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Li Y, Zheng Y, Rong L, Zhou Y, Zhu Z, Xie Q, Liang Z, Zhao X. Altered Function and Structure of the Cerebellum Associated with Gut-Brain Regulation in Crohn's Disease: a Structural and Functional MRI Study. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01715-9. [PMID: 39096431 DOI: 10.1007/s12311-024-01715-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 08/05/2024]
Abstract
This study employed structural and functional magnetic resonance imaging (MRI) to investigate changes in the function and structure of the cerebellum associated with gut-brain axis (GBA) regulation in patients diagnosed with Crohn's disease (CD). The study comprised 20 CD patients, including 12 with active disease (CD-A) and 8 in remission (CD-R), as well as 21 healthy controls. Voxel-based morphometry (VBM) was utilized for structural analysis of cerebellar gray matter volume, while independent component analysis (ICA) was applied for functional analysis of cerebellar functional connectivity (FC). The results showed significant GMV reduction in the left posterior cerebellar lobe across all CD patients compared to HCs, with more pronounced differences in the CD-A subgroup. Additionally, an increase in mean FC of the cerebellar network was observed in all CD patients, particularly in the CD-A subgroup, which demonstrated elevated FC in the vermis and bilateral posterior cerebellum. Correlation analysis revealed a positive relationship between cerebellar FC and the Crohn's Disease Activity Index (CDAI) and a trend toward a negative association with the reciprocal of the Self-rating Depression Scale (SDS) score in CD patients. The study's findings suggest that the cerebellum may play a role in the abnormal regulation of the GBA in CD patients, contributing to a better understanding of the neural mechanisms underlying CD and highlighting the cerebellum's potential role in modulating gut-brain interactions.
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Affiliation(s)
- Yunfei Li
- Department of Radiology, The Fifth People's Hospital of Shanghai Fudan University, Shanghai, China
| | - Yanling Zheng
- Department of Radiology, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
| | - Lan Rong
- Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Zhu
- Department of Radiology, Putuo People's Hospital, Tongji University, Shanghai, China
| | - Qian Xie
- Department of Radiology, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
| | - Zonghui Liang
- Department of Radiology, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, China.
| | - Xiaohu Zhao
- Department of Radiology, The Fifth People's Hospital of Shanghai Fudan University, Shanghai, China.
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Zu Y, Zhang Z, Hao Z, Jiang Z, Chen K, Wang Y, Zou C, Ge L, Yu Q, Zheng F, Wang C. Changes in brain structure and function during early aging in patients with chronic low back pain. Front Aging Neurosci 2024; 16:1356507. [PMID: 38912520 PMCID: PMC11190087 DOI: 10.3389/fnagi.2024.1356507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
Objective To explore the structural and functional changes in cognition-related brain regions in patients with chronic low back pain (CLBP) at earlier ages, and explore the impact of the interaction between CLBP and age on the brain. Methods Seventy-six patients with CLBP were recruited and divided into "younger" age group (20-29 years, YA), "middle" age group (30-39 years, MA), and "older" age group (40-49 years, OA). All patients underwent functional magnetic resonance imaging (fMRI) as well as clinical psychological and pain-related symptoms assessments. Results Structural analysis showed that patients in OA group had lower gray matter (GM) volumes in the orbitofrontal cortex (OFC) bilaterally and the right superior frontal gyrus (SFG) compared to YA group. The resting-state brain activity analysis showed that amplitude of low-frequency fluctuation (ALFF) values in the bilateral postcentral gyrus and left ventral medial prefrontal cortex (mPFC) were significantly different in the OA group. The functional connectivity (FC) in the right ventral dorsolateral prefrontal cortex (DLPFC) and the right insula was significantly decreased in the OA group compared to the YA and MA groups. Likewise, the FC in the left caudal parahippocampal gyrus (PHG) and left inferior parietal lobule (IPL) were significantly lower in the MA and OA groups compared to the YA group. In addition, both the structural properties and the FC values of these brain regions were significantly correlated with age. Conclusion This preliminary study concludes that CLBP affects the aging process. The synergistic effects of CLBP and aging accelerate the functional and structural decline of certain areas of the brain, which not only affects pain processing, but are also may be associated with cognitive declines.
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Affiliation(s)
- Yao Zu
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhou Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zengming Hao
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zimu Jiang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yu Wang
- College of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Changcheng Zou
- College of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Le Ge
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fuming Zheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Kong N, Zhou F, Zhang F, Gao C, Wu L, Guo Y, Gao Y, Lin J, Xu M. Morphological and regional spontaneous functional aberrations in the brain associated with Crohn's disease: a systematic review and coordinate-based meta-analyses. Cereb Cortex 2024; 34:bhae116. [PMID: 38566507 DOI: 10.1093/cercor/bhae116] [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: 12/07/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Crohn's disease is an acknowledged "brain-gut" disorder with unclear physiopathology. This study aims to identify potential neuroimaging biomarkers of Crohn's disease. Gray matter volume, cortical thickness, amplitude of low-frequency fluctuations, and regional homogeneity were selected as indices of interest and subjected to analyses using both activation likelihood estimation and seed-based d mapping with permutation of subject images. In comparison to healthy controls, Crohn's disease patients in remission exhibited decreased gray matter volume in the medial frontal gyrus and concurrently increased regional homogeneity. Furthermore, gray matter volume reduction in the medial superior frontal gyrus and anterior cingulate/paracingulate gyri, decreased regional homogeneity in the median cingulate/paracingulate gyri, superior frontal gyrus, paracentral lobule, and insula were observed. The gray matter changes of medial frontal gyrus were confirmed through both methods: decreased gray matter volume of medial frontal gyrus and medial superior frontal gyrus were identified by activation likelihood estimation and seed-based d mapping with permutation of subject images, respectively. The meta-regression analyses showed a positive correlation between regional homogeneity alterations and patient age in the supplementary motor area and a negative correlation between gray matter volume changes and patients' anxiety scores in the medial superior frontal gyrus. These anomalies may be associated with clinical manifestations including abdominal pain, psychiatric disorders, and possibly reflective of compensatory mechanisms.
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Affiliation(s)
- Ning Kong
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Feini Zhou
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Fan Zhang
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
- Key Laboratory of Digestive Pathophysiology of Zhejiang Province, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
| | - Chen Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Linyu Wu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Yifan Guo
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Yiyuan Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Jiangnan Lin
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Maosheng Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
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Bonifacio C, Savini G, Reca C, Garoli F, Levi R, Vatteroni G, Balzarini L, Allocca M, Furfaro F, Dal Buono A, Armuzzi A, Danese S, Matteoli M, Rescigno M, Fiorino G, Politi LS. The gut-brain axis: Correlation of choroid plexus volume and permeability with inflammatory biomarkers in Crohn's disease. Neurobiol Dis 2024; 192:106416. [PMID: 38272141 DOI: 10.1016/j.nbd.2024.106416] [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: 10/21/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The dysregulation of the gut-brain axis in chronic inflammatory bowel diseases can cause neuro-psychological disturbances, but the underlying mechanisms are still not fully understood. The choroid plexus (CP) maintains brain homeostasis and nourishment through the secretion and clearance of cerebrospinal fluid. Recent research has demonstrated the existence of a CP vascular barrier in mice which is modulated during intestinal inflammation. This study investigates possible correlations between CP modifications and inflammatory activity in patients with Crohn's disease (CD). METHODS In this prospective study, 17 patients with CD underwent concomitant abdominal and brain 3 T MRI. The volume and permeability of CP were compared with levels of C-reactive protein (CRP), fecal calprotectin (FC), sMARIA and SES-CD scores. RESULTS The CP volume was negatively correlated with CRP levels (R = -0.643, p-value = 0.024) and FC (R = -0.571, p-value = 0.050). DCE metrics normalized by CP volume were positively correlated with CRP (K-trans: R = 0.587, p-value = 0.045; Vp: R = 0.706, p-value = 0.010; T1: R = 0.699, p-value = 0.011), and FC (Vp: R = 0.606, p-value = 0.037). CONCLUSIONS Inflammatory activity in patients with CD is associated with changes in CP volume and permeability, thus supporting the hypothesis that intestinal inflammation could affect the brain through the modulation of CP vascular barrier also in humans.
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Affiliation(s)
- Cristiana Bonifacio
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanni Savini
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Neuroradiology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Christian Reca
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Federico Garoli
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Riccardo Levi
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Neuroradiology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulia Vatteroni
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Luca Balzarini
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Furfaro
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Arianna Dal Buono
- IBD Center, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IBD Center, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Michela Matteoli
- Laboratory of Pharmacology and Brain Pathology, Neuro Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Institute of Neuroscience, National Research Council of Italy (CNR) c/o Humanitas Mirasole S.p.A, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Maria Rescigno
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Gionata Fiorino
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy; Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, Rome, Italy
| | - Letterio S Politi
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Neuroradiology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
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Li F, Zhao Q, Tang T, Liu Y, Wang Z, Wang Z, Han X, Xu Z, Chang Y, Li Y. Brain imaging derived phenotypes: a biomarker for the onset of inflammatory bowel disease and a potential mediator of mental complications. Front Immunol 2024; 15:1359540. [PMID: 38469291 PMCID: PMC10925669 DOI: 10.3389/fimmu.2024.1359540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
Background and aims Inflammatory bowel disease (IBD), mainly categorized into Crohn's disease (CD) and ulcerative colitis (UC), is a chronic relapsing gastrointestinal disorder that significantly impairs patients' quality of life. IBD patients often experience comorbidities such as anxiety and depression, and the underlying mechanisms and treatment strategies remain areas of investigation. Methods We conducted a Mendelian randomization(MR) analysis utilizing brain image derived phenotypes (IDP) from the UK Biobank database to investigate the causal relationships between IBD and alterations in brain structural morphology and connectivity of neural tracts. This study aimed to identify biological evidence linking IBD to psychiatric disorders such as anxiety and depression. Results Specifically, the volume of grey matter in the Left Frontal Orbital Cortex exhibited a negative association with the onset of Crohn's disease (odds ratio (OR) [95% confidence interval (CI)]: 0.315[0.180~0.551], adjusted P=0.001), while the volume of the superior frontal cortex in the right hemisphere showed a positive correlation with the development of Ulcerative colitis (OR [95% CI]: 2.285[1.793~2.911], adjusted P<0.001), and the volume of lateral occipital cortex in the left hemisphere demonstrated a positive relationship with Crohn's disease onset (OR [95% CI]: 1.709[1.671~1.747], adjusted P<0.001). In the context of reverse causality, the onset of UC or CD has led to alterations in imaging derived phenotypes associated with five disorders (anxiety, depression, schizophrenia, bipolar disorder, pain) and three functions (memory, emotion, language). Conclusion Our study has demonstrated a causal relationship between IBD and IDPs. IDPs may serve as potential biomarkers for the progression of IBD and as predictive intermediaries for the development of neurological diseases in IBD patients.
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Affiliation(s)
- Fan Li
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Qi Zhao
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Tongyu Tang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
| | - Yuyuan Liu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Zhaodi Wang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Zhi Wang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Xiaoping Han
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Zifeng Xu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Yu Chang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Yuqin Li
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
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Zhang Y, Wu X, Sun J, Yue K, Lu S, Wang B, Liu W, Shi H, Zou L. Exploring changes in brain function in IBD patients using SPCCA: a study of simultaneous EEG-fMRI. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:2646-2670. [PMID: 38454700 DOI: 10.3934/mbe.2024117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Research on functional changes in the brain of inflammatory bowel disease (IBD) patients is emerging around the world, which brings new perspectives to medical research. In this paper, the methods of canonical correlation analysis (CCA), kernel canonical correlation analysis (KCCA), and sparsity preserving canonical correlation analysis (SPCCA) were applied to the fusion of simultaneous EEG-fMRI data from 25 IBD patients and 15 healthy individuals. The CCA, KCCA and SPCCA fusion methods were used for data processing to compare the results obtained by the three methods. The results clearly show that there is a significant difference in the activation intensity between IBD and healthy control (HC), not only in the frontal lobe (p < 0.01) and temporal lobe (p < 0.01) regions, but also in the posterior cingulate gyrus (p < 0.01), gyrus rectus (p < 0.01), and amygdala (p < 0.01) regions, which are usually neglected. The mean difference in the SPCCA activation intensity was 60.1. However, the mean difference in activation intensity was only 36.9 and 49.8 by using CCA and KCCA. In addition, the correlation of the relevant components selected during the SPCCA calculation was high, with correlation components of up to 0.955; alternatively, the correlations obtained from CCA and KCCA calculations were only 0.917 and 0.926, respectively. It can be seen that SPCCA is indeed superior to CCA and KCCA in processing high-dimensional multimodal data. This work reveals the process of analyzing the brain activation state in IBD disease, provides a further perspective for the study of brain function, and opens up a new avenue for studying the SPCCA method and the change in the intensity of brain activation in IBD disease.
