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Zheng T, Jiang T, Li R, Zhu Y, Han Q, Wang M. Circulating interleukins concentrations and post-stroke depression: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111050. [PMID: 38844127 DOI: 10.1016/j.pnpbp.2024.111050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/06/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
Interleukins may play a role in supporting the diagnosis of post-stroke depression (PSD). Here, eight databases were employed to search for studies on circulating interleukins concentrations in patients with PSD. A total of 45 studies exploring circulating interleukins in PSD and stroke patients without depression (NPSD) were included in the retrieval database, including IL-1(5), IL-1β (10), IL-2(6), IL-6(35), IL-10(7), IL-17(5), IL-18(6). Then, the RevMan 5.4 software was used for meta-analysis. The results of the meta-analysis showed that the PSD patients have higher concentrations of IL-1, IL-4, IL-6, and lower concentrations of IL-10 than NPSD patients. Additionally, the circulating IL-1, IL-6, and IL-18 concentrations in PSD patients were significantly higher than those in NPSD patients in the acute phase; the circulating IL-6 and IL-17 concentrations in PSD patients were significantly higher than those in NPSD patients at discharge; the PSD patients have lower concentrations sin IL-2 but higher concentrations in IL-6 and IL-17 than NPSD patients at the 3rd and 6th month. Our research provides evidence that circulating interleukins may have clinical utility as a biomarker for identifying PSD.
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Affiliation(s)
- Ting Zheng
- Department of Neurology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, China; The Second Clinical Medical School, Lanzhou University, Lanzhou 730030, China
| | - Taotao Jiang
- Department of Neurology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, China; The Second Clinical Medical School, Lanzhou University, Lanzhou 730030, China
| | - Rundong Li
- The Second Clinical Medical School, Lanzhou University, Lanzhou 730030, China
| | - Yanping Zhu
- Department of Neurology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, China
| | - Qian Han
- School of Public Health, Lanzhou University, Lanzhou 730030, China
| | - Manxia Wang
- Department of Neurology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, China.
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Lu W, Wen J. Neuroinflammation and Post-Stroke Depression: Focus on the Microglia and Astrocytes. Aging Dis 2024:AD.2024.0214-1. [PMID: 38421829 DOI: 10.14336/ad.2024.0214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
Post-stroke depression (PSD), a frequent and disabling complication of stroke, has a strong impact on almost thirty percent of stroke survivors. The pathogenesis of PSD is not completely clear so far. Neuroinflammation following stroke is one of underlying mechanisms that involves in the pathophysiology of PSD and plays an important function in the development of depression and is regarded as a sign of depression. During the neuroinflammation after ischemic stroke onset, both astrocytes and microglia undergo a series of morphological and functional changes and play pro-inflammatory or anti-inflammatory effect in the pathological process of stroke. Importantly, astrocytes and microglia exert dual roles in the pathological process of PSD due to the phenotypic transformation. We summarize the latest evidence of neuroinflammation involving in PSD in this review, focus on the phenotypic transformation of microglia and astrocytes following ischemic stroke and reveal the dual roles of both microglia and astrocytes in the PSD via modulating the neuroinflammation.
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Affiliation(s)
- Weizhuo Lu
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- Medical Branch, Hefei Technology College, Hefei, China
| | - Jiyue Wen
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
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Wen L, Yan C, Si T, Huang L, Nie Y, Shen H, Qu M, Zhang X. The predictive role of early inflammation and oxidative stress and the dynamics of cytokines networks in post-stroke depression. J Affect Disord 2024; 347:469-476. [PMID: 38065474 DOI: 10.1016/j.jad.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/24/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUNDS Chronic inflammation and oxidative stress play an important role in the pathogenesis of PSD. The main purposes of this study were to examine the dynamic changes of cytokines networks in PSD and the predictive role of early inflammation and oxidative stress for 2-week PSD. METHODS Patients with ischemic stroke were recruited on day 3, and those with Hamilton Depression Rating Scale 24-Item (HAMD-24) ≥8 were classified as ischemic stroke patients with depressive symptoms and others as ischemic stroke patients without depressive symptoms. Subjects were then followed up at 2 weeks and 3 months, with those meeting diagnostic criteria for depressive symptoms on the HAMD ≥8 and the Statistical Manual of Mental Disorders-V (DSM-V) as the PSD group, and the others as the non-PSD group. RESULTS At 3 days, IFN-γ, IL-12(p70), IL-12(p40), IL-2, IL-28A/IFNλ2, and IL-19 were elevated in ischemic stroke patients with depressive symptoms. At 2 weeks, IL-12(p40), IL-19, IL-22, IFN-β and MMP-1 all were increased in PSD patients. At 3 months, IL-2, IFN-β and sCD163 increased in PSD group. Longitudinally, the inflammatory response decreased significantly in PSD group from 2 weeks to 3 months of follow-up, while it gradually decreased in non-PSD group from 3 days to 3 months of follow-up. SOD was positively related to IL-12(p70), IFN-γ and IL-20. Plasma IFN-γ at 3 days may be a potential predictive biomarker for 2-week PSD. CONCLUSIONS Peripheral inflammation and oxidative stress are involved in the pathogenesis of PSD, providing new insights for its diagnosis and treatment.
