepressant like effects, melatonin also modulates the structural plasticity of axons in granule cells in the DG.
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Affiliation(s)
- Gerardo Bernabé Ramírez-Rodríguez
- Laboratorio de Neurogenesis, Subidrección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, México City C.P. 14370, México.
| | - Sandra Olvera-Hernández
- Laboratorio de Neurogenesis, Subidrección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, México City C.P. 14370, México.
| | - Nelly Maritza Vega-Rivera
- Laboratorio de Neuropsicofarmacología, Dirección de Neurociencias, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, México City C.P. 14370, México.
| | - Leonardo Ortiz-López
- Laboratorio de Neurogenesis, Subidrección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Tlalpan, México City C.P. 14370, México.
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6
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Woods DL, Buckwalter K. Taking Another Look: Thoughts on Behavioral Symptoms in Dementia and Their Measurement. Healthcare (Basel) 2018; 6:healthcare6040126. [PMID: 30360369 PMCID: PMC6316419 DOI: 10.3390/healthcare6040126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022] Open
Abstract
This article proposes taking another look at behavioral symptoms of dementia (BSDs) both from a theoretical perspective that informs research and practice and from a measurement perspective. We discuss why this rethinking of behaviors impacts current models of care and our ability to better detect outcomes from interventions. We propose that BSDs be viewed from a pattern perspective and provide some suggestions for how to identify and measure these patterns that can influence the timing and type of intervention. Evidence suggests that BSDs are complex, sequential, patterned clusters of behavior recurring repeatedly in the same individual and escalate significantly without timely intervention. However, BSDs are frequently viewed as separate behaviors rather than patterns or clusters of behaviors, a view that affects current research questions as well as the choice, timing, and outcomes of interventions. These symptoms cause immense distress to persons with the disease and their caregivers, trigger hospitalizations and nursing home placement, and are associated with increased care costs. Despite their universality and that symptoms manifest across disease etiologies and stages, behaviors tend to be underrecognized, undertreated, and overmanaged by pharmacological treatments that may pose more harm than benefit.
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Affiliation(s)
- Diana Lynn Woods
- School of Nursing, Azusa Pacific University, Azusa, CA 91702, USA.
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7
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Chiappelli F, Khakshooy A. Individual Patient Research (IPR) Outcomes with Alzheimer's Disease: The Psycho-neuro-immune Viewpoint. Bioinformation 2016; 12:263-265. [PMID: 28246459 PMCID: PMC5295040 DOI: 10.6026/97320630012263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 01/22/2023] Open
Abstract
Traditional research in the health sciences has involved control and experimental groups of patients, and descriptive and inferential statistical analyses performed on the measurements obtained from the samples in each group. As the novel model of translational healthcare, which integrates translational research and translational effectiveness, becomes increasingly established in modern contemporary medicine, healthcare continues to evolve into a model of care that is evidence-based, effectiveness-focused and patientcentered. Patient-centered care requires the timely and critical development and validation of a new research paradigm, which is referred to as "individual patient research (IPR)", as opposed as the customary group research approach. That is to say, research in geriatric disease conditions, such as Alzheimer's Disease (AD) must be performed from the viewpoint of individual patient research outcomes, and individual patient data analysis. Here, we discuss IPR in patients with AD in the context of the best available research evidence that indicates psychological symptoms, endocrine deregulation, and immune alterations in AD. We propose a clinical adaptive cluster randomized stepped wedge blinded controlled trial, with sequential with sequential roll-out of an evidence-based intervention in a crossover paradigm.