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Affiliation(s)
- Yin Zhang
- School of Microelectronics and Control Engineering, Changzhou University, Changzhou 213164, China
| | - Xintong Wu
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Jingwen Sun
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Kecen Yue
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Shuangshuang Lu
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Bingjian Wang
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Wenjia Liu
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Haifeng Shi
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Ling Zou
- School of Microelectronics and Control Engineering, Changzhou University, Changzhou 213164, China
- School of Computer and Artificial Intelligence, Changzhou University, Changzhou, Jiangsu 213164, China
- Key Laboratory of Brain Machine Collaborative Intelligence Foundation of Zhejiang Province, Hangzhou 310018, China
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Wang J, Liu G, Xu K, Ai K, Huang W, Zhang J. The role of neurotransmitters in mediating the relationship between brain alterations and depressive symptoms in patients with inflammatory bowel disease. Hum Brain Mapp 2023; 44:5357-5371. [PMID: 37530546 PMCID: PMC10543356 DOI: 10.1002/hbm.26439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
A growing body of evidence from neuroimaging studies suggests that inflammatory bowel disease (IBD) is associated with functional and structural alterations in the central nervous system and that it has a potential link to emotional symptoms, such as anxiety and depression. However, the neurochemical underpinnings of depression symptoms in IBD remain unclear. We hypothesized that changes in cortical gamma-aminobutyric acid (GABA+) and glutamine (Glx) concentrations are related to cortical thickness and resting-state functional connectivity in IBD as compared to healthy controls. To test this, we measured whole-brain cortical thickness and functional connectivity within the medial prefrontal cortex (mPFC), as well as the concentrations of neurotransmitters in the same brain region. We used the edited magnetic resonance spectroscopy (MRS) with the MEGA-PRESS sequence at a 3 T scanner to quantitate the neurotransmitter levels in the mPFC. Subjects with IBD (N = 37) and healthy control subjects (N = 32) were enrolled in the study. Compared with healthy controls, there were significantly decreased GABA+ and Glx concentrations in the mPFC of patients with IBD. The cortical thickness of patients with IBD was thin in two clusters that included the right medial orbitofrontal cortex and the right posterior cingulate cortex. A seed-based functional connectivity analysis indicated that there was higher connectivity of the mPFC with the left precuneus cortex (PC) and the posterior cingulate cortex, and conversely, lower connectivity in the left frontal pole was observed. The functional connectivity between the mPFC and the left PC was negatively correlated with the IBD questionnaire score (r = -0.388, p = 0.018). GABA+ concentrations had a negative correlation with the Hamilton Depression Scale (HAMD) score (r = -0.497, p = 0.002). Glx concentration was negatively correlated with the HAMD score (r = -0.496, p = 0.002) and positively correlated with the Short-Form McGill Pain Questionnaire score (r = 0.330, p = 0.046, uncorrected). There was a significant positive correlation between the ratio of Glx to GABA+ and the HAMD score (r = 0.428, p = 0.008). Mediation analysis revealed that GABA+ significantly mediated the main effect of the relationship between the structural and functional alterations and the severity of depression in patients with IBD. Our study provides initial evidence of neurochemistry that can be used to identify potential mechanisms underlying the modulatory effects of GABA+ on the development of depression in patients with IBD.
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Affiliation(s)
- Jun Wang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
| | - Guangyao Liu
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
| | - Kun Xu
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
| | - Kai Ai
- Deparment of Clinical and Technical Support, Philips HealthcareXi'anChina
| | - Wenjing Huang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
| | - Jing Zhang
- Department of Magnetic ResonanceLanzhou University Second HospitalLanzhouChina
- Second Clinical SchoolLanzhou UniversityLanzhouChina
- Gansu Province Clinical Research Center for Functional and Molecular ImagingLanzhou University Second HospitalLanzhouChina
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Kornelsen J, McIver T, Uddin MN, Figley CR, Marrie RA, Patel R, Fisk JD, Carter S, Graff L, Mazerolle EL, Bernstein CN. Altered voxel-based and surface-based morphometry in inflammatory bowel disease. Brain Res Bull 2023; 203:110771. [PMID: 37797750 DOI: 10.1016/j.brainresbull.2023.110771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023]
Abstract
Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is characterized by inflammation of the gastrointestinal tract and is a disorder of the brain-gut axis. Neuroimaging studies of brain function and structure have helped better understand the relationships between the brain, gut, and comorbidity in IBD. Studies of brain structure have primarily employed voxel-based morphometry to measure grey matter volume and surface-based morphometry to measure cortical thickness. Far fewer studies have employed other surface-based morphometry metrics such as gyrification, cortical complexity, and sulcal depth. In this study, brain structure differences between 72 adults with IBD and 90 healthy controls were assessed using all five metrics. Significant differences were found for cortical thickness with the IBD group showing extensive left-lateralized thinning, and for cortical complexity with the IBD group showing greater complexity in the left fusiform and right posterior cingulate. No significant differences were found in grey matter volume, gyrification, or sulcal depth. Within the IBD group, a post hoc analysis identified that disease duration is associated with cortical complexity of the right supramarginal gyrus, albeit with a more lenient threshold applied.
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Affiliation(s)
- Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada; University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada.
| | - Theresa McIver
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Md Nasir Uddin
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Neurology, School of Medicine & Dentistry, University of Rochester, Rochester, NY, United States; Department of Biomedical Engineering, Hajim School of Engineering & Applied Sciences, University of Rochester, Rochester, NY, United States
| | - Chase R Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - John D Fisk
- Nova Scotia Health and Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sean Carter
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lesley Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Erin L Mazerolle
- Department of Psychology, Computer Science, and Biology, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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9
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Baillie S, Norton C, Saxena S, Pollok R. Chronic abdominal pain in inflammatory bowel disease: a practical guide. Frontline Gastroenterol 2023; 15:144-153. [PMID: 38420131 PMCID: PMC10897648 DOI: 10.1136/flgastro-2023-102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 03/02/2024] Open
Abstract
Pain is common in inflammatory bowel disease (IBD), yet many patients feel their pain is not addressed by healthcare professionals. Listening to a patient's concerns about pain, assessing symptoms and acknowledging the impact these have on daily life remain crucial steps in addressing pain in IBD. While acute pain may be effectively controlled by pain medication, chronic pain is more complex and often pharmacological therapies, particularly opioids, are ineffective. Low-dose tricyclic antidepressants and psychological approaches, including cognitive-behavioural therapy, have shown some promise in offering effective pain management while lifestyle changes such as a trial of low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet in those with overlapping irritable bowel syndrome may also reduce pain. Patients benefit from a long-term, trusting relationship with their healthcare professional to allow a holistic approach combining pharmacological, psychological, lifestyle and dietary approaches to chronic pain. We present a practical review to facilitate management of chronic abdominal pain in IBD.
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Affiliation(s)
- Samantha Baillie
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sonia Saxena
- Primary Care and Public Health, Imperial College London, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
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10
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Coates MD, Clarke K, Williams E, Jeganathan N, Yadav S, Giampetro D, Gordin V, Smith S, Vrana K, Bobb A, Gazzio TT, Tressler H, Dalessio S. Abdominal Pain in Inflammatory Bowel Disease: An Evidence-Based, Multidisciplinary Review. CROHN'S & COLITIS 360 2023; 5:otad055. [PMID: 37867930 PMCID: PMC10588456 DOI: 10.1093/crocol/otad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Indexed: 10/24/2023] Open
Abstract
Abdominal pain is one of the most common and impactful symptoms associated with inflammatory bowel disease (IBD), including both Crohn's disease and ulcerative colitis. A great deal of research has been undertaken over the past several years to improve our understanding and to optimize management of this issue. Unfortunately, there is still significant confusion about the underlying pathophysiology of abdominal pain in these conditions and the evidence underlying treatment options in this context. There is also a relative paucity of comprehensive reviews on this topic, including those that simultaneously evaluate pharmacological and nonpharmacological therapeutic options. In this review, our multidisciplinary team examines evidence for various currently available medical, surgical, and other analgesic options to manage abdominal pain in IBD.
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Affiliation(s)
- Matthew D Coates
- Department of Medicine, Division of Gastroenterology & Hepatology, Penn State College of Medicine, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Kofi Clarke
- Department of Medicine, Division of Gastroenterology & Hepatology, Penn State College of Medicine, Hershey, PA, USA
| | - Emmanuelle Williams
- Department of Medicine, Division of Gastroenterology & Hepatology, Penn State College of Medicine, Hershey, PA, USA
| | - Nimalan Jeganathan
- Department of Surgery, Division of Colorectal Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Sanjay Yadav
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - David Giampetro
- Department of Anesthesia & Perioperative Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Vitaly Gordin
- Department of Anesthesia & Perioperative Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Sadie Smith
- Department of Anesthesia & Perioperative Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Kent Vrana
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Anne Bobb
- Department of Surgery, Division of Colorectal Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Thu Thi Gazzio
- Department of Surgery, Division of Colorectal Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Heather Tressler
- Department of Medicine, Division of Gastroenterology & Hepatology, Penn State College of Medicine, Hershey, PA, USA
| | - Shannon Dalessio
- Department of Medicine, Division of Gastroenterology & Hepatology, Penn State College of Medicine, Hershey, PA, USA
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11
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Cox JG, de Groot M, Cole JH, Williams SCR, Kempton MJ. A meta-analysis of structural MRI studies of the brain in systemic lupus erythematosus (SLE). Clin Rheumatol 2023; 42:319-326. [PMID: 36534349 PMCID: PMC9873736 DOI: 10.1007/s10067-022-06482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
A comprehensive search of published literature in brain volumetry was conducted in three autoimmune diseases - systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and ulcerative colitis (UC) - with the intention of performing a meta-analysis of published data. Due to the lack of data in RA and UC, the reported meta-analysis was limited to SLE. The MEDLINE database was searched for studies from 1988 to March 2022. A total of 175 papers met the initial inclusion criteria, and 16 were included in a random-effects meta-analysis. The reduction in the number of papers included in the final analysis is primarily due to the lack of overlap in measured and reported brain regions. A significantly lower volume was seen in patients with SLE in the hippocampus, corpus callosum, and total gray matter volume measurements as compared to age- and sex-matched controls. There were not enough studies to perform a meta-analysis for RA and UC; instead, we include a summary of published volumetric studies. The meta-analyses revealed structural brain abnormalities in patients with SLE, suggesting that lower global brain volumes are associated with disease status. This volumetric difference was seen in both the hippocampus and corpus callosum and total gray matter volume measurements. These results indicate both gray and white matter involvements in SLE and suggest there may be both localized and global reductions in brain volume.
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Affiliation(s)
- Jennifer G Cox
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | | | - James H Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Steven C R Williams
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew J Kempton
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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12
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Henn AT, Larsen B, Frahm L, Xu A, Adebimpe A, Scott JC, Linguiti S, Sharma V, Basbaum AI, Corder G, Dworkin RH, Edwards RR, Woolf CJ, Habel U, Eickhoff SB, Eickhoff CR, Wagels L, Satterthwaite TD. Structural imaging studies of patients with chronic pain: an anatomical likelihood estimate meta-analysis. Pain 2023; 164:e10-e24. [PMID: 35560117 PMCID: PMC9653511 DOI: 10.1097/j.pain.0000000000002681] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/09/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Neuroimaging is a powerful tool to investigate potential associations between chronic pain and brain structure. However, the proliferation of studies across diverse chronic pain syndromes and heterogeneous results challenges data integration and interpretation. We conducted a preregistered anatomical likelihood estimate meta-analysis on structural magnetic imaging studies comparing patients with chronic pain and healthy controls. Specifically, we investigated a broad range of measures of brain structure as well as specific alterations in gray matter and cortical thickness. A total of 7849 abstracts of experiments published between January 1, 1990, and April 26, 2021, were identified from 8 databases and evaluated by 2 independent reviewers. Overall, 103 experiments with a total of 5075 participants met the preregistered inclusion criteria. After correction for multiple comparisons using the gold-standard family-wise error correction ( P < 0.05), no significant differences associated with chronic pain were found. However, exploratory analyses using threshold-free cluster enhancement revealed several spatially distributed clusters showing structural alterations in chronic pain. Most of the clusters coincided with regions implicated in nociceptive processing including the amygdala, thalamus, hippocampus, insula, anterior cingulate cortex, and inferior frontal gyrus. Taken together, these results suggest that chronic pain is associated with subtle, spatially distributed alterations of brain structure.