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Affiliation(s)
- Lulu Wen
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, China
| | - Chuming Yan
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, China
| | - Tong Si
- Neurology Department, Beijing Shijitan Hospital, Beijing, China
| | - Liyuan Huang
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, China
| | - Yuting Nie
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, China
| | - Huixin Shen
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, China
| | - Miao Qu
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Hanafy KA, Jovin TG. Brain FADE syndrome: the final common pathway of chronic inflammation in neurological disease. Front Immunol 2024; 15:1332776. [PMID: 38304427 PMCID: PMC10830639 DOI: 10.3389/fimmu.2024.1332776] [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: 11/03/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Importance While the understanding of inflammation in the pathogenesis of many neurological diseases is now accepted, this special commentary addresses the need to study chronic inflammation in the propagation of cognitive Fog, Asthenia, and Depression Related to Inflammation which we name Brain FADE syndrome. Patients with Brain FADE syndrome fall in the void between neurology and psychiatry because the depression, fatigue, and fog seen in these patients are not idiopathic, but instead due to organic, inflammation involved in neurological disease initiation. Observations A review of randomized clinical trials in stroke, multiple sclerosis, Parkinson's disease, COVID, traumatic brain injury, and Alzheimer's disease reveal a paucity of studies with any component of Brain FADE syndrome as a primary endpoint. Furthermore, despite the relatively well-accepted notion that inflammation is a critical driving factor in these disease pathologies, none have connected chronic inflammation to depression, fatigue, or fog despite over half of the patients suffering from them. Conclusions and relevance Brain FADE Syndrome is important and prevalent in the neurological diseases we examined. Classical "psychiatric medications" are insufficient to address Brain FADE Syndrome and a novel approach that utilizes sequential targeting of innate and adaptive immune responses should be studied.
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Affiliation(s)
- Khalid A Hanafy
- Cooper Neurological Institute and Cooper Medical School at Rowan University, Camden, NJ, United States
- Center for Neuroinflammation at Cooper Medical School at Rowan University, Camden, NJ, United States
| | - Tudor G Jovin
- Cooper Neurological Institute and Cooper Medical School at Rowan University, Camden, NJ, United States
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Zhang Y, Yang Y, Li H, Feng Q, Ge W, Xu X. Investigating the Potential Mechanisms and Therapeutic Targets of Inflammatory Cytokines in Post-stroke Depression. Mol Neurobiol 2024; 61:132-147. [PMID: 37592185 DOI: 10.1007/s12035-023-03563-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
Post-stroke depression (PSD) affects approximately one-third of stroke survivors, severely impacting general recovery and quality of life. Despite extensive studies, the exact mechanisms underlying PSD remain elusive. However, emerging evidence implicates proinflammatory cytokines, including interleukin-1β, interleukin-6, tumor necrosis factor-alpha, and interleukin-18, play critical roles in PSD development. These cytokines contribute to PSD through various mechanisms, including hypothalamic-pituitary-adrenal (HPA) axis dysfunction, neurotransmitter alterations, neurotrophic factor changes, gut microbiota imbalances, and genetic predispositions. This review is aimed at exploring the role of cytokines in stroke and PSD while identifying their potential as specific therapeutic targets for managing PSD. A more profound understanding of the mechanisms regulating inflammatory cytokine expression and anti-inflammatory cytokines like interleukin-10 in PSD may facilitate the development of innovative interventions to improve outcomes for stroke survivors experiencing depression.