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Affiliation(s)
- Francesco Chiappelli
- Oral Biology & Medicine, Center for the Health Sciences UCLA
- Health Sciences, California State University, Northridge
- Evidence-Based Decisions Practice-Based Research Network (EBD-PBRN.org)
| | - Allen Khakshooy
- Oral Biology & Medicine, Center for the Health Sciences UCLA
- Health Sciences, California State University, Northridge
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8
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Paul R, Borah A. The potential physiological crosstalk and interrelationship between two sovereign endogenous amines, melatonin and homocysteine. Life Sci 2015; 139:97-107. [PMID: 26281918 DOI: 10.1016/j.lfs.2015.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/07/2015] [Accepted: 07/31/2015] [Indexed: 12/13/2022]
Abstract
The antioxidant melatonin and the non-proteinogenic excitotoxic amino acid homocysteine (Hcy) are very distinct but related reciprocally to each other in their mode of action. The elevated Hcy level has been implicated in several disease pathologies ranging from cardio- and cerebro-vascular diseases to neurodegeneration owing largely to its free radical generating potency. Interestingly, melatonin administration potentially normalizes the elevated Hcy level, thereby protecting the cells from the undesired Hcy-induced excitotoxicity and cell death. However, the exact mechanism and between them remain obscure. Through literature survey we have found an indistinct but a vital link between melatonin and Hcy i.e., the existence of reciprocal regulation between them, and this aspect has been thoroughly described herein. In this review, we focus on all the possibilities of co-regulation of melatonin and Hcy at the level of their production and metabolism both in basal and in pathological conditions, and appraised the potential of melatonin in ameliorating homocysteinemia-induced cellular stresses. Also, we have summarized the differential mode of action of melatonin and Hcy on health and disease states.
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Affiliation(s)
- Rajib Paul
- Cellular and Molecular Neurobiology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, Assam, India
| | - Anupom Borah
- Cellular and Molecular Neurobiology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, Assam, India.
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9
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Ramírez-Rodríguez G, Gómez-Sánchez A, Ortíz-López L. Melatonin maintains calcium-binding calretinin-positive neurons in the dentate gyrus during aging of Balb/C mice. Exp Gerontol 2014; 60:147-52. [PMID: 25446980 DOI: 10.1016/j.exger.2014.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/15/2014] [Accepted: 10/28/2014] [Indexed: 02/07/2023]
Abstract
Melatonin, the main product synthesized by the pineal gland, modulates several brain functions through different mechanisms, some of them involving the activation or participation of calcium binding intracellular proteins, such as the alpha calcium dependent protein kinase C and calmodulin. Another calcium-binding protein is calretinin, which exerts an essential role for adult hippocampal neurogenesis. Melatonin favors calretinin-positive neurons in the dentate gyrus (DG) of young mice but hippocampal neurogenesis and plasma levels of melatonin decrease during aging. Thus, in this study, we analyzed the impact of exogenous supplementation with melatonin in calretinin-neurons and their distribution along the dorsal-ventral DG in the hippocampus at three different time points (1, 3, or 6 months) after daily treatment with melatonin (8 mg/kg) in male Balb/C mice. We found an increase in the number of calretinin-positive neurons in the DG after treatment (>66%). Although a significant decline in the number of calretinin-neurons was found in both treated (~60.46-69.56%) and untreated mice (~68.81-70.34%) with respect to the youngest mice analyzed, melatonin still maintained higher number of cells in the DG. Also, the distribution of calretinin-neurons along the dorsal-ventral DG significantly showed more cells in the ventral-DG of mice treated with melatonin. Together, the data suggest that melatonin also acts on calretinin in the DG, supporting it as a molecule connecting calcium signaling and neuronal development.
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Affiliation(s)
- Gerardo Ramírez-Rodríguez
- Laboratory of Neurogenesis, Division of Clinical Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Calz. México-Xochimilco 101, 14370 México, D.F., Mexico.
| | - Ariadna Gómez-Sánchez
- Laboratory of Neurogenesis, Division of Clinical Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Calz. México-Xochimilco 101, 14370 México, D.F., Mexico
| | - Leonardo Ortíz-López
- Laboratory of Neurogenesis, Division of Clinical Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Calz. México-Xochimilco 101, 14370 México, D.F., Mexico
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10
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Mathews SB, Arnold SE, Epperson CN. Hospitalization and cognitive decline: Can the nature of the relationship be deciphered? Am J Geriatr Psychiatry 2014; 22:465-80. [PMID: 23567430 PMCID: PMC4080837 DOI: 10.1016/j.jagp.2012.08.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/09/2012] [Accepted: 08/29/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Evidence for a relationship between hospitalization and incident cognitive decline exists mainly in the literature focusing on critical care hospitalization. Recent studies, however, have also found an association between noncritical care hospitalization and the development of cognitive decline. OBJECTIVE This article will review the literature pertaining to hospitalization and cognitive decline, including hospitalizations for both critical and noncritical care, and in medical and surgical patients. The article will also explore the various factors that have been implicated in the development of cognitive decline and dementia. METHODS Review of the literature was completed using PubMed and Medline search programs. RESULTS Several articles supporting evidence for the association between hospitalization and cognitive decline are available. Evidence for potential mediating factors also does exist. CONCLUSIONS There is evidence to support an association between hospitalization and development of cognitive decline. Factors that could mediate this association include, but may not be limited to, delirium, medications, stress, and depression. There is a need for further research in this area in order to better understand the underlying pathophysiology involved in the development of cognitive decline and dementia and to determine if preventive measures might be beneficial in decreasing risk for cognitive decline for patients who are hospitalized.