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Affiliation(s)
- Alina T. Henn
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
| | - Bart Larsen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - Lennart Frahm
- Institute of Neuroscience and Medicine (INM7), Forschungszentrum Jülich, Jülich, Germany
| | - Anna Xu
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
- Department of Psychology, Stanford University, Stanford, Carlifornia, US
| | - Azeez Adebimpe
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - J. Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA (Veterans Affairs) Medical Center, Philadelphia, Pennsylvania, US
| | - Sophia Linguiti
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - Vaishnavi Sharma
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
| | - Allan I. Basbaum
- Department of Anatomy, University of California, San Francisco, US
| | - Gregory Corder
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, US
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, US
| | - Clifford J. Woolf
- FM Kirby Neurobiology Center, Boston Children’s Hospital, Boston, Massachusetts, US
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, US
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
- JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine (INM7), Forschungszentrum Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Claudia R. Eickhoff
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Institute of Neuroscience and Medicine (INM1), Forschungszentrum Jülich, Jülich, Germany
| | - Lisa Wagels
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
- JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Theodore D. Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, US
- Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania
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13
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Thapaliya G, Eldeghaidy S, Asghar M, McGing J, Radford S, Francis S, Moran GW. The relationship between Central Nervous System morphometry changes and key symptoms in Crohn’s disease. Brain Imaging Behav 2022; 17:149-160. [PMID: 36409402 PMCID: PMC10049962 DOI: 10.1007/s11682-022-00742-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/22/2022]
Abstract
AbstractAlterations in grey matter volume (GMV) and cortical thickness (CT) in Crohn’s disease (CD) patients has been previously documented. However, the findings are inconsistent, and not a true representation of CD burden, as only CD patients in remission have been studied thus far. We investigate alterations in brain morphometry in patients with active CD and those in remission, and study relationships between brain structure and key symptoms of fatigue, abdominal pain, and extraintestinal manifestations (EIM). Magnetic Resonance Imaging brain scans were collected in 89 participants; 34 CD participants with active disease, 13 CD participants in remission and 42 healthy controls (HCs); Voxel based morphometry (VBM) assessed GMV and white matter volume (WMV), and surface-based analysis assessed cortical thickness (CT). We show a significant reduction in global cerebrospinal fluid (CSF) volume in CD participants compared with HCs, as well as, a reduction in regional GMV, WMV and CT in the left precentral gyrus (motor cortex), and an increase in GMV in the frontal brain regions in CD compared with HCs. Atrophy of the supplementary motor area (SMA) was associated with greater fatigue in CD. We also show alterations in brain structure in multiple regions in CD associated with abdominal pain and extraintestinal inflammations (EIMs). These brain structural alterations likely reflect neuroplasticity to a chronic systemic inflammatory response, abdominal pain, EIMs and fatigue. These findings will aid our understanding of the cross-linking between chronic inflammation, brain structural changes and key unexplained CD symptomatology like fatigue.
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Affiliation(s)
- Gita Thapaliya
- Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Sally Eldeghaidy
- NIHR Nottingham Biomedical Research Centre, The University of Nottingham, Nottingham University Hospitals NHS Trust and School of Medicine, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, The University of Nottingham, Nottingham, UK
- School of Biosciences and Future Food Beacon, The University of Nottingham, Nottingham, UK
| | - Michael Asghar
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, The University of Nottingham, Nottingham, UK
| | - Jordan McGing
- NIHR Nottingham Biomedical Research Centre, The University of Nottingham, Nottingham University Hospitals NHS Trust and School of Medicine, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, The University of Nottingham, Nottingham, UK
| | - Shellie Radford
- NIHR Nottingham Biomedical Research Centre, The University of Nottingham, Nottingham University Hospitals NHS Trust and School of Medicine, Nottingham, UK
| | - Susan Francis
- NIHR Nottingham Biomedical Research Centre, The University of Nottingham, Nottingham University Hospitals NHS Trust and School of Medicine, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, The University of Nottingham, Nottingham, UK
| | - Gordon William Moran
- NIHR Nottingham Biomedical Research Centre, The University of Nottingham, Nottingham University Hospitals NHS Trust and School of Medicine, Nottingham, UK.
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, The University of Nottingham, Nottingham, UK.
- Translational Medical Sciences Unit, University of Nottingham, Nottingham, UK.
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14
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Bisgaard TH, Allin KH, Keefer L, Ananthakrishnan AN, Jess T. Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nat Rev Gastroenterol Hepatol 2022; 19:717-726. [PMID: 35732730 DOI: 10.1038/s41575-022-00634-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic, relapsing immune-mediated disease with a varying and sometimes severe disease course. IBD is often diagnosed in early adulthood and can lead to a substantial decline in quality of life. It has been suggested that patients with IBD are at increased risk of depression and anxiety, but it is still unclear to what extent these diseases co-occur and in what sequence they arise. This Review summarizes the literature on the degree of co-occurrence of IBD with depression and anxiety and the temporal relationship between these diseases. We also discuss the effect of psychological stress on the onset and course of IBD. In addition, we outline the possible mechanisms underlying the co-occurrence of IBD and depression and anxiety, which include changes in brain signalling and morphology, increases in peripheral and intracerebral pro-inflammatory cytokines, impairment of the nitric oxide pathway, changes in vagal nerve signalling, gut dysbiosis and genetics. Finally, we examine the possible effects of treatment of depression and anxiety on the risk and course of IBD, the influence of psychological interventions on IBD, and the effects of IBD treatment on psychiatric comorbidity.
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Affiliation(s)
- Tania H Bisgaard
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Kristine H Allin
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.,Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Laurie Keefer
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark. .,Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.
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15
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Qiu Y, Li Q, Wu D, Zhang Y, Cheng J, Cao Z, Zhou Y. Altered mean apparent propagator-based microstructure and the corresponding functional connectivity of the parahippocampus and thalamus in Crohn’s disease. Front Neurosci 2022; 16:985190. [PMID: 36203806 PMCID: PMC9530355 DOI: 10.3389/fnins.2022.985190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Crohn’s disease (CD) is a chronic and relapsing inflammatory bowel disorder that has been shown to generate neurological impairments, which has the potential to signify disease activity in an underlying neurological manner. The objective of this study was to investigate the abnormalities of brain microstructure and the corresponding functional connectivity (FC) in patients with CD, as well as their associations with disease condition. Twenty-two patients with CD and 22 age-, gender-, and education-matched healthy controls (HCs) were enrolled in this study. All subjects underwent mean apparent propagator (MAP)-MRI and resting-state functional magnetic resonance imaging (MRI) (rs-fMRI) data collection. Each patient was evaluated clinically for the condition and duration of the disease. The MAP metrics were extracted and compared between two groups. Pearson’s correlation analysis was conducted to determine the relationship between disease characteristics and significantly abnormal MAP metrics in the CD group. Regions of interest (ROIs) for ROI-wise FC analysis were selected based on their correlation with MAP metrics. Results showed that multiple brain regions, including the parahippocampus and thalamus, exhibited statistically significant differences in MAP metrics between CD patients and HCs. Additionally, CD patients exhibited decreased FC between the left parahippocampus and bilateral thalamus, as well as the right parahippocampus and bilateral thalamus. The findings of this work provide preliminary evidence that structural abnormalities in the parahippocampal gyrus (PHG) and thalamus, as well as decreased FC between them, may reflect the degree of inflammatory of the disease and serve as brain biomarkers for evaluating CD activity.
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Affiliation(s)
- Yage Qiu
- Department of Radiology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingshang Li
- Department of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Gastroenterology, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University School of Physics and Electronics Science, Shanghai, China
| | - Yiming Zhang
- Department of Radiology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiahui Cheng
- Department of Radiology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhijun Cao
- Department of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Zhijun Cao,
| | - Yan Zhou
- Department of Radiology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yan Zhou,
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16
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Evaluation of Subcortical Structure Volumes in Patients with Non-Specific Digestive Diseases. Diagnostics (Basel) 2022; 12:diagnostics12092199. [PMID: 36140600 PMCID: PMC9497680 DOI: 10.3390/diagnostics12092199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: To evaluate volume of subcortical structures such as hippocampus, globus pallidus, putamen, thalamus, nucleus accumbens, amygdala, caudate in patients with non-specific digestive diseases (functional dyspepsia—FD, irritable bowel syndrome—IBS) and non-specific inflammatory bowel diseases—IBD (colitis ulcerosa and Crohn’s disease) in comparison to healthy control group (CON). (2) Material: The analysis included data obtained from 57 patients (FD-18, IBS-20, IBD-19) and 19 persons in control group. Both groups underwent examination in a 3T scanner (Achieva TX Philips Healthcare). (3) Results: Significant differences between the IBD group and Control group in volume of left thalamus and IBD group vs Control group in volume of right thalamus. (4) Conclusions: The brain-gut axis hypothesis explains connection between biological behavior, emotions and cognitive functions in patients with gastrointestinal disease. We found that there is a difference between volume of thalamus in IBD patients in comparison to both IBS and control group and it occurred to be smaller. Excess inflammation can be linked with psychological disorders like depressive symptoms, sleep difficulties and/or fatigue. Therefore, there is a need for using treatment both for depressive symptoms and IBD to reduce the causes and effects of inflammation.
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17
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Nass BYS, Dibbets P, Markus CR. Impact of the COVID‐19 pandemic on inflammatory bowel disease: The role of emotional stress and social isolation. Stress Health 2022; 38:222-233. [PMID: 34273129 PMCID: PMC8420478 DOI: 10.1002/smi.3080] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 12/17/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic health condition exacerbated by negative emotional stress experiences. In the current study, we examined whether the outbreak of the COVID-19 pandemic coincided with an increase in stress experiences and accordingly an aggravation of disease activity in IBD patients. Sixty-three IBD patients (30 Crohn's disease or CD, 33 ulcerative colitis) completed an online survey during the COVID-19-related lockdown, assessing clinical disease activity, disease-related quality of life, presence of functional gastrointestinal symptoms, social isolation and stress experiences. Scores were then compared to pre-lockdown baseline screening. The pandemic yielded a significant baseline-to-lockdown increase in emotional stress and social isolation. Stress increments, particularly those occasioned by interpersonal tension and excessive interpersonal proximity, were associated with a worsening of functional gastrointestinal symptoms. Exacerbations of loneliness coincided with an escalation of CD activity, functional gastrointestinal symptoms and a decline in subjective health. Lastly, COVID-19 anxiety was significantly related to CD symptom severity and social dysfunction. The findings show that shifts in IBD expression are closely linked to changes in emotional stress experiences and interpersonal relatedness. As such, they contribute to a better understanding of inter-individual differences in IBD progression and provide leads for therapeutic interventions.