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Affiliation(s)
- Yutong Zhang
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Yuehua Yang
- Department of Neurology, Suzhou Yongding Hospital, Suzhou, 215028, China
| | - Hao Li
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Qian Feng
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Wei Ge
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221600, China.
| | - Xingshun Xu
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
- Institute of Neuroscience, Soochow University, Suzhou, 215123, China.
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Soochow University, Suzhou, 215123, Jiangsu, China.
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Sobolewska-Nowak J, Wachowska K, Nowak A, Orzechowska A, Szulc A, Płaza O, Gałecki P. Exploring the Heart-Mind Connection: Unraveling the Shared Pathways between Depression and Cardiovascular Diseases. Biomedicines 2023; 11:1903. [PMID: 37509542 PMCID: PMC10377477 DOI: 10.3390/biomedicines11071903] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
Civilization diseases are defined as non-communicable diseases that affect a large part of the population. Examples of such diseases are depression and cardiovascular disease. Importantly, the World Health Organization warns against an increase in both of these. This narrative review aims to summarize the available information on measurable risk factors for CVD and depression based on the existing literature. The paper reviews the epidemiology and main risk factors for the coexistence of depression and cardiovascular disease. The authors emphasize that there is evidence of a link between depression and cardiovascular disease. Here, we highlight common risk factors for depression and cardiovascular disease, including obesity, diabetes, and physical inactivity, as well as the importance of the prevention and treatment of CVD in preventing depression and other mental disorders. Conversely, effective treatment of CVD can also help prevent depression and improve mental health outcomes. It seems advisable to introduce screening tests for depression in patients treated for cardiac reasons. Importantly, in patients treated for mood disorders, it is worth controlling CVD risk factors, for example, by checking blood pressure and pulse during routine visits. It is also worth paying attention to the mental condition of patients with CVD. This study underlines the importance of interdisciplinary co-operation.
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Affiliation(s)
| | - Katarzyna Wachowska
- Department of Adult Psychiatry, Medical Univeristy of Lodz, 90-419 Lodz, Poland
| | - Artur Nowak
- Department of Immunopathology, Medical Univeristy of Lodz, 90-419 Lodz, Poland
| | - Agata Orzechowska
- Department of Adult Psychiatry, Medical Univeristy of Lodz, 90-419 Lodz, Poland
| | - Agata Szulc
- Psychiatric Clinic of the Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Olga Płaza
- Psychiatric Clinic of the Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Piotr Gałecki
- Department of Adult Psychiatry, Medical Univeristy of Lodz, 90-419 Lodz, Poland
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Sun S, Li Z, Xiao Q, Tan S, Hu B, Jin H. An updated review on prediction and preventive treatment of post-stroke depression. Expert Rev Neurother 2023; 23:721-739. [PMID: 37427452 DOI: 10.1080/14737175.2023.2234081] [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: 04/17/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Post-stroke depression (PSD), one of the most common complications following stroke, affects approximately one-third of stroke patients and is significantly associated with increased disability and mortality as well as decreased quality of life, which makes it an important public health concern. Treatment of PSD significantly ameliorates depressive symptoms and improves the prognosis of stroke. AREAS COVERED The authors discuss the critical aspects of the clinical application of prediction and preventive treatment of PSD. Then, the authors update the biological factors associated with the onset of PSD. Furthermore, they summarize the recent progress in pharmacological preventive treatment in clinical trials and propose potential treatment targets. The authors also discuss the current roadblocks in the preventive treatment of PSD. Finally, the authors put postulate potential directions for future studies so as to discover accurate predictors and provide individualized preventive treatment. EXPERT OPINION Sorting out high-risk PSD patients using reliable predictors will greatly assist PSD management. Indeed, some predictors not only predict the incidence of PSD but also predict prognosis, which indicates that they might also aid the development of an individualized treatment scheme. Preventive application of antidepressants may also be considered.