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Affiliation(s)
- Sarah B Mathews
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA; Penn Center for Women's Behavioral Wellness, University of Pennsylvania, Philadelphia, PA.
| | - Steven E Arnold
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - C Neill Epperson
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA; Penn Center for Women's Behavioral Wellness, University of Pennsylvania, Philadelphia, PA; Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA
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11
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Hardeland R. Chronobiology of Melatonin beyond the Feedback to the Suprachiasmatic Nucleus-Consequences to Melatonin Dysfunction. Int J Mol Sci 2013; 14:5817-41. [PMID: 23481642 PMCID: PMC3634486 DOI: 10.3390/ijms14035817] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 12/28/2022] Open
Abstract
The mammalian circadian system is composed of numerous oscillators, which gradually differ with regard to their dependence on the pacemaker, the suprachiasmatic nucleus (SCN). Actions of melatonin on extra-SCN oscillators represent an emerging field. Melatonin receptors are widely expressed in numerous peripheral and central nervous tissues. Therefore, the circadian rhythm of circulating, pineal-derived melatonin can have profound consequences for the temporal organization of almost all organs, without necessarily involving the melatonin feedback to the suprachiasmatic nucleus. Experiments with melatonin-deficient mouse strains, pinealectomized animals and melatonin receptor knockouts, as well as phase-shifting experiments with explants, reveal a chronobiological role of melatonin in various tissues. In addition to directly steering melatonin-regulated gene expression, the pineal hormone is required for the rhythmic expression of circadian oscillator genes in peripheral organs and to enhance the coupling of parallel oscillators within the same tissue. It exerts additional effects by modulating the secretion of other hormones. The importance of melatonin for numerous organs is underlined by the association of various diseases with gene polymorphisms concerning melatonin receptors and the melatonin biosynthetic pathway. The possibilities and limits of melatonergic treatment are discussed with regard to reductions of melatonin during aging and in various diseases.
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Affiliation(s)
- Rüdiger Hardeland
- Johann Friedrich Blumenbach Institute of Zoology and Anthropology, University of Göttingen, Berliner Str. 28, Göttingen D-37073, Germany.
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12
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Melatonin Antioxidative Defense: Therapeutical Implications for Aging and Neurodegenerative Processes. Neurotox Res 2012; 23:267-300. [DOI: 10.1007/s12640-012-9337-4] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/12/2012] [Accepted: 06/13/2012] [Indexed: 12/12/2022]
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13
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Hardeland R. Neurobiology, pathophysiology, and treatment of melatonin deficiency and dysfunction. ScientificWorldJournal 2012; 2012:640389. [PMID: 22629173 PMCID: PMC3354573 DOI: 10.1100/2012/640389] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/05/2012] [Indexed: 12/13/2022] Open
Abstract
Melatonin is a highly pleiotropic signaling molecule, which is released as a hormone of the pineal gland predominantly during night. Melatonin secretion decreases during aging. Reduced melatonin levels are also observed in various diseases, such as types of dementia, some mood disorders, severe pain, cancer, and diabetes type 2. Melatonin dysfunction is frequently related to deviations in amplitudes, phasing, and coupling of circadian rhythms. Gene polymorphisms of melatonin receptors and circadian oscillator proteins bear risks for several of the diseases mentioned. A common symptom of insufficient melatonin signaling is sleep disturbances. It is necessary to distinguish between symptoms that are curable by short melatonergic actions and others that require extended actions during night. Melatonin immediate release is already effective, at moderate doses, for reducing difficulties of falling asleep or improving symptoms associated with poorly coupled circadian rhythms, including seasonal affective and bipolar disorders. For purposes of a replacement therapy based on longer-lasting melatonergic actions, melatonin prolonged release and synthetic agonists have been developed. Therapies with melatonin or synthetic melatonergic drugs have to consider that these agents do not only act on the SCN, but also on numerous organs and cells in which melatonin receptors are also expressed.