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Affiliation(s)
- Boukje Yentl Sundari Nass
- Department of Neuropsychology and PsychopharmacologyFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands,Dr. Rath Health FoundationHeerlenThe Netherlands
| | - Pauline Dibbets
- Clinical Psychological ScienceMaastricht UniversityMaastrichtThe Netherlands
| | - C. Rob Markus
- Department of Neuropsychology and PsychopharmacologyFaculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
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18
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Li L, Ma J, Hua X, Zhou Y, Qiu Y, Zhu Z, Zheng Y, Xie Q, Liang Z, Xu J. Altered Intra- and Inter-Network Functional Connectivity in Patients With Crohn’s Disease: An Independent Component Analysis-Based Resting-State Functional Magnetic Resonance Imaging Study. Front Neurosci 2022; 16:855470. [PMID: 35310085 PMCID: PMC8926075 DOI: 10.3389/fnins.2022.855470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMany studies have reported changes in the structure and function of several brain areas in patients with Crohn’s disease (CD). However, little is known about whether the possible functional connectivity of resting-state networks (RSNs) is altered in CD patients.PurposeAim to investigate the intra- and inter-network alterations between related RSNs in patients with CD and the potential relationships between altered neuroimaging and CD clinical indices.Materials and MethodsIn this study, 20 CD patients and 22 age- and sex-matched healthy controls were included. All participants underwent functional magnetic resonance imaging examination. We used independent component analysis (ICA) to explore the changes in RSNs and evaluated functional connectivity between different RSNs using functional network connectivity (FNC) analysis, and Pearson correlation analysis was performed between altered intra- and inter-network functional connectivity and CD clinical index.ResultsSix CD-related RSNs were identified via ICA, namely the high visual, prime visual, language, dorsal default mode, posterior insula, and precuneus networks. Compared to healthy controls, patients with CD showed significant changes in prime visual and language networks. Additionally, the functional connectivity (FC) values of the left calcarine within the prime visual network were negatively correlated with CD duration. The inter-alterations showed that a significantly increased FNC existed between the language and dorsal default mode networks.ConclusionThe results showed CD-related changes in brain functional networks. This evidence provides more insights into the pathophysiological mechanisms of brain plasticity in CD.
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Affiliation(s)
- Lu Li
- Department of Radiology, Jing’an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
| | - Jie Ma
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuyun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yage Qiu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Zhu
- Department of Radiology, Putuo People’s Hospital, Tongji University, Shanghai, China
| | - Yanling Zheng
- Department of Radiology, Jing’an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
| | - Qian Xie
- Department of Radiology, Jing’an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
| | - Zonghui Liang
- Department of Radiology, Jing’an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
- *Correspondence: Zonghui Liang,
| | - Jianguang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Jianguang Xu,
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19
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Matisz C, Gruber A. Neuroinflammatory remodeling of the anterior cingulate cortex as a key driver of mood disorders in gastrointestinal disease and disorders. Neurosci Biobehav Rev 2022; 133:104497. [DOI: 10.1016/j.neubiorev.2021.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 02/08/2023]
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20
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Prüß MS, Bayer A, Bayer KE, Schumann M, Atreya R, Mekle R, Fiebach JB, Siegmund B, Neeb L. Functional Brain Changes Due to Chronic Abdominal Pain in Inflammatory Bowel Disease: A Case-Control Magnetic Resonance Imaging Study. Clin Transl Gastroenterol 2022; 13:e00453. [PMID: 35060939 PMCID: PMC8865502 DOI: 10.14309/ctg.0000000000000453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Various chronic pain conditions go along with functional and structural brain changes. This study aimed to investigate functional and structural brain changes by magnetic resonance imaging (MRI) in inflammatory bowel disease (IBD) patients with chronic abdominal pain. METHODS Sixty-four subjects were included in the final analysis (32 IBD patients with chronic abdominal pain; 32 age-matched and sex-matched controls). All patients suffered from chronic abdominal pain, defined as a score of ≥3/10 on the visual analog scale for at least 3 months in the past 6 months. Besides structural MRI, resting state functional MRI was used to compare functional connectivity of 10 networks between groups. RESULTS Patients with IBD showed no structural brain alterations but a significantly increased resting state functional connectivity of the secondary somatosensory cortex within the salience network. DISCUSSION Because the secondary somatosensory cortex saves sensory stimuli and compares novel information with latter experiences, these functions may be maladaptive in IBD patients with abdominal pain.
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Affiliation(s)
- Magdalena S. Prüß
- Medizinische Klinik m. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Arian Bayer
- Medizinische Klinik m. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kian-Elias Bayer
- Medizinische Klinik m. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Schumann
- Medizinische Klinik m. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Raja Atreya
- Medical Department I, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf Mekle
- Neuroradiology, Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jochen B. Fiebach
- Neuroradiology, Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Britta Siegmund
- Medizinische Klinik m. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lars Neeb
- Department of Neurology, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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21
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Öhlmann H, Koenen LR, Labrenz F, Engler H, Theysohn N, Langhorst J, Elsenbruch S. Altered Brain Structure in Chronic Visceral Pain: Specific Differences in Gray Matter Volume and Associations With Visceral Symptoms and Chronic Stress. Front Neurol 2021; 12:733035. [PMID: 34744973 PMCID: PMC8564184 DOI: 10.3389/fneur.2021.733035] [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] [Received: 06/29/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Structural brain alterations in chronic pain conditions remain incompletely understood, especially in chronic visceral pain. Patients with chronic-inflammatory or functional bowel disorders experience recurring abdominal pain in concert with other gastrointestinal symptoms, such as altered bowel habits, which are often exacerbated by stress. Despite growing interest in the gut-brain axis and its underlying neural mechanisms in health and disease, abnormal brain morphology and possible associations with visceral symptom severity and chronic stress remain unclear. We accomplished parallelized whole-brain voxel-based morphometry analyses in two patient cohorts with chronic visceral pain, i.e., ulcerative colitis in remission and irritable bowel syndrome, and healthy individuals. In addition to analyzing changes in gray matter volume (GMV) in each patient cohort vs. age-matched healthy controls using analysis of covariance (ANCOVA), multiple regression analyses were conducted to assess correlations between GMV and symptom severity and chronic stress, respectively. ANCOVA revealed reduced GMV in frontal cortex and anterior insula in ulcerative colitis compared to healthy controls, suggesting alterations in the central autonomic and salience networks, which could however not be confirmed in supplemental analyses which rigorously accounted for group differences in the distribution of sex. In irritable bowel syndrome, more widespread differences from healthy controls were observed, comprising both decreased and increased GMV within the sensorimotor, central executive and default mode networks. Associations between visceral symptoms and GMV within frontal regions were altered in both patient groups, supporting a role of the central executive network across visceral pain conditions. Correlations with chronic stress, on the other hand, were only found for irritable bowel syndrome, encompassing numerous brain regions and networks. Together, these findings complement and expand existing brain imaging evidence in chronic visceral pain, supporting partly distinct alterations in brain morphology in patients with chronic-inflammatory and functional bowel disorders despite considerable overlap in symptoms and comorbidities. First evidence pointing to correlations with chronic stress in irritable bowel syndrome inspires future translational studies to elucidate the mechanisms underlying the interconnections of stress, visceral pain and neural mechanisms of the gut-brain axis.
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Affiliation(s)
- Hanna Öhlmann
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Laura Ricarda Koenen
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro-and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Franziska Labrenz
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro-and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jost Langhorst
- Department for Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany.,Department for Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany.,Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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22
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McGing JJ, Radford SJ, Francis ST, Serres S, Greenhaff PL, Moran GW. Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies. Aliment Pharmacol Ther 2021; 54:368-387. [PMID: 34228817 DOI: 10.1111/apt.16465] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/30/2020] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue is the inability to achieve or maintain an expected work output resulting from central or peripheral mechanisms. The prevalence of inflammatory bowel disease (IBD) fatigue can reach 86% in active disease, persisting in 50%-52% of patients with mild to inactive disease. Fatigue is the commonest reason for work absence in IBD, and patients often report fatigue burden to be greater than that of primary disease symptoms. Relatively few evidence-based treatment options exist, and the aetiology is poorly understood. AIM To review the available data and suggest a possible aetiology of IBD fatigue and to consider the efficacy of existing management strategies and highlight potential future interventions. METHODS We reviewed fatigue-related literature in IBD using PubMed database. RESULTS Disease related factors such as inflammation and pharmacological treatments negatively impact skeletal muscle and brain physiology, likely contributing to fatigue symptoms. Secondary factors such as malnutrition, anaemia, sleep disturbance and psychological comorbidity are potential determinants. Immune profile, faecal microbiota composition and physical fitness differ significantly between fatigued and non-fatigued patients, suggesting these may be aetiological factors. Solution-focused therapy, high-dosage thiamine supplementation and biological therapy may reduce fatigue perception in IBD. The effect of physical activity interventions is inconclusive. CONCLUSIONS A multimodal approach is likely required to treat IBD fatigue. Established reversible factors like anaemia, micronutrient deficiencies and active disease should initially be resolved. Psychosocial intervention shows potential efficacy in reducing fatigue perception in quiescent disease. Restoring physical deconditioning by exercise training intervention may further improve fatigue burden.
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Affiliation(s)
- Jordan J McGing
- School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Shellie Jean Radford
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Sébastien Serres
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Paul L Greenhaff
- National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Gordon W Moran
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
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23
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Li L, Ma J, Xu J, Zheng Y, Xie Q, Rong L, Liang Z. Brain functional changes in patients with Crohn's disease: A resting-state fMRI study. Brain Behav 2021; 11:e2243. [PMID: 34124857 PMCID: PMC8413760 DOI: 10.1002/brb3.2243] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is a chronic recurrent intestinal inflammatory disease, often accompanied by poor adaptation and excessive stress response. However, the potential neurological mechanisms of these symptoms have not yet been studied in-depth. OBJECTIVE To investigate alterations in brain activity in patients with Crohn's disease and study the relationship between altered regions and clinical indices. METHODS A total of 15 CD patients and 26 matched healthy controls were recruited. All participants underwent fMRI scans. The amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) assessed differences in spontaneous regional brain activity. Differences between the groups were selected as seeds for functional connectivity (FC) analyses. Correlations between disease duration and ALFF/ReHo/FC values in abnormal regions were analyzed. RESULTS Patients with CD had significantly higher ALFF values in the left superior frontal gyrus, anterior cingulate cortex, and supplementary motor area, and lower values in the left hippocampus. They also had higher ReHo values in the left anterior cingulate cortex, supplementary motor area, putamen, and the bilateral superior frontal gyri. FC strength in the left precentral and middle temporal gyri was found to be increased when the left superior frontal gyrus was used as the seed point. FC strength was also observed to be increased in the left postcentral, middle frontal gyri, inferior frontal orbital cortex, and right rolandic operculum when the left anterior cingulate cortex was used as the seed point. CONCLUSION CD demonstrated abnormal neural activity and FC in various regions primarily associated with emotional, pain and cognitive-related functions, which provides more information to further understand the neural mechanisms of the disease.
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Affiliation(s)
- Lu Li
- Department of Radiology, Jing'an District Centre Hospital of ShanghaiFudan UniversityShanghaiChina
| | - Jie Ma
- School of Rehabilitation ScienceShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jian‐Guang Xu
- School of Rehabilitation ScienceShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yan‐Ling Zheng
- Department of Radiology, Jing'an District Centre Hospital of ShanghaiFudan UniversityShanghaiChina
| | - Qian Xie
- Department of Radiology, Jing'an District Centre Hospital of ShanghaiFudan UniversityShanghaiChina
| | - Lan Rong
- Department of Gastroenterology, Huashan HospitalFudan UniversityShanghaiChina
| | - Zong‐Hui Liang
- Department of Radiology, Jing'an District Centre Hospital of ShanghaiFudan UniversityShanghaiChina
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24
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Engel F, Berens S, Gauss A, Schaefert R, Eich W, Tesarz J. Higher Levels of Psychological Burden and Alterations in Personality Functioning in Crohn's Disease and Ulcerative Colitis. Front Psychol 2021; 12:671493. [PMID: 34248767 PMCID: PMC8264053 DOI: 10.3389/fpsyg.2021.671493] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/03/2021] [Indexed: 12/19/2022] Open
Abstract
Aims: Is there evidence for increased psychological distress and alterations in personality functioning in patients with Crohn’s disease (CD) and ulcerative colitis (UC) compared to healthy controls (HCs)? Background: In patients with CD and UC, perceived stress is closely associated with changes in disease activity. The stress response is influenced by psychological burden and personality functioning, but only little is known about these factors in inflammatory bowel diseases (IBD). Study: A total of 62 patients with an endoscopic ensured CD/UC without remission (n = 31 per group) and 31 HC were included. Patients with an active CD/UC and HC were individually matched (n = 93, 31 per group) for age, sex, education, and disease activity. Depression and anxiety were assessed to evaluate the effect of psychological burden (Patient Health Questionnaire-9/PHQ-9, Generalized Anxiety Disorder-7/GAD-7). Personality functioning was measured by validated questionnaires for psychodynamic structural characteristics, mentalization, and attachment (Operationalized Psychodynamic Diagnosis-Structure Questionnaire/OPD-SQ, Mentalization Questionnaire/MZQ, and Experiences in Close Relationships scale/ECR-RD 12). Results: Levels of depression and anxiety were higher in CD/UC patients than in HC with large effect sizes. Comparing personality functioning in CD/UC with HC, psychodynamic structural characteristics differed between CD/UC and HC with medium effect sizes, with structural differences occurring primarily in the domain of self-perception and regulation. Only minor differences were found regarding mentalization and attachment. CD and UC differed only with small effect sizes. Conclusion: Our data show that compared to HC, patients with CD/UC are characterized by a higher level of psychological burden and structural alterations in the domain of self.