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Affiliation(s)
- Shuai Sun
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhifang Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qinghui Xiao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Senwei Tan
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Zhang X, Wang X, Wang S, Zhang Y, Wang Z, Yang Q, Wang S, Cao R, Yu B, Zheng Y, Dang Y. Machine learning algorithms assisted identification of post-stroke depression associated biological features. Front Neurosci 2023; 17:1146620. [PMID: 36968495 PMCID: PMC10030717 DOI: 10.3389/fnins.2023.1146620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesPost-stroke depression (PSD) is a common and serious psychiatric complication which hinders functional recovery and social participation of stroke patients. Stroke is characterized by dynamic changes in metabolism and hemodynamics, however, there is still a lack of metabolism-associated effective and reliable diagnostic markers and therapeutic targets for PSD. Our study was dedicated to the discovery of metabolism related diagnostic and therapeutic biomarkers for PSD.MethodsExpression profiles of GSE140275, GSE122709, and GSE180470 were obtained from GEO database. Differentially expressed genes (DEGs) were detected in GSE140275 and GSE122709. Functional enrichment analysis was performed for DEGs in GSE140275. Weighted gene co-expression network analysis (WGCNA) was constructed in GSE122709 to identify key module genes. Moreover, correlation analysis was performed to obtain metabolism related genes. Interaction analysis of key module genes, metabolism related genes, and DEGs in GSE122709 was performed to obtain candidate hub genes. Two machine learning algorithms, least absolute shrinkage and selection operator (LASSO) and random forest, were used to identify signature genes. Expression of signature genes was validated in GSE140275, GSE122709, and GSE180470. Gene set enrichment analysis (GSEA) was applied on signature genes. Based on signature genes, a nomogram model was constructed in our PSD cohort (27 PSD patients vs. 54 controls). ROC curves were performed for the estimation of its diagnostic value. Finally, correlation analysis between expression of signature genes and several clinical traits was performed.ResultsFunctional enrichment analysis indicated that DEGs in GSE140275 enriched in metabolism pathway. A total of 8,188 metabolism associated genes were identified by correlation analysis. WGCNA analysis was constructed to obtain 3,471 key module genes. A total of 557 candidate hub genes were identified by interaction analysis. Furthermore, two signature genes (SDHD and FERMT3) were selected using LASSO and random forest analysis. GSEA analysis found that two signature genes had major roles in depression. Subsequently, PSD cohort was collected for constructing a PSD diagnosis. Nomogram model showed good reliability and validity. AUC values of receiver operating characteristic (ROC) curve of SDHD and FERMT3 were 0.896 and 0.964. ROC curves showed that two signature genes played a significant role in diagnosis of PSD. Correlation analysis found that SDHD (r = 0.653, P < 0.001) and FERM3 (r = 0.728, P < 0.001) were positively related to the Hamilton Depression Rating Scale 17-item (HAMD) score.ConclusionA total of 557 metabolism associated candidate hub genes were obtained by interaction with DEGs in GSE122709, key modules genes, and metabolism related genes. Based on machine learning algorithms, two signature genes (SDHD and FERMT3) were identified, they were proved to be valuable therapeutic and diagnostic biomarkers for PSD. Early diagnosis and prevention of PSD were made possible by our findings.