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Affiliation(s)
- Rüdiger Hardeland
- Johann Friedrich Blumenbach Institute of Zoology and Anthropology, Georg August University, 37073 Göttingen, Germany.
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Mondelli V, Pariante CM, Navari S, Aas M, D'Albenzio A, Di Forti M, Handley R, Hepgul N, Reis Marques T, Taylor H, Papadopoulos AS, Aitchison KJ, Murray RM, Dazzan P. Higher cortisol levels are associated with smaller left hippocampal volume in first-episode psychosis. Schizophr Res 2010; 119:75-8. [PMID: 20071148 PMCID: PMC3513409 DOI: 10.1016/j.schres.2009.12.021] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 12/17/2009] [Accepted: 12/19/2009] [Indexed: 11/28/2022]
Abstract
This study investigated the relationship between cortisol secretion and hippocampal volume in first-episode psychosis and healthy controls. Hippocampal volume was measured by magnetic resonance imaging (MRI) in 24 first-episode psychosis patients and in 18 healthy controls, together with diurnal cortisol levels. Twelve patients received a second MRI scan at 3-month follow-up. Diurnal cortisol levels were inversely correlated with left hippocampal volume in patients, both at baseline and at follow-up, while no correlation was found in controls. Our findings suggest that smaller hippocampal volume in first-episode psychosis can partly be explained by stress-related processes in the brain, as measured by cortisol hyper-secretion.
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Affiliation(s)
- Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
| | - Carmine M. Pariante
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Serena Navari
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Monica Aas
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Alessandro D'Albenzio
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Marta Di Forti
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Rowena Handley
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Nilay Hepgul
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Tiago Reis Marques
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Heather Taylor
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Andrew S. Papadopoulos
- Section of Neurobiology of Mood Disorders, Institute of Psychiatry, King's College London, London, UK, Affective Disorders Laboratory, National Affective Disorders Unit, Bethlem Royal Hospital, Kent, UK
| | - Katherine J. Aitchison
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Robin M. Murray
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
| | - Paola Dazzan
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
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15
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Xu J, Lecanu L, Tan M, Greeson J, Papadopoulos V. Identification of a benzamide derivative that inhibits stress-induced adrenal corticosteroid synthesis. Molecules 2009; 14:3392-410. [PMID: 19783933 PMCID: PMC6254727 DOI: 10.3390/molecules14093392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 08/14/2009] [Accepted: 09/01/2009] [Indexed: 11/30/2022] Open
Abstract
Elevated serum glucocorticoid levels contribute to the progression of many diseases, including depression, Alzheimer’s disease, hypertension, and acquired immunodeficiency syndrome. Here we show that the benzamide derivative N-[2-(4-cyclopropanecarbonyl-3-methyl-piperazin-1-yl)-1-(tert-butyl-1H-indol-3-yl-methyl)-2-oxo-ethyl]-4-nitrobenzamide (SP-10) inhibits dibutyryl cyclic AMP (dbcAMP)-induced corticosteroid synthesis in a dose-dependent manner in Y-1 adrenal cortical mouse tumor cells, without affecting basal steroid synthesis and reduced stress-induced corticosterone increases in rats without affecting the physiological levels of the steroid in blood. SP-10 did not affect cholesterol transport and metabolism by the mitochondria but was unexpectedly found to increase 3-hydroxy-3-methylglutaryl-coenzyme A, low density lipoprotein receptor, and scavenger receptor class B type I (SR-BI) expression. However, it also markedly reduced dbcAMP-induced NBD-cholesterol uptake, suggesting that this is a compensatory mechanism aimed at maintaining cholesterol levels. SP-10 also induced a redistribution of filamentous (F-) and monomeric (G-) actin, leading to decreased actin levels in the submembrane cytoskeleton suggesting that SP-10-induced changes in actin distribution might prevent the formation of microvilli– cellular structures required for SR-BI-mediated cholesterol uptake in adrenal cells.