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Affiliation(s)
- Felicitas Engel
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabrina Berens
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany.,Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Annika Gauss
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany.,Division of Internal Medicine, Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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25
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Thomann AK, Schmitgen MM, Kmuche D, Ebert MP, Thomann PA, Szabo K, Gass A, Griebe M, Reindl W, Wolf RC. Exploring joint patterns of brain structure and function in inflammatory bowel diseases using multimodal data fusion. Neurogastroenterol Motil 2021; 33:e14078. [PMID: 33368950 DOI: 10.1111/nmo.14078] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/24/2020] [Accepted: 12/05/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND A growing number of neuroimaging studies suggest distinct neural changes in inflammatory bowel diseases (IBDs). Whether such changes may show similar spatial patterns across distinct neural features within and between specific IBD is unclear. To address this question, we used multivariate multimodal data fusion analysis to investigate structure/function modulation in remitted patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Patients with IBD (n = 46; n = 31 with CD, n = 15 with UC) in stable remission and 17 healthy controls (HC) underwent structural magnetic resonance imaging (sMRI) and resting-state functional magnetic resonance imaging (rs-fMRI) as well as cognitive testing. Anxiety, depression, and fatigue were assessed using self-rating questionnaires. sMRI data were analyzed via voxel-based morphometry (VBM) and rs-fMRI data via amplitude of low-frequency fluctuations (ALFFs) and regional homogeneity (ReHo). Detection of cross-information between VBM, ALFF, and ReHo was conducted by means of a joint independent component analysis (jICA), followed by group-inference statistics. KEY RESULTS Joint independent component analysis detected structural alterations in middle frontal and temporal regions (VBM), and functional changes in the superior frontal gyrus (ReHo) and the medial as well as inferior frontal, inferior temporal, rectal, and subcallosal gyrus (ALFF). One joint component of extracted features of the three modalities differed significantly between IBD patients and controls (p = 0.03), and most distinctly between HC and patients with UC. CONCLUSIONS AND INFERENCES Using a multivariate data fusion technique, this study provides further evidence to brain alterations in IBD. The data suggest distinct neural differences between CD and UC, particularly in frontotemporal regions.
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Affiliation(s)
- Anne Kerstin Thomann
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mike Michael Schmitgen
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Dagny Kmuche
- Department of Neurology, University Medical Center Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias Philip Ebert
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Kristina Szabo
- Department of Neurology, University Medical Center Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Achim Gass
- Department of Neurology, University Medical Center Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Griebe
- Department of Neurology, University Medical Center Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang Reindl
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robert Christian Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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26
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Structural and functional changes in the brain of patients with Crohn's disease: an activation likelihood estimation meta-analysis. Brain Imaging Behav 2021; 15:807-818. [PMID: 32333318 DOI: 10.1007/s11682-020-00291-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Multiple reports for brain functional and structural alterations in patients with Crohn's disease (CD) were published. The current study aimed to meta-analyze the existing neuroimaging data and hence produce a brain map revealing areas with functional and structural differences between patients with CD and healthy controls. Original studies published until 2019 were identified from Scopus, Web of Science and PubMed databases, and included into the analysis if they reported relevant results from task-related or resting state functional magnetic resonance imaging (fMRI or rsfMRI) or voxel-based morphometry (VBM), in the form of standardized brain coordinates based on whole-brain analysis. The brain coordinates and sample size of significant results were extracted from eligible studies to be meta-analyzed with the activation likelihood estimation method using the GingerALE software. Sixteen original studies comprised of a total of 865 participants fulfilled the inclusion criteria. Compared to healthy controls, patients with CD had reduced resting state brain connectivity in the paracentral lobule and cingulate gyrus as well as reduced grey matter volume in the medial frontal gyrus. No significant results were found vice versa. These neural correlates allow a better understanding on the effects of CD on the pain expectation, emotion, and quality of life of patients and potentially serve as useful biomarkers for evaluating treatment efficacy.
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27
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Lee YM, Seo SH, Cho SY, Choi DH, Cheon MW, Kim HY, Youn DH, Pak SC, Son HS, Na CS. Herbal Medicine and Acupuncture Combined Treatment Attenuates Colitis in Rats. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2021; 49:965-982. [PMID: 33827383 DOI: 10.1142/s0192415x21500464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aimed to verify the efficacy of a combined treatment of Jakyakgamcho-tang (JGT) and acupuncture (CV12, ST25, CV4) on colitis induced by dextrane sulfate sodium (DSS). Changes in immuno-mediated factors and metabolites were investigated. Colitis symptoms such as body weight loss and elevated disease activity index were alleviated by the combined treatment. Moreover, treatment with JGT and acupuncture restored the disturbed architecture of colon by suppressing inflammatory cytokine levels of IFN-[Formula: see text] ([Formula: see text] < 0.05), IL-5 ([Formula: see text] < 0.05), and IL-13 ([Formula: see text] < 0.0001) compared with the DSS group. Analysis of metabolic profiles of serum revealed that treatment groups were clearly separated from the DSS group, suggesting that JGT and acupuncture treatment altered serum metabolites. Furthermore, treatments caused opposite metabolite patterns for dimethylbenzimidazole, 1,5-anhydro-D-glucitol, proline, phosphate, glycolic acid, aspartic acid, tryptophan, phthalic acid, ornithine, and glutamic acid compared with the DSS group. The combined treatment group induced more effective metabolite patterns than the JGT group, implying that acupuncture treatment can restore metabolic changes caused by DSS induction. These results indicate that the simultaneous treatment of JGT administration and acupuncture procedure provides better management of the immune function and inflammatory expression of colitis than a single treatment. It is assumed that intestinal microbial control can be achieved by acupuncture stimulation as well as by taking herbal medicine.
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Affiliation(s)
- Yu-Mi Lee
- College of Korean Medicine, Dongshin University, Naju, Jeollanam-do 58245, Korea
| | - Seung-Ho Seo
- College of Korean Medicine, Dongshin University, Naju, Jeollanam-do 58245, Korea
| | - Seong-Young Cho
- College of Korean Medicine, Dongshin University, Naju, Jeollanam-do 58245, Korea
| | - Dong-Hee Choi
- College of Korean Medicine, Dongshin University, Naju, Jeollanam-do 58245, Korea
| | - Min-Woo Cheon
- Department of Health Administration, Dongshin University, Naju, Jeollanam-do, Korea
| | - Hee-Young Kim
- College of Korean Medicine Daegu Haany University Daegu 42158, Korea
| | - Dae-Hwan Youn
- College of Korean Medicine, Dongshin University, Naju, Jeollanam-do 58245, Korea
| | - Sok Cheon Pak
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Hong-Seok Son
- Department of Food Biosciences and Technology, Korea University, Seoul 02841, Korea
| | - Chang-Su Na
- College of Korean Medicine, Dongshin University, Naju, Jeollanam-do 58245, Korea
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28
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Mavroudis G, Strid H, Jonefjäll B, Simrén M. Visceral hypersensitivity is together with psychological distress and female gender associated with severity of IBS-like symptoms in quiescent ulcerative colitis. Neurogastroenterol Motil 2021; 33:e13998. [PMID: 33034406 DOI: 10.1111/nmo.13998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND A subset of ulcerative colitis (UC) patients in remission demonstrate IBS-like symptoms. Visceral hypersensitivity is a key pathophysiological mechanism in IBS, but its relevance to IBS-like symptoms in inactive UC remains unclear. METHODS UC patients in remission (UCR) were screened for IBS-like symptoms. Rectal sensitivity was assessed with rectal balloon distensions, with determination of sensory thresholds and unpleasantness/pain intensity ratings. Patients completed questionnaires evaluating gastrointestinal (GI) and psychological symptoms. Age- and gender-matched IBS subjects and healthy controls (HC) also underwent a rectal sensitivity test. KEY RESULTS We included 36 UCR patients (18 with IBS-like symptoms (UCR + IBS) and 18 without (UCR - IBS)), 36 IBS subjects, and 14 HC. UCR and IBS patients were more sensitive to rectal balloon distensions than HC, but no differences between UCR and IBS patients were observed. UCR + IBS patients had lower sensory thresholds and higher unpleasantness ratings than UCR - IBS. In UCR patients, the overall GI symptom severity, pain, and bloating, but not diarrhea, constipation or satiety, were associated with rectal sensitivity. In multivariate analyses, rectal sensitivity, psychological distress, and female gender were identified as factors independently associated with GI symptom severity. 61% of UCR patients demonstrated rectal hypersensitivity, and these patients more commonly reported at least mild bloating and pain, and overall GI symptoms, compared to those with normal rectal sensitivity. CONCLUSION & INFERENCES Visceral hypersensitivity was associated with IBS-like symptoms, in particular pain and bloating, in inactive UC. Together with psychological factors and female gender, visceral hypersensitivity seems to be involved in GI symptom generation in quiescent UC.
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Affiliation(s)
- Georgios Mavroudis
- Department of Internal Medicine, Kungälv Hospital, Kungälv, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Strid
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Internal Medicine, Södra Älvsborg Hospital, Borås, Sweden
| | - Börje Jonefjäll
- Department of Internal Medicine, Kungälv Hospital, Kungälv, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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29
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Kong N, Gao C, Xu M, Gao X. Changes in the anterior cingulate cortex in Crohn's disease: A neuroimaging perspective. Brain Behav 2021; 11:e02003. [PMID: 33314765 PMCID: PMC7994700 DOI: 10.1002/brb3.2003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Evidence suggests that Crohn's disease (CD) pathophysiology goes beyond the gastrointestinal tract and is also strongly associated with the brain. In particular, the anterior cingulate cortex (ACC), which plays an integral role in the first brain as part of the default mode network (DMN) and pain matrix, shows abnormalities using multiple neuroimaging modalities. This review summarizes nine related studies that investigated changes in the ACC using structural magnetic resonance imaging, resting-state functional magnetic resonance imaging, and magnetic resonance spectroscopy. METHODS An extensive PubMed literature search was conducted from 1980 to August 2020. In a review of the articles identified, particular attention was paid to analysis methods, technical protocol characteristics, and specific changes in the ACC. RESULTS In terms of morphology, a decrease in gray matter volume and cortical thickness was observed along with an increase in local gyrification index. In terms of function, functional connectivity (FC) within the DMN was increased. FC between the ACC and the amygdala was decreased. Higher amplitudes of low-frequency fluctuation and graph theory results, including connectivity strength, clustering coefficient, and local efficiency, were detected. In terms of neurotransmitter changes, the concentrations of glutamate increased along with a decrease in gamma-aminobutyric acid, providing a rational explanation for abdominal pain. These changes may be attributed to stress, pain, and negative emotions, as well as changes in gut microbiota. CONCLUSIONS For patients with CD, the ACC demonstrates structural, functional, and metabolic changes. In terms of clinical findings, the ACC plays an important role in the onset of depression/anxiety and abdominal pain. Therefore, successful modulation of this pathway may guide treatment.
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Affiliation(s)
- Ning Kong
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chen Gao
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Maosheng Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuning Gao
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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30
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Brenner L, Zerlin L, Tan LL. Functional disruption of cortical cingulate activity attenuates visceral hypersensitivity and anxiety induced by acute experimental colitis. Sci Rep 2021; 11:2103. [PMID: 33483524 PMCID: PMC7822936 DOI: 10.1038/s41598-021-81256-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022] Open
Abstract
Visceral pain is a highly complex experience and is the most common pathological feature in patients suffering from inflammatory gastrointestinal disorders. Whilst it is increasingly recognized that aberrant neural processing within the gut-brain axis plays a key role in development of neurological symptoms, the underlying mechanisms remain largely unknown. Here, we investigated the cortical activation patterns and effects of non-invasive chemogenetic suppression of cortical activity on visceral hypersensitivity and anxiety-related phenotypes in a well-characterized mouse model of acute colitis induced by dextran sulfate sodium (DSS). We found that within the widespread cortical network, the mid-cingulate cortex (MCC) was consistently highly activated in response to innocuous and noxious mechanical stimulation of the colon. Furthermore, during acute experimental colitis, impairing the activity of the MCC successfully alleviated visceral hypersensitivity, anxiety-like behaviors and visceromotor responses to colorectal distensions (CRDs) via downregulating the excitability of the posterior insula (PI), somatosensory and the rostral anterior cingulate cortices (rACC), but not the prefrontal or anterior insula cortices. These results provide a mechanistic insight into the central cortical circuits underlying painful visceral manifestations and implicate MCC plasticity as a putative target in cingulate-mediated therapies for bowel disorders.