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Affiliation(s)
- Xintong Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiangyu Wang
- Department of Rehabilitation Medicine, The Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, China
| | - Shuwei Wang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Yingjie Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zeyu Wang
- Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Qingyan Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Song Wang
- Department of Neurological Rehabilitation, Wuxi Yihe Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Risheng Cao
- Department of Science and Technology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Risheng Cao,
| | - Binbin Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Binbin Yu,
| | - Yu Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Yu Zheng,
| | - Yini Dang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- *Correspondence: Yini Dang,
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Ai Z, Liu Y, Shi X, Hu W, Zhang Y, An R, Lei G. The Protective Effects of Apple Pectin and Citrus Pectins on Post-Cerebral I/R Depression in Mice: The Role of NF-κB-p65 and pSTAT3 pathways. ARAB J CHEM 2023. [DOI: 10.1016/j.arabjc.2023.104864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Chen H, Huang X, Zeng C, Sun D, Liu F, Zhang J, Liao Q, Luo S, Xu W, Xiao Y, Zeng D, Song M, Tian F. The role of indoleamine 2,3-dioxygenase 1 in early-onset post-stroke depression. Front Immunol 2023; 14:1125634. [PMID: 36911716 PMCID: PMC9998486 DOI: 10.3389/fimmu.2023.1125634] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Background The immune-inflammatory response has been widely considered to be involved in the pathogenesis of post-stroke depression (PSD), but there is ambiguity about the mechanism underlying such association. Methods According to Diagnostic and Statistical Manual of Mental Disorders (5th edition), depressive symptoms were assessed at 2 weeks after stroke onset. 15 single nucleotide polymorphisms (SNPs) in genes of indoleamine 2,3-dioxygenase (IDO, including IDO1 and IDO2) and its inducers (including pro-inflammatory cytokines interferon [IFN]-γ, tumor necrosis factor [TNF]-α, interleukin [IL]-1β, IL-2 and IL-6) were genotyped using SNPscan™ technology, and serum IDO1 levels were detected by double-antibody sandwich enzyme-linked immune-sorbent assay. Results Fifty-nine patients (31.72%) were diagnosed with depression at 2 weeks after stroke onset (early-onset PSD). The IDO1 rs9657182 T/T genotype was independently associated with early-onset PSD (adjusted odds ratio [OR] = 3.008, 95% confidence interval [CI] 1.157-7.822, p = 0.024) and the frequency of rs9657182 T allele was significantly higher in patients with PSD than that in patients with non-PSD (χ2 = 4.355, p = 0.037), but these results did not reach the Bonferroni significance threshold (p > 0.003). Serum IDO1 levels were also independently linked to early-onset PSD (adjusted OR = 1.071, 95% CI 1.002-1.145, p = 0.044) and patients with PSD had higher serum IDO1 levels than patients with non-PSD in the presence of the rs9657182 T allele but not homozygous C allele (t = -2.046, p = 0.043). Stroke patients with the TNF-α rs361525 G/G genotype had higher serum IDO1 levels compared to those with the G/A genotype (Z = -2.451, p = 0.014). Conclusions Our findings provided evidence that IDO1 gene polymorphisms and protein levels were involved in the development of early-onset PSD and TNF-α polymorphism was associated with IDO1 levels, supporting that IDO1 which underlie strongly regulation by cytokines may be a specific pathway for the involvement of immune-inflammatory mechanism in the pathophysiology of PSD.
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Affiliation(s)
- Hengshu Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xia Huang
- Department of Critical Care Medicine, The First People's Hospital of Huaihua, Huaihua, China
| | - Chang Zeng
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Dongren Sun
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Fan Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jingyuan Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiao Liao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Shihang Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Weiye Xu
- Department of Human Anatomy and Neurobiology, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Yeqing Xiao
- Department of Neurology, Hengyang Central Hospital, Hengyang, China
| | - Danfeng Zeng
- Department of Neurology, Xiangtan Central Hospital, Xiangtan, China
| | - Mingyu Song
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Fafa Tian
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
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Neoagaro-Oligosaccharides Ameliorate Chronic Restraint Stress-Induced Depression by Increasing 5-HT and BDNF in the Brain and Remodeling the Gut Microbiota of Mice. Mar Drugs 2022; 20:md20110725. [PMID: 36422003 PMCID: PMC9693468 DOI: 10.3390/md20110725] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Neoagaro-oligosaccharides (NAOs) belong to the algae oligosaccharides. NAOs have been found to have diverse biological activities. However, the effects of NAOs on depression and their underlying mechanism have not been thoroughly studied. A chronic restraint stress (CRS)-induced C57BL/6J mouse model was used to assess the antidepressant effects of NAOs. Anxiety and depression behaviors were assessed by open field tests (OFT) and forced swimming tests (FST), while interleukin 18 (IL-18), 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) were the molecular biomarkers of depression. Fecal microbiota transplantation (FMT) was performed. The results showed that NAO treatment significantly improved the body weight of depressed mice and reduced the central area time in the OFT and immobility time in the FST. NAO treatment decreased the levels of IL-18 in the serum and increased the levels of 5-HT in the serum and whole brain and of BDNF in the whole brain. NAO treatment mitigated the gut microbiota dysbiosis in the depressed mice and reversed the decreased levels of short-chain fatty acids (SCFAs) in the cecum of the depressed mice. FMT indicated that the gut microbiota is, indeed, linked to depression, which was reflected in the changes in weight gain and behaviors. In a word, NAOs effectively reversed the CRS-induced mice model of depression, which depended on the changes in the gut microbiota and SCFAs, as well as its modulation of 5-HT and BDNF.