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Affiliation(s)
- Jing Xu
- Department of Biochemistry & Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC 20057, USA; E-mails: (J.X.); (M.T.)
| | - Laurent Lecanu
- Department of Biochemistry & Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC 20057, USA; E-mails: (J.X.); (M.T.)
- The Research Institute of the McGill University Health Centre, Montreal, Quebec, H3G 1A4, Canada; E-mail: (L.L.)
- Department of Medicine, McGill University, Montreal, Quebec, H3G 1A4, Canada
| | - Matthew Tan
- Department of Biochemistry & Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC 20057, USA; E-mails: (J.X.); (M.T.)
| | - Janet Greeson
- Samaritan Pharmaceuticals, Las Vegas, NV 89109, USA; E-mail: (J.G.)
| | - Vassilios Papadopoulos
- Department of Biochemistry & Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC 20057, USA; E-mails: (J.X.); (M.T.)
- The Research Institute of the McGill University Health Centre, Montreal, Quebec, H3G 1A4, Canada; E-mail: (L.L.)
- Department of Medicine, McGill University, Montreal, Quebec, H3G 1A4, Canada
- Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, H3G 1A4, Canada
- Author to whom correspondence should be addressed; E-mail: ; Tel.: +514 934 1934 ext. 44580; Fax: +514 934 8439
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Walker E, Mittal V, Tessner K. Stress and the hypothalamic pituitary adrenal axis in the developmental course of schizophrenia. Annu Rev Clin Psychol 2008; 4:189-216. [PMID: 18370616 DOI: 10.1146/annurev.clinpsy.4.022007.141248] [Citation(s) in RCA: 431] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Diathesis-stress models of schizophrenia and other psychotic disorders have dominated theorizing about etiology for over three decades. More recently, with advances in our understanding of the biological processes mediating the effects of stress, these models have incorporated mechanisms to account for the adverse impact of stress on brain function. This review examines recent scientific findings on the role of the hypothalamic-pituitary-adrenal (HPA) axis, one of the primary neural systems triggered by stress exposure, in the expression of vulnerability for schizophrenia. The results indicate that psychotic disorders are associated with elevated baseline and challenge-induced HPA activity, that antipsychotic medications reduce HPA activation, and that agents that augment stress hormone (cortisol) release exacerbate psychotic symptoms. The cumulative findings are discussed in light of a neural diathesis-stress model that postulates that cortisol has the potential to increase activity of dopamine pathways that have been implicated in schizophrenia and other psychotic disorders.
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Affiliation(s)
- Elaine Walker
- Department of Psychology, Emory University, Atlanta, Georgia 30322, USA.
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17
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Helmreich DL, Parfitt DB, Walton JR, Richards LM. Dexamethasone and stressor-magnitude regulation of stress-induced transcription of HPA axis secretagogues in the rat. Stress 2008; 11:302-11. [PMID: 18574790 DOI: 10.1080/10253890701794767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Regulation of the production of hypothalamic-pituitary-adrenal (HPA) axis secretagogues, corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP), may be differentially sensitive to the negative feedback effects of glucocorticoids. We chose to study this phenomenon by examining the ability of dexamethasone to influence CRH and AVP heteronuclear RNA (hnRNA) levels in an escapable/inescapable (ES/IS) foot-shock stress paradigm. On Day 1, adult male rats were subjected to either ES or IS foot-shock; on Day 2, saline or dexamethasone (100 microg/kg) was administered 2 h prior to the stressor. We found that ES/IS foot-shock stimulated similar robust increases in plasma adrenocorticotrophic hormone (ACTH) and corticosterone concentrations, and medial parvocellular division of the paraventricular nucleus (mpPVN) AVP and CRH hnRNA and c-fos mRNA levels in saline-treated ES/IS rats. Dexamethasone pretreatment suppressed ACTH and corticosterone levels similarly in IS and ES animals. Dexamethasone pretreatment also suppressed mpPVN CRH and AVP hnRNA levels at 30 min. However, by 120 min, the mpPVN AVP hnRNA levels in dexamethasone-treated rats were similar to those measured in the saline group. We also found that rats that received the most shocks on Day 1 had greater HPA axis activation on Day 2. We conclude that the magnitude of the foot-shock stressor, determined by learned and immediate cues, is important in determining the magnitude of the HPA response.
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Affiliation(s)
- D L Helmreich
- Department of Psychiatry, University of Rochester, Rochester, NY 14642, USA.