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Affiliation(s)
- Lukas Brenner
- Institute of Pharmacology, Heidelberg University, Im Neuenheimer Feld 366, 69120, Heidelberg, Germany
| | - Leah Zerlin
- Institute of Pharmacology, Heidelberg University, Im Neuenheimer Feld 366, 69120, Heidelberg, Germany
| | - Linette Liqi Tan
- Institute of Pharmacology, Heidelberg University, Im Neuenheimer Feld 366, 69120, Heidelberg, Germany.
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31
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MRI-based brain structural changes following radiotherapy of Nasopharyngeal Carcinoma: A systematic review. Cancer Radiother 2021; 25:62-71. [PMID: 33414057 DOI: 10.1016/j.canrad.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Nasopharyngeal carcinoma (NPC) radiotherapy (RT) irradiates parts of the brain which may cause cerebral tissue changes. This study aimed to systematically review the brain microstructure changes using MRI-based measures, diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI) and voxel-based morphometry (VBM) and the impact of dose and latency following RT. METHODS PubMed and Scopus databases were searched based on PRISMA guideline to determine studies focusing on changes following NPC RT. RESULTS Eleven studies fulfilled the inclusion criteria. Microstructural changes occur most consistently in the temporal region. The changes were correlated with latency in seven studies; fractional anisotropy (FA) and gray matter (GM) volume remained low even after a longer period following RT and areas beyond irradiation site with reduced FA and GM measures. For dosage, only one study showed correlation, thus requiring further investigations. CONCLUSION DTI, DKI and VBM may be used as a surveillance tool in detecting brain microstructural changes of NPC patients which correlates to latency and brain areas following RT.
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32
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Hopkins CWP, Powell N, Norton C, Dumbrill JL, Hayee B, Moulton CD. Cognitive Impairment in Adult Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. J Acad Consult Liaison Psychiatry 2021; 62:387-403. [PMID: 34219654 DOI: 10.1016/j.psym.2020.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND People living with inflammatory bowel disease (IBD) are exposed to multiple risk factors for cognitive impairment and frequently report cognitive difficulties. However, the presence of cognitive impairment in IBD has not been systematically reviewed. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic multidatabase search for cross-sectional and longitudinal studies comparing adults with IBD versus healthy controls for domain-specific cognitive function or scores on multidomain cognitive screening tools. For any domain reported by 3 or more studies, we conducted random-effects meta-analysis to calculate the standardized mean difference between groups; lower scores reflected poorer performance. Between-study heterogeneity was assessed using the I2 statistic and study quality assessed using an IBD-modified Newcastle-Ottawa scale. RESULTS Of 8302 articles screened, 12 studies (n = 687) were included in the qualitative synthesis and 11 in meta-analyses. All studies were cross-sectional. Studies generally excluded people with active IBD and older adults. Despite no significant differences on multidomain screening tools such as the Mini Mental State Examination (-0.27 [95% confidence interval -0.68, 0.08], P = 0.14), people with IBD showed significant deficits compared with healthy controls in attention (standardized mean difference -0.36 [-0.60, -0.12], P = 0.003, I2 = 0%), executive function (standardized mean difference -0.45 [-0.77, -0.13, P = 0.005, I2 = 42.5%), and specifically in working memory (standardized mean difference -0.58 [-0.85, -0.30], P < 0.001, I2 = 0%). Deficits in learning and recall were nonsignificant (P = 0.089) and other domains insufficient for meta-analysis. CONCLUSIONS People with IBD show deficits in attention and executive function, particularly in working memory, suggesting that cognitive impairment is a potential extraintestinal manifestation of IBD.
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Affiliation(s)
| | - Nick Powell
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Bu'Hussain Hayee
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Calum D Moulton
- Department of Psychological Medicine, King's College London, London, UK.
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33
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Sohrabi M, Pecoraro HL, Combs CK. Gut Inflammation Induced by Dextran Sulfate Sodium Exacerbates Amyloid-β Plaque Deposition in the AppNL-G-F Mouse Model of Alzheimer's Disease. J Alzheimers Dis 2021; 79:1235-1255. [PMID: 33427741 PMCID: PMC8122495 DOI: 10.3233/jad-201099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although it is known that the brain communicates with the gastrointestinal (GI) tract via the well-established gut-brain axis, the influence exerted by chronic intestinal inflammation on brain changes in Alzheimer's disease (AD) is not fully understood. We hypothesized that increased gut inflammation would alter brain pathology of a mouse model of AD. OBJECTIVE Determine whether colitis exacerbates AD-related brain changes. METHODS To test this idea, 2% dextran sulfate sodium (DSS) was dissolved in the drinking water and fed ad libitum to male C57BL/6 wild type and AppNL-G-F mice at 6-10 months of age for two cycles of three days each. DSS is a negatively charged sulfated polysaccharide which results in bloody diarrhea and weight loss, changes similar to human inflammatory bowel disease (IBD). RESULTS Both wild type and AppNL-G-F mice developed an IBD-like condition. Brain histologic and biochemical assessments demonstrated increased insoluble Aβ1-40/42 levels along with the decreased microglial CD68 immunoreactivity in DSS treated AppNL-G-F mice compared to vehicle treated AppNL-G-F mice. CONCLUSION These data demonstrate that intestinal dysfunction is capable of altering plaque deposition and glial immunoreactivity in the brain. This study increases our knowledge of the impact of peripheral inflammation on Aβ deposition via an IBD-like model system.
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Affiliation(s)
- Mona Sohrabi
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND
| | - Heidi L. Pecoraro
- Veterinary Diagnostic Laboratory, North Dakota State University, Fargo ND
| | - Colin K. Combs
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND
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34
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Supraspinal Mechanisms of Intestinal Hypersensitivity. Cell Mol Neurobiol 2020; 42:389-417. [PMID: 33030712 DOI: 10.1007/s10571-020-00967-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
Gut inflammation or injury causes intestinal hypersensitivity (IHS) and hyperalgesia, which can persist after the initiating pathology resolves, are often referred to somatic regions and exacerbated by psychological stress, anxiety or depression, suggesting the involvement of both the spinal cord and the brain. The supraspinal mechanisms of IHS remain to be fully elucidated, however, over the last decades the series of intestinal pathology-associated neuroplastic changes in the brain has been revealed, being potentially responsible for the phenomenon. This paper reviews current clinical and experimental data, including the authors' own findings, on these functional, structural, and neurochemical/molecular changes within cortical, subcortical and brainstem regions processing and modulating sensory signals from the gut. As concluded in the review, IHS can develop and maintain due to the bowel inflammation/injury-induced persistent hyperexcitability of viscerosensory brainstem and thalamic nuclei and sensitization of hypothalamic, amygdala, hippocampal, anterior insular, and anterior cingulate cortical areas implicated in the neuroendocrine, emotional and cognitive modulation of visceral sensation and pain. An additional contribution may come from the pathology-triggered dysfunction of the brainstem structures inhibiting nociception. The mechanism underlying IHS-associated regional hyperexcitability is enhanced NMDA-, AMPA- and group I metabotropic receptor-mediated glutamatergic neurotransmission in association with altered neuropeptide Y, corticotropin-releasing factor, and cannabinoid 1 receptor signaling. These alterations are at least partially mediated by brain microglia and local production of cytokines, especially tumor necrosis factor α. Studying the IHS-related brain neuroplasticity in greater depth may enable the development of new therapeutic approaches against chronic abdominal pain in inflammatory bowel disease.
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35
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Sanchez JMS, McNally JS, Cortez MM, Hemp J, Pace LA, Clardy SL. Neuroimmunogastroenterology: At the Interface of Neuroimmunology and Gastroenterology. Front Neurol 2020; 11:787. [PMID: 32849234 PMCID: PMC7412790 DOI: 10.3389/fneur.2020.00787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
The central nervous system (CNS) is an important regulator of the gastrointestinal tract, and CNS dysfunction can result in significant and disabling gastrointestinal symptom manifestation. For patients with neuroimmunologic and neuroinflammatory conditions, the recognition of gastrointestinal symptoms is under-appreciated, yet the gastrointestinal manifestations have a dramatic impact on quality of life. The current treatment strategies, often employed independently by the neurologist and gastroenterologist, raise the question of whether such patients are being treated optimally when siloed in one specialty. Neuroimmunogastroenterology lies at the borderlands of medical specialties, and there are few resources to guide neurologists in this area. Here, we provide an overview highlighting the potential mechanisms of crosstalk between immune-mediated neurological disorders and gastrointestinal dysfunction.
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Affiliation(s)
- John Michael S. Sanchez
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, UT, United States
| | - J. Scott McNally
- Department of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, United States
| | - Melissa M. Cortez
- Department of Neurology, Imaging and Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - James Hemp
- Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Laura A. Pace
- Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Stacey L. Clardy
- Department of Neurology, Imaging and Neurosciences Center, University of Utah, Salt Lake City, UT, United States
- George E. Whalen Veterans Affairs Medical Center, Salt Lake City, UT, United States
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36
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Pirwani AF, Fang Z, Li B, Smith A, Northoff G, Ismail N. The effects of gastrointestinal symptoms on structural grey matter volume in youth. Int J Dev Neurosci 2020; 80:477-488. [PMID: 32479685 DOI: 10.1002/jdn.10044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022] Open
Abstract
Previous neuroimaging studies have examined the association between changes in brain structure and gastrointestinal symptoms (GIS), seen in disorders such as Irritable Bowel Syndrome and Irritable Bowel Disease. Studies in adults have found changes in white and grey matter volume (GMV) in patients with various gastrointestinal disorders. However, it is unclear whether GIS-related structural changes in the brain are limited to adults or could be present throughout the lifespan. Given that gastrointestinal disorders are typically diagnosed between 4 and 18 years old, we investigated GIS-induced morphological changes in pre-adolescents (8-10), adolescents (12-16 years) and young adults (17-21 years). Using a voxel-based morphometry (VBM) analysis, we compared regional grey matter volume (GMV) between participants with GIS and controls, using structural brain images from the Philadelphia Neurodevelopmental Cohort (PNC) database. A total of 211 participants (107 participants with GISs and 104 control participants) who had undergone structural magnetic resonance imaging were analysed. VBM analysis was used to objectively analyse GMV across the whole brain and compare between participants with GIS and controls. Participants experiencing GIS showed smaller GMV in regions within the limbic system/basal ganglia (bilateral caudate, bilateral ventral hippocampus, bilateral amygdala and bilateral superior orbital frontal cortex), and larger GMV in regions within the pain-matrix (thalamus, bilateral putamen, right mid-frontal gyrus) compared to controls. These differences were most prominent in the adolescent and young adult groups compared to pre-adolescents. In conclusion, the structural differences found in participants with GIS support the need for further research into the neurophysiological impact of these symptoms.