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Fang C, Zhang Z, Xu H, Liu Y, Wang X, Yuan L, Xu Y, Zhu Z, Zhang A, Shao A, Lou M. Natural Products for the Treatment of Post-stroke Depression. Front Pharmacol 2022; 13:918531. [PMID: 35712727 PMCID: PMC9196125 DOI: 10.3389/fphar.2022.918531] [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: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
Post-stroke depression (PSD) is the most frequent and important neuropsychiatric consequence of stroke. It is strongly associated with exacerbated deterioration of functional recovery, physical and cognitive recoveries, and quality of life. However, its mechanism is remarkably complicated, including the neurotransmitters hypothesis (which consists of a monoaminergic hypothesis and glutamate-mediated excitotoxicity hypothesis), inflammation hypothesis, dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, and neurotrophic hypothesis and neuroplasticity. So far, the underlying pathogenesis of PSD has not been clearly defined yet. At present, selective serotonin reuptake inhibitors (SSRIs) have been used as the first-line drugs to treat patients with PSD. Additionally, more than SSRIs, a majority of the current antidepressants complied with multiple side effects, which limits their clinical application. Currently, a wide variety of studies revealed the therapeutic potential of natural products in the management of several diseases, especially PSD, with minor side effects. Accordingly, in our present review, we aim to summarize the therapeutic targets of these compounds and their potential role in-clinic therapy for patients with PSD.
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Affiliation(s)
- Chaoyou Fang
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zeyu Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Houshi Xu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yibo Liu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Xiaoyu Wang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Ling Yuan
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanzhi Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengyang Zhu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anke Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
- *Correspondence: Anke Zhang, ; Anwen Shao, ; Meiqing Lou,
| | - Anwen Shao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
- *Correspondence: Anke Zhang, ; Anwen Shao, ; Meiqing Lou,
| | - Meiqing Lou
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Anke Zhang, ; Anwen Shao, ; Meiqing Lou,
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Li Y, Zhang M, Dong C, Xue M, Li J, Wu G. Elevated Red Blood Cell Distribution Width Levels at Admission Predicts Depression After Acute Ischemic Stroke: A 3-Month Follow-Up Study. Neuropsychiatr Dis Treat 2022; 18:695-704. [PMID: 35391945 PMCID: PMC8979940 DOI: 10.2147/ndt.s351136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Red blood cell distribution width (RDW) is closely related to inflammatory-related disease markers. The present study aimed to investigate the association between the red blood cell distribution width (RDW) and post-stroke depression (PSD). PATIENTS AND METHODS A total of 414 patients with acute ischemic stroke (AIS) admitted to our hospital from June 2018 to July 2021 were consecutively enrolled and received 3 months' follow-up. According to the 17-item Hamilton Depression Scale (HAMD) assessment, they were divided into PSD group and non-PSD group. Diagnosis of PSD was made in accordance with DSM-IV. RDW was recorded within 24 hours of admission. RESULTS Among the included 414 patients, 95 (22.95%) patients were diagnosed as having PSD at 3 months after stroke. The results showed significantly higher level of RDW in patients with depression (13.69 (IQR13.24-13.88) vs. 13.56 (IQR 12.67-13.77), P<0.001) at admission than patients without depression. After adjustment for potential confounding factors, the odds ratio of PSD was 5.707 (95% CI, 2.717-11.989) for the highest tertile of RDW compared with the lowest tertile. Moreover, based on the receiver operating characteristic (ROC) curve, the optimal cutoff of RDW levels as an indicator for the prediction of PSD was projected as 13.01, which yielded a sensitivity of 83% and a specificity of 41.0%, with an area under the curve (AUC) of 0.643 (95% CI, 0.585-0.701; P = 0.012). CONCLUSION Higher RDW levels at admission were found to be correlated with PSD 3 months after stroke.