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18
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The relation of cortisol levels with hippocampus volumes under baseline and challenge conditions. Brain Res 2007; 1179:70-8. [DOI: 10.1016/j.brainres.2007.05.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 05/15/2007] [Accepted: 05/19/2007] [Indexed: 02/03/2023]
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19
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Rojo LE, Fernández JA, Maccioni AA, Jimenez JM, Maccioni RB. Neuroinflammation: implications for the pathogenesis and molecular diagnosis of Alzheimer's disease. Arch Med Res 2007; 39:1-16. [PMID: 18067990 DOI: 10.1016/j.arcmed.2007.10.001] [Citation(s) in RCA: 245] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 05/31/2007] [Indexed: 12/27/2022]
Abstract
During the past few years, an increasing set of evidence has supported the major role of deregulation of the interaction patterns between glial cells and neurons in the pathway toward neuronal degeneration. Neurons and glial cells, together with brain vessels, constitute an integrated system for brain function. Inflammation is a process related with the onset of several neurodegenerative disorders, including Alzheimer's disease (AD). Several hypotheses have been postulated to explain the pathogenesis of AD, but none provides insight into the early events that trigger metabolic and cellular alterations in neuronal degeneration. The amyloid hypothesis was sustained on the basis that Abeta-peptide deposition into senile plaques is responsible for neurodegeneration. However, recent findings point to Abeta oligomers as responsible for synaptic impairment in neuronal degeneration. Amyloid is only one among many other major factors affecting the quality of neuronal cells. Another explanation derives from the tau hypothesis, supported by the observations that tau hyperphosphorylations constitute a common feature of most of the altered signaling pathways in degenerating neurons. Altered tau patterns have been detected in the cerebrospinal fluids of AD patients, and a close correlation was observed between the levels of hyperphosphorylated tau isoforms and the degree of cognitive impairment. On the other hand, the anomalous effects of cytokines and trophic factors share in common the activation of tau hyperphosphorylation patterns. In this context, a neuroimmunological approach to AD becomes relevant. When glial cells that normally provide neurotrophic factors essential for neurogenesis are activated by a set of stressing events, they overproduce cytokines and NGF, thus triggering altered signaling patterns in the etiopathogenesis of AD. A solid set of discoveries has strengthened the idea that altered patterns in the glia-neuron interactions constitute early molecular events within the cascade of cellular signals that lead to neurodegeneration in AD. A direct correlation has been established between the Abeta-induced neurodegeneration and cytokine production and its subsequent release. In effect, neuroinflammation is responsible for an abnormal secretion of proinflammatory cytokines that trigger signaling pathways that activate brain tau hyperphosphorylation in residues that are not modified under normal physiological conditions. Other cytokines such as IL-3 and TNF-alpha seem to display neuroprotective activities. Elucidation of the events that control the transitions from neuroprotection to neurodegeneration should be a critical point toward elucidation of AD pathogenesis.
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Affiliation(s)
- Leonel E Rojo
- Laboratory of Cellular and Molecular Neurosciences, Faculty of Sciences, University of Chile, Santiago, Chile
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20
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Lehmann DJ, Barnardo MCNM, Fuggle S, Quiroga I, Sutherland A, Warden DR, Barnetson L, Horton R, Beck S, Smith AD. Replication of the association of HLA-B7 with Alzheimer's disease: a role for homozygosity? J Neuroinflammation 2006; 3:33. [PMID: 17176470 PMCID: PMC1764414 DOI: 10.1186/1742-2094-3-33] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Accepted: 12/18/2006] [Indexed: 11/17/2022] Open
Abstract
Background There are reasons to expect an association with Alzheimer's disease (AD) within the HLA region. The HLA-B & C genes have, however, been relatively understudied. A geographically specific association with HLA-B7 & HLA-Cw*0702 had been suggested by our previous, small study. Methods We studied the HLA-B & C alleles in 196 cases of 'definite' or 'probable' AD and 199 elderly controls of the OPTIMA cohort, the largest full study of these alleles in AD to date. Results We replicated the association of HLA-B7 with AD (overall, adjusted odds ratio = 2.3, 95% confidence interval = 1.4–3.7, p = 0.001), but not the previously suggested interaction with the ε4 allele of apolipoprotein E. Results for HLA-Cw*0702, which is in tight linkage disequilibrium with HLA-B7, were consistent with those for the latter. Homozygotes of both alleles appeared to be at particularly high risk of AD. Conclusion HLA-B7 and HLA-Cw*0702 are associated with AD in the Oxford population. Because of the contradictions between cohorts in our previous study, we suggest that these results may be geographically specific. This might be because of differences between populations in the structure of linkage disequilibrium or in interactions with environmental, genetic or epigenetic factors. A much larger study will be needed to clarify the role of homozygosity of HLA alleles in AD risk.