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Affiliation(s)
- Atiqa F Pirwani
- Neuroimmunology, Stress and Endocrinology (NISE) Lab, Faculty of Social Science, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Zhuo Fang
- University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada.,Brain Imaging Group (BIG) Lab, Faculty of Social Science, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Bo Li
- Advanced Research Institute of Multidisciplinary Science, Beijing Institute of Technology, Beijing, China.,Beijing Key Laboratory for Separation and Analysis in Biomedicine and Pharmaceuticals, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Andra Smith
- Brain Imaging Group (BIG) Lab, Faculty of Social Science, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Georg Northoff
- University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nafissa Ismail
- Neuroimmunology, Stress and Endocrinology (NISE) Lab, Faculty of Social Science, School of Psychology, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
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37
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Clarke G, Kennedy PJ, Groeger JA, Quigley EM, Shanahan F, Cryan JF, Dinan TG. Impaired cognitive function in Crohn's disease: Relationship to disease activity. Brain Behav Immun Health 2020; 5:100093. [PMID: 34589862 PMCID: PMC8474502 DOI: 10.1016/j.bbih.2020.100093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 01/04/2023] Open
Abstract
Background & aims Impaired attention and response inhibition have been reported in patients with Crohn’s disease (CD) in clinical remission. Prospective studies are needed to determine whether this is a stable feature of CD and whether a similar impairment is evident in ulcerative colitis (UC). Thus, our aims were to examine whether patients with CD and UC exhibited a persistent impairment in attentional performance, and if this impairment was related to key biological indices of relevance to cognition. Methods A prospective observational study was conducted on fifteen patients with CD and 7 with UC in clinical remission recruited from a specialty clinic and 30 healthy matched control participants. A neuropsychological assessment was carried out at baseline (visit 1) and at a 6 month follow-up (visit 2). Plasma proinflammatory cytokines, the plasma kynurenine:tryptophan (Kyn:Trp) ratio and the salivary cortisol awakening response (CAR) were also determined at each visit. Results Across visits, patients with CD exhibited impaired attentional performance (p = 0.023). Plasma IL-6 (P = 0.001) and the Kyn:Trp ratio (P = 0.03) were consistently elevated and the CAR significantly blunted (P < 0.05) in patients with CD. No significant relationships were identified between any biochemical parameter and altered cognitive performance. Conclusions Impaired cognitive function is a stable feature of patients with CD. These data suggest that even where remission has been achieved, the functional impact of an organic gastrointestinal disorder on cognition is still evident. However, it is unclear at present if physiological changes due to disease activity play a role in cognitive impairment in CD. Crohn’s disease (CD) patients previously associated with impaired cognition. CD patients consistently exhibited impaired attentional performance at multiple visits. Functional impact of organic gastrointestinal disorder on cognition still evident in remission. Increased IL-6, kynurenine pathway activation and blunted cortisol awakening response in CD. Biochemical parameters not associated with altered cognitive performance.
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Key Words
- ACC, anterior cingulate cortex
- BMI, body mass index
- CANTAB®, Cambridge Neuropsychological Test Automated Battery
- CAR, cortisol awakening response
- CD, Crohn’s disease
- Cognition
- Crohn’s disease
- EM, Expectation-maximization
- Gut-brain axis
- HBI, Harvey Bradshaw Index
- HSD, Honestly Significant Difference
- IBD, Inflammatory bowel disease
- IED, Intra-Extradimensional Set Shift
- Immune system
- Inflammatory bowel disease
- MCAR, missing completely at random
- MRT, mean response time
- PAL, Paired Associates Learning
- PFC, prefrontal cortex
- SCCAI, Short Clinical Colitis Activity Index
- SWM, Spatial Working Memory
- Tryptophan
- UC, ulcerative colitis
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Affiliation(s)
- Gerard Clarke
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Paul J Kennedy
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - John A Groeger
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Eamonn Mm Quigley
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Fergus Shanahan
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
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38
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Colonnello V, Agostini A. Disease course, stress, attachment, and mentalization in patients with inflammatory bowel disease. Med Hypotheses 2020; 140:109665. [PMID: 32155541 DOI: 10.1016/j.mehy.2020.109665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
Abstract
Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, are chronic intestinal disorders that requires lifelong treatments. IBD are associated with perceived stress, poor quality of life, and psychopathological disorders. Previous studies have documented that psychological distress and depression are risk factors for IBD. On the other hand, IBD itself might be a source of psychological stress. IBD negatively affect individuals' daily social interactions and close interpersonal relationships. Despite IBD's detrimental effects on quality of life, patients' adherence to medicaments remains low, increasing the risk of relapses and the subsequent worsening of the clinical condition. Drawing on attachment and mentalization theories, we aim to contribute to understanding of the mechanisms involved in the poor quality of social relationships and the tendency for medication non-adherence in patients with IBD. We hypothesize a bidirectional link between IBD and attachment style and related mentalization abilities, where an individual's attachment style refers to a complex and characteristic pattern of relating to self and others and mentalization refers to the process of inferring one's own and others' mental and physical states. This hypothesized link between IBD and insecure attachment style, mediated by reduced mentalizing abilities, may be a risk factor for developing both IBD-related psychological disorders and reduced medication adherence, which could then lead to worsening disease management and prognoses for the disease course. The medication nonadherence is here considered as both an outcome and a risk factor of this vicious circle. We share the view that preventing the worsening of the IBD condition and promoting patients' medication adherence would be possible by considering the circular relationship between IBD, attachment, and mentalization and by promoting reflective functioning in patients with IBD, from the onset of the disease.
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Affiliation(s)
- Valentina Colonnello
- Department of Experimental, Diagnostic, and Specialty Medicine DIMES St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Agostini
- Department of Experimental, Diagnostic, and Specialty Medicine DIMES St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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39
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Kornelsen J, Wilson A, Labus JS, Witges K, Mayer EA, Bernstein CN. Brain Resting-State Network Alterations Associated With Crohn's Disease. Front Neurol 2020; 11:48. [PMID: 32132964 PMCID: PMC7040490 DOI: 10.3389/fneur.2020.00048] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic disease that is associated with aspects of brain anatomy and activity. In this preliminary MRI study, we investigated differences in brain structure and in functional connectivity (FC) of brain regions in 35 participants with Crohn's disease (CD) and 21 healthy controls (HC). Voxel-based morphometry (VBM) analysis was performed to contrast CD and HC structural images. Region of interest (ROI) analyses were run to assess FC for resting-state network nodes. Independent component analysis (ICA) identified whole brain differences in FC associated with resting-state networks. Though no structural differences were found, ROI analyses showed increased FC between the frontoparietal (FP) network and salience network (SN), and decreased FC between nodes of the default mode network (DMN). ICA results revealed changes involving cerebellar (CER), visual (VIS), and SN components. Differences in FC associated with sex were observed for both ROI analysis and ICA. Taken together, these changes are consistent with an influence of CD on the brain and serve to direct future research hypotheses.
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Affiliation(s)
- Jennifer Kornelsen
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada.,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Alyssia Wilson
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer S Labus
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Kelcie Witges
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Emeran A Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Charles N Bernstein
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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Dempsey E, Abautret-Daly Á, Docherty NG, Medina C, Harkin A. Persistent central inflammation and region specific cellular activation accompany depression- and anxiety-like behaviours during the resolution phase of experimental colitis. Brain Behav Immun 2019; 80:616-632. [PMID: 31063848 DOI: 10.1016/j.bbi.2019.05.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 02/08/2023] Open
Abstract
Depression and anxiety-related psychological symptoms are increasingly recognised as important co-morbidities in patients with inflammatory bowel disease (IBD). Dextran sulfate sodium (DSS) -induced colitis is an animal model of IBD in which afferent activation of the gut-brain axis can be assessed and explored as a source of behavioural change. Exposure of adult male Wistar rats to DSS (5%) in drinking water induced distal colitis. In parallel to local inflammatory responses in the gut wall, increased expression of IL-6 and iNOS was found in the cerebral cortex and an increase in ventricular volume. Immunoreactivity of immediate early gene FosB/ΔFosB activation was measured as an index of cellular activation and was increased in the nucleus accumbens and dorsal raphe nucleus in acutely colitic animals. Following resolution of the acute colitic response, sustained anhedonia in the saccharin preference test, immobility in the forced swim test, reduced burying behaviour in the marble burying test, and mild signs of anxiety in the elevated plus maze and light/dark box were observed. Central increases in iNOS expression persisted during the recovery phase and mapped to reactive microglia, particularly those found in the parenchyma surrounding circumventricular regions. Evidence of associated nitration was also found. Sustained increases in ventricular volume and reduced T2 magnetic resonance relaxometry time in cortical regions were observed during the recovery period. FosB/ΔFosB activation was evident in the dorsal raphe during recovery. Persistent central inflammation and cellular activation may underpin the emergence of symptoms of depression and anxiety in experimental colitis.
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Affiliation(s)
- Elaine Dempsey
- Neuropsychopharmacology Research Group, Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland; School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin 2, Ireland
| | - Áine Abautret-Daly
- Neuropsychopharmacology Research Group, Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland; School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin 2, Ireland
| | - Neil G Docherty
- Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland; Department of Physiology, School of Medicine, Trinity College, Dublin 2, Ireland
| | - Carlos Medina
- School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin 2, Ireland; Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - Andrew Harkin
- Neuropsychopharmacology Research Group, Trinity College Institute of Neuroscience, Trinity College, Dublin 2, Ireland; School of Pharmacy & Pharmaceutical Sciences, Trinity College, Dublin 2, Ireland.
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41
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Thomann AK, Reindl W, Wüstenberg T, Kmuche D, Ebert MP, Szabo K, Wolf RC, Hirjak D, Niesler B, Griebe M, Thomann PA. Aberrant brain structural large-scale connectome in Crohn's disease. Neurogastroenterol Motil 2019; 31:e13593. [PMID: 30983094 DOI: 10.1111/nmo.13593] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/18/2019] [Accepted: 03/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Disturbed brain-gut interactions and a bidirectional relationship between inflammation and psychiatric symptoms such as anxiety and depression are being discussed in patients with inflammatory bowel diseases (IBD). Alterations of brain structure and function in IBD have been reported with heterogeneous results. Whether these changes reflect independent localized deficits or rather a systematic disruption in the anatomical organization of large-scale brain networks remains unclear. The present study investigated the gray matter structural connectome in patients with Crohn's disease (CD). METHODS Sixty participants (30 with quiescent CD and 30 matched healthy controls [HC]) underwent high-resolution brain MRI at 3 Tesla. Well-established graph theoretical metrics were analyzed at the global and regional network level and compared between groups. KEY RESULTS The networks in both groups followed a small-world organization, that is, an architecture that is simultaneously highly segregated and integrated. However, transitivity, a measure of global network segregation, was significantly reduced in patients (P = 0.003). Regionally, patients showed a reduction of nodal betweenness centrality in the right insula and cuneus and the left superior frontal cortex and reduced nodal degree within the left-hemispheric cingulate and the left lateral and right medial orbitofrontal cortex. CONCLUSION AND INFERENCES These findings lend support to the hypothesis that CD is accompanied by alterations in both global network organization and regional connectivity. A deeper understanding of neural central networks in IBD may facilitate the development of complementary strategies in the treatment of "extraintestinal" comorbid conditions such as depression or anxiety.
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Affiliation(s)
- Anne K Thomann
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang Reindl
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry and Psychotherapy, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Dagny Kmuche
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias P Ebert
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Kristina Szabo
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Beate Niesler
- Department of Human Molecular Genetics, Heidelberg University Hospital, Heidelberg, Germany.,Interdisciplinary Center of Neuroscience, Heidelberg University, Heidelberg, Germany
| | - Martin Griebe
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philipp A Thomann
- Center for Mental Health, Odenwald District Healthcare Centre, Erbach, Germany
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42
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Nair VA, Dodd K, Rajan S, Santhanubosu A, Beniwal-Patel P, Saha S, Prabhakaran V. A Verbal Fluency Task-Based Brain Activation fMRI Study in Patients with Crohn's Disease in Remission. J Neuroimaging 2019; 29:630-639. [PMID: 31134699 DOI: 10.1111/jon.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND PURPOSE In this pilot study, we investigated functional brain activation changes in patients with Crohn's disease (CD) in remission compared to age and gender-matched healthy controls (HCs). METHODS Data from 20 patients with CD in remission (age range 19-63 years) and 20 HCs (matched in age and gender) were analyzed. Task functional MRI (fMRI) data were collected while participants performed a cognitive (phonemic verbal fluency) task in the scanner. All participants also performed the same task outside the scanner. RESULTS Task fMRI results showed greater bi-hemispheric activation in CD patients compared to controls. Because this pattern is commonly reported with normal aging, we performed further analyses to investigate fMRI responses in a subset of the younger CD patients (N = 12, age < = 35 years) compared to matched young HCs (age < = 35 years), and an older cohort of HCs (age > = 50 years). Results showed that task activation patterns were similar between young CD patients and older HCs, and that both groups differed significantly from younger HCs. Activation intensity in specific brain regions for patients was associated with disease duration. CONCLUSIONS These results suggest that CD patients in remission may show accelerated signs of aging in terms of brain responses to a typical cognitive task. Future work with larger sample size will need to replicate these results as well as investigate the influence of factors, such as chronicity of the disease and medication effects on task-associated brain activation patterns in this patient population.