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Affiliation(s)
- Yaqiang Li
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan, 232001, Anhui, People's Republic of China.,Department of Neurology, People's Hospital of Lixin County, Lixin, 236700, Anhui, People's Republic of China
| | - Mei Zhang
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan, 232001, Anhui, People's Republic of China
| | - Chunhui Dong
- School of Medicine, Anhui University of Science and Technology, Huainan, 232001, Anhui, People's Republic of China
| | - Min Xue
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan, 232001, Anhui, People's Republic of China
| | - Jing Li
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan, 232001, Anhui, People's Republic of China
| | - Guixiang Wu
- Department of Neurology, People's Hospital of Lixin County, Lixin, 236700, Anhui, People's Republic of China
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Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis. World Neurosurg 2021; 163:e1-e42. [PMID: 34728391 DOI: 10.1016/j.wneu.2021.10.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The goal of this study was to systematically review the utility of serum biomarkers in the setting of ischemic stroke (IS) to predict long-term outcome. METHODS A systematic literature review was performed using the PubMed and MEDLINE databases for studies published between 1986-2018. All studies assessing long-term functional outcome (defined as 30 days or greater) following IS with respect to serum biomarkers were included. Data were extracted and pooled using a meta-analysis of odds ratios. RESULTS Of the total 2928 articles in the original literature search, 183 studies were ultimately selected. A total of 127 serum biomarkers were included. Biomarkers were grouped into several categories: inflammatory (32), peptide/enzymatic (30), oxidative/metabolic (28), hormone/steroid based (23), and hematologic/vascular (14). The most commonly studied biomarkers in each category were found to be CRP, S100β, albumin, copeptin, and D-dimer. With the exception of S100β, all were found to be statistically associated with >30-day outcome after ischemic stroke. CONCLUSIONS Serum-based biomarkers have the potential to predict functional outcome in IS patients. This meta-analysis has identified CRP, albumin, copeptin, and D-dimer to be significantly associated with long-term outcome after IS. These biomarkers have the potential to serve as a platform for prognosticating stroke outcomes after 30 days. These serum biomarkers, some of which are routinely ordered, can be combined with imaging biomarkers and used in artificial intelligence algorithms to provide refined predictive outcomes after injury. Ultimately these tools will assist physicians in providing guidance to families with regards to long-term independence of patients.
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Predictive Value of Red Blood Cell Distribution Width in Poststroke Depression. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:8361504. [PMID: 34335867 PMCID: PMC8315889 DOI: 10.1155/2021/8361504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/03/2021] [Indexed: 12/28/2022]
Abstract
Purpose Red blood cell distribution width (RDW) is increased in a variety of inflammatory-related diseases. However, there is no report of its clinical significance in poststroke depression (PSD). This study explores the clinical significance of RDW in PSD patients. Methods A total of 185 patients with first-ever acute ischaemic stroke (AIS) in the Second Hospital of Anhui Medical University were chosen as subjects. A retrospective observational study was conducted from February 2019 to February 2020. PSD patients were diagnosed at 6 months after stroke based on the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Clinical and laboratory data were obtained from all patients. Coefficient of Variation (RDW-CV) and standard deviation (RDW-SD) were used to statistically report the performance of red blood cell distribution width. Results At the 6-month follow-up, 46 patients were diagnosed with PSD. Compared with non-PSD patients, PSD patients exhibited an increase in RDW-CV and RDW-SD, which positively correlated with serum interleukin 6 (IL-6) concentrations. In PSD patients, only RDW-SD demonstrated a consistent positive association with the Hamilton Rating Scale for Depression (HAM-D) scores at 6 months after admission. RDW-CV, RDW-SD, and IL-6 were recognized as independent predictors of PSD. The area under the receiver operating characteristic (ROC) curve (AUC) of RDW-SD was 0.796 (95% CI: 0.731-0.852) for the prediction of PSD, which was superior to that of RDW-CV. The specificity for predicting PSD was 60.43%, and the sensitivity was 91.30% if RDW-SD was higher than 43.80 fL. Conclusions RDW-SD is a simple, inexpensive, rapid, and easily accessible parameter that can be used to predict PSD in patients with stroke.