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Affiliation(s)
- Donald J Lehmann
- The Oxford Project to Investigate Memory and Ageing (OPTIMA), University Department of Pharmacology & Radcliffe Infirmary, Oxford, UK
- Oxford Centre for Gene Function, University Department of Physiology, Anatomy & Genetics, Parks Rd, Oxford OX1 3PT, UK
| | - Martin CNM Barnardo
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Oxford Transplant Centre, Churchill Hospital, Oxford OX3 7LJ, UK
| | - Susan Fuggle
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Oxford Transplant Centre, Churchill Hospital, Oxford OX3 7LJ, UK
| | - Isabel Quiroga
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Oxford Transplant Centre, Churchill Hospital, Oxford OX3 7LJ, UK
| | - Andrew Sutherland
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Oxford Transplant Centre, Churchill Hospital, Oxford OX3 7LJ, UK
| | - Donald R Warden
- The Oxford Project to Investigate Memory and Ageing (OPTIMA), University Department of Pharmacology & Radcliffe Infirmary, Oxford, UK
- Oxford Centre for Gene Function, University Department of Physiology, Anatomy & Genetics, Parks Rd, Oxford OX1 3PT, UK
| | - Lin Barnetson
- The Oxford Project to Investigate Memory and Ageing (OPTIMA), University Department of Pharmacology & Radcliffe Infirmary, Oxford, UK
| | - Roger Horton
- Immunogenomics Laboratory, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Stephan Beck
- Immunogenomics Laboratory, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - A David Smith
- The Oxford Project to Investigate Memory and Ageing (OPTIMA), University Department of Pharmacology & Radcliffe Infirmary, Oxford, UK
- Oxford Centre for Gene Function, University Department of Physiology, Anatomy & Genetics, Parks Rd, Oxford OX1 3PT, UK
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Ferrari E, Cravello L, Bonacina M, Salmoiraghi F, Magri F. Stress and dementia. HANDBOOK OF STRESS AND THE BRAIN - PART 2: STRESS: INTEGRATIVE AND CLINICAL ASPECTS 2005. [DOI: 10.1016/s0921-0709(05)80064-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
The ovarian hormone estrogen has long been used to treat the physical symptoms of menopause and to aid in the prevention of osteoporosis in postmenopausal women. Cumulative evidence from basic science and clinical research suggests that estrogen also plays a significant neuromodulatory and neuroprotective role. The numerous estrogenic effects in the brain include the modulation of synaptogenesis, increased cerebral blood flow, mediation of important neurotransmitters and hormones, protection against apoptosis, anti-inflammatory actions, and antioxidant properties. These multiple actions in the central nervous system support estrogen as a potential treatment for the cognitive decline associated with Alzheimer's disease (AD), the most common form of dementia. Evidence from epidemiological studies supports enhanced cognitive function in women with AD taking estrogen replacement therapy (ERT) as well as a reduced risk for developing AD in healthy women receiving ERT. Additional clinical evidence suggests that estrogen may modulate specific cognitive functions such as working memory and verbal learning and memory. However, results from more recent controlled trials have not consistently shown a beneficial effect of estrogen on the cognitive function of women with AD. Future research should focus on examining the influence of multiple potential mediators of ERT including the route of estrogen administration, form of estrogen (conjugated estrogens vs estradiol), duration of treatment, opposed versus unopposed estrogen and the use of estrogen analogues. Further, sensitive neuropsychological measures may provide more detailed information concerning the specific effects of estrogen on cognitive function. These important issues must be addressed in order to establish the role of estrogen for the prevention and treatment of AD in women.
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Affiliation(s)
- Brenna Cholerton
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle/Tacoma, Washington, USA
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