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Affiliation(s)
- Veena A Nair
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Keith Dodd
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
| | - Shruti Rajan
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Anu Santhanubosu
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin-Madison, Madison, WI
| | - Vivek Prabhakaran
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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43
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Falling C, Stebbings S, Baxter GD, Mani R. Central hypersensitivity - A model for persistent musculoskeletal pain in inflammatory bowel diseases. Med Hypotheses 2019; 129:109243. [PMID: 31371091 DOI: 10.1016/j.mehy.2019.109243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/28/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022]
Abstract
Pain is reported to affect over 70% of individuals with inflammatory bowel diseases (IBD), with abdominal and musculoskeletal (MSK) pain representing the most common complaints. MSK pain is typically considered within the narrow framework of inflammatory extraintestinal manifestations of IBD, resulting in a limited scope for the nature and underlying mechanisms participating in MSK pain experiences in this population. Symptoms related to central sensitization have recently demonstrated association with active IBD and worse MSK pain experiences, suggesting a potential roll for central mechanisms in MSK-related pain. Current literature exploring persistent pain in chronic inflammatory and MSK populations propose complex pain models comprised of dynamic nervous system relationships influenced by primary disease features and concomitant pain states, as well as affective and cognitive components. Nervous system contributions in the development and maintenance of persistent pain are postulated to include mechanisms of peripheral and central sensitization, changes in descending central modulation, as well as structural brain changes. These models go beyond current MSK pain models described in IBD literature, highlighting the need for new frameworks for considering MSK-related pain in IBD. Consequently, this paper proposes a broader theoretical model whereby central mechanisms, such as central sensitization and grey matter changes, as well as psychological and disease factors are suggested to modulate pain experiences in this population. Exploration of relationships within the proposed framework may provide not only a deeper understanding of the generation and maintenance of persistent MSK pain in IBD, but also highlight the need for new targeted management pathways in this population. This paper hypothesizes that exploration of central sensitization in IBD patients will demonstrate altered somatosensory functioning in patients with MSK pain, and that IBD activity and psychological factors will be associated with altered somatosensory functioning and worse pain experiences.
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Affiliation(s)
- Carrie Falling
- University of Otago, School of Physiotherapy, New Zealand.
| | | | - G David Baxter
- University of Otago, School of Physiotherapy, New Zealand
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Mallio CA, Piervincenzi C, Gianolio E, Cirimele V, Papparella LG, Marano M, Quintiliani L, Aime S, Carducci F, Parizel PM, Quattrocchi CC. Absence of dentate nucleus resting-state functional connectivity changes in nonneurological patients with gadolinium-related hyperintensity on T1
-weighted images. J Magn Reson Imaging 2019; 50:445-455. [DOI: 10.1002/jmri.26669] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Carlo A. Mallio
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Claudia Piervincenzi
- Department of Physiology and Pharmacology, Neuroimaging Laboratory; Università La Sapienza; Rome Italy
| | - Eliana Gianolio
- Department of Molecular Biotechnology and Health Sciences; Università di Torino; Torino Italy
| | - Vincenzo Cirimele
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Luigi G. Papparella
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Massimo Marano
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Livia Quintiliani
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
| | - Silvio Aime
- Department of Molecular Biotechnology and Health Sciences; Università di Torino; Torino Italy
| | - Filippo Carducci
- Department of Physiology and Pharmacology, Neuroimaging Laboratory; Università La Sapienza; Rome Italy
| | - Paul M. Parizel
- Department of Radiology; Antwerp University Hospital; Edegem Belgium
| | - Carlo C. Quattrocchi
- Departmental Faculty of Medicine and Surgery; Università Campus Bio-Medico di Roma; Rome Italy
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45
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Saghazadeh A, Rezaei N. The Physical Burden of Immunoperception. BIOPHYSICS AND NEUROPHYSIOLOGY OF THE SIXTH SENSE 2019. [PMCID: PMC7123546 DOI: 10.1007/978-3-030-10620-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The previous chapter introduced the ImmunoEmotional Regulatory System (IMMERS). Also, there was a brief discussion about psychological states/psychiatric disorders that so far have been linked to the IMMERS. The present chapter considers another aspect of the IMMERS in which physiological states/physical diseases can be fit to the IMMERS.
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46
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Bao C, Liu P, Liu H, Jin X, Shi Y, Wu L, Zeng X, Zhang J, Wang D, Calhoun VD, Tian J, Wu H. Difference in regional neural fluctuations and functional connectivity in Crohn's disease: a resting-state functional MRI study. Brain Imaging Behav 2018; 12:1795-1803. [PMID: 29464530 PMCID: PMC6218319 DOI: 10.1007/s11682-018-9850-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patients with Crohn's disease (CD) are shown to have abnormal changes in brain structures. This study aimed to further investigate whether these patients have abnormal brain activities and network connectivity. Sixty patients with CD and 40 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (fMRI) scans. Amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity (FC) were used to assess differences in spontaneous regional brain activity and functional connectivity. Compared to the HCs, patients with CD showed significantly higher ALFF values in hippocampus and parahippocampus (HIPP/paraHIPP), anterior cingulate cortex, insula, superior frontal cortex and precuneus. The ALFF values were significantly lower in secondary somatosensory cortex (S2), precentral gyrus, and medial prefrontal cortex. Functional connectivities between left HIPP and left inferior temporal cortex, and right middle cingulate cortex, HIPP, and fusiform area were significantly lower. The functional connectivities between right HIPP and right inferior orbitofrontal cortex and left HIPP were also significantly lower. Patients with CD showed higher or lower spontaneous activity in multiple brain regions. Altered activities in these brain regions may collectively reflect abnormal function and regulation of visceral pain and sensation, external environmental monitoring, and cognitive processing in these patients. Lower functional connectivity of the hippocampus-limbic system was observed in these patients. These findings may provide more information to elucidate the neurobiological mechanisms of the disease.
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Affiliation(s)
- Chunhui Bao
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Peng Liu
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Huirong Liu
- Outpatient Department, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China.
| | - Xiaoming Jin
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Yin Shi
- Outpatient Department, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Luyi Wu
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Xiaoqing Zeng
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jianye Zhang
- Department of Radiology, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200030, China
| | - Di Wang
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, NM, 87131, USA
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Jie Tian
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Huangan Wu
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China.
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47
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Progression of Structural Brain Changes in Patients With Chronic Pancreatitis and Its Association to Chronic Pain: A 7-Year Longitudinal Follow-up Study. Pancreas 2018; 47:1267-1276. [PMID: 30211804 DOI: 10.1097/mpa.0000000000001151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Temporal information about the structural brain changes in chronic pancreatitis (CP) and its relation to the clinical manifestations is lacking. This study investigated changes in morphological brain parameters over 7 years in painful CP patients, compared with controls. METHODS In this 7-year longitudinal magnetic resonance imaging study, we included 23 CP patients and 14 controls. Gray matter volume (GMV) and cortical thickness were examined using voxel-based and surface-based morphometry. In addition, patients completed pain questionnaires and diary. RESULTS At baseline, patients had reduced GMV and cortical thickness in widespread brain areas compared with controls. After 7 years of follow-up, the GMV loss was more pronounced in patients compared with controls, particularly in precentral gyrus and putamen. Moreover, an increase in pain scores was associated with a less reduction of thalamic GMV (P = 0.046), whereas an increase in brief pain inventory score was associated with more reduction in cortical thickness of precentral (P = 0.005) and superior temporal gyri (P = 0.019), indicating that brain morphological alterations are associated with the pain. CONCLUSIONS Chronic pancreatitis pain is associated with morphological brain changes over time in several areas, reflecting that brain plasticity may be a consequence of repeated long-term nociceptive signaling.
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48
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Colitis-induced alterations in response properties of visceral nociceptive neurons in the rat caudal medulla oblongata and their modulation by 5-HT3 receptor blockade. Brain Res Bull 2018; 142:183-196. [PMID: 30031817 DOI: 10.1016/j.brainresbull.2018.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/15/2018] [Accepted: 07/17/2018] [Indexed: 12/17/2022]
Abstract
There is considerable clinical and experimental evidence that intestinal inflammation is associated with altered visceral nociceptive processing in the spinal cord and brain, but the underlying neuronal mechanisms, especially acting at the supraspinal level, remain unclear. Considering that the caudal ventrolateral medulla (CVLM) and the nucleus tractus solitarius (NTS) are the first sites for supraspinal processing of visceral pain signals, in the present study we evaluated the experimental colitis-induced changes in response properties of CVLM and NTS medullary neurons to noxious colorectal distension (CRD) in urethane-anesthetized adult male Wistar rats. To determine if gut inflammation alters the 5-HT3 receptor-dependent modulation of visceral pain-related CVLM and NTS cells, we examined the effects of intravenously administered selective 5-HT3 antagonist granisetron on ongoing and CRD-evoked activity of CVLM and NTS neurons in healthy control and colitic animals. In the absence of colonic pathology, the CVLM neurons were more excited by noxious CRD that the NTS cells, which demonstrated a greater tendency to be inhibited by the stimulation. The difference was eliminated after the development of colitis due to the increase in the proportion of CRD-excited neurons in both medullary regions associated with enhanced magnitude of the neuronal nociceptive responses. Intravenous granisetron (1 or 2 mg/kg) produced the dose-dependent suppression of the ongoing and evoked firing of CRD-excited cells within both the CVLM and NTS in normal conditions as well as was able to substantially reduce excitability of the caudal medullary neurons in the presence of colonic inflammation, arguing for the potential efficacy of the 5-HT3 receptor blockade with granisetron against both acute and inflammatory abdominal pain. Taken together, the data obtained can contribute to a deeper understanding of supraspinal serotonergic mechanisms responsible for the persistence of visceral hypersensitivity and hyperalgesia triggered by colonic inflammation.
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49
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Pitiot A, Smith JK, Humes DJ, Garratt J, Francis ST, Gowland PA, Spiller RC, Marciani L. Cortical differences in diverticular disease and correlation with symptom reports. Neurogastroenterol Motil 2018; 30:e13303. [PMID: 29392838 DOI: 10.1111/nmo.13303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/07/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent studies have shown that the brain of patients with gastrointestinal disease differ both structurally and functionally from that of controls. Highly somatizing diverticular disease (HSDD) patients were also shown to differ from low somatizing (LSDD) patients functionally. This study aimed to investigate how they differed structurally. METHODS Four diseases subgroups were studied in a cross-sectional design: 20 patients with asymptomatic diverticular disease (ADD), 18 LSDD, 16 HSDD, and 18 with irritable bowel syndrome. We divided DD patients into LSDD and HSDD using a cutoff of 6 on the Patient Health Questionnaire 12 Somatic Symptom (PHQ12-SS) scale. All patients underwent a 1-mm isotropic structural brain MRI scan and were assessed for somatization, hospital anxiety, depression, and pain catastrophizing. Whole brain volumetry, cortical thickness analysis and voxel-based morphometry were carried out using Freesurfer and SPM. KEY RESULTS We observed decreases in gray matter density in the left and right dorsolateral prefrontal cortex (dlPFC), and in the mid-cingulate and motor cortex, and increases in the left (19, 20) and right (19, 38) Brodmann Areas. The average cortical thickness differed overall across groups (P = .002) and regionally: HSDD > ADD in the posterior cingulate cortex (P = .03), HSDD > LSDD in the dlPFC (P = .03) and in the ventrolateral PFC (P < .001). The thickness of the anterior cingulate cortex and of the mid-prefrontal cortex were also found to correlate with Pain Catastrophizing (Spearman's ρ = 0.24, P = .043 uncorrected and Spearman's ρ = 0.25, P = .03 uncorrected). CONCLUSION & INFERENCES This is the first study of structural gray matter abnormalities in diverticular disease patients. The data show brain differences in the pain network.
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Affiliation(s)
- A Pitiot
- Laboratory of Image & Data Analysis, Ilixa Ltd., Nottingham, UK
| | - J K Smith
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - D J Humes
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - J Garratt
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - S T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - P A Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - R C Spiller
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - L Marciani
- Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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50
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Liu P, Li R, Bao C, Wei Y, Fan Y, Liu Y, Wang G, Wu H, Qin W. Altered topological patterns of brain functional networks in Crohn’s disease. Brain Imaging Behav 2018; 12:1466-1478. [DOI: 10.1007/s11682-017-9814-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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