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Korostynski M, Hoinkis D, Piechota M, Golda S, Pera J, Slowik A, Dziedzic T. Toll-like receptor 4-mediated cytokine synthesis and post-stroke depressive symptoms. Transl Psychiatry 2021; 11:246. [PMID: 33903586 PMCID: PMC8076201 DOI: 10.1038/s41398-021-01359-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022] Open
Abstract
Altered cytokine synthesis thought to contribute to the pathophysiology of post-stroke depression (PSD). Toll-like receptor 4 (TLR4) is a master regulator of innate immunity. The aim of this study was to explore the putative association between TLR4-mediated cytokine synthesis and subsequent symptoms of PSD. In total, 262 patients with ischemic stroke and without a history of PSD were included. Depressive symptoms were assessed using the Patient Health Questionnaire-9 in 170 patients on Day 8 and in 146 at 3 months after stroke. Blood samples taken on Day 3 after stroke were stimulated ex vivo with lipopolysaccharide (LPS). Ex vivo synthesized cytokines (TNFα, IP-10, IL-1β, IL-6, IL-8, IL-10, and IL-12p70) and circulating cytokines (TNFα, IL-6, sIL-6R, and IL-1ra) were measured using the enzyme-linked immunoassay or cytometric method. RNA sequencing was used to determine the gene expression profile of LPS-induced cytokines and chemokines. LPS-induced cytokine synthesis and the gene expression of TLR4-dependent cytokines and chemokines did not differ between patients with and without greater depressive symptoms. The plasma level of IL-6, but not TNFα, sIL-6R, and IL-1ra, was higher in patients who developed depressive symptoms at 3 months after stroke (median: 4.7 vs 3.4 pg/mL, P = 0.06). Plasma IL-6 predicted the severity of depressive symptoms at 3 months after stroke (β = 0.42, P = 0.03). In conclusion, TLR4-dependent cytokine synthesis was not associated with greater post-stroke depressive symptoms in this study. Circulating IL-6 might be associated with depressive symptoms occurring at 3 months after stroke.
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Affiliation(s)
- Michal Korostynski
- grid.418903.70000 0001 2227 8271Department of Molecular Neuropharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | | | - Marcin Piechota
- grid.418903.70000 0001 2227 8271Department of Molecular Neuropharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | - Slawomir Golda
- grid.418903.70000 0001 2227 8271Department of Molecular Neuropharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | - Joanna Pera
- grid.5522.00000 0001 2162 9631Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Slowik
- grid.5522.00000 0001 2162 9631Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dziedzic
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
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17
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Wijeratne T, Sales C. Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression. J Clin Med 2021; 10:jcm10081674. [PMID: 33919670 PMCID: PMC8069768 DOI: 10.3390/jcm10081674] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions.
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Affiliation(s)
- Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne 3000, Australia
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapura 50000, Sri Lanka
- Correspondence:
| | - Carmela Sales
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
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18
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Ribeiro NF, Madruga L. A sudden and severe depressive episode after a left cingulate gyrus stroke: a case report of post-stroke depression and review of literature. J Neural Transm (Vienna) 2021; 128:711-716. [PMID: 33825944 DOI: 10.1007/s00702-021-02334-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
Post-stroke depression is a frequent complication of cerebrovascular lesions and mainly occurs within the first 6 months after stroke. Stroke patients who develop depression have slower recovery, greater disability, and higher mortality rates. The pathophysiology of post-stroke depression is not yet clearly defined, but studies suggest contributions from both psychosocial factors and stroke-related factors, such as lesions affecting the frontal-subcortical circuits. Early treatment has a positive impact on post-stroke rehabilitation outcome and survival. We present the case of an 82-year-old man with no psychiatric history who was brought to the psychiatric emergency department after two suicide attempts in the span of 7 days. He was severely depressed, with feelings of hopelessness, insomnia, and suicidal ideation. He had suffered a stroke the week before, affecting the anterior portion of the left cingulate gyrus, causing right hemiparesis and paresthesia. The psychiatric symptoms developed immediately after the stroke and were not present before the event. He was admitted to the psychiatry ward, treated with sertraline 100 mg/day and quetiapine 50 mg/day and discharged within 28 days, after full remission of symptoms. Our case strengthens the association between lesions located to the frontal-subcortical circuits and post-stroke depression. Physicians should be vigilant regarding the occurrence of depression in stroke patients, especially those who suffer lesions affecting the frontal-subcortical circuits and related regions.
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Affiliation(s)
- Nuno Filipe Ribeiro
- Department of Psychiatry and Mental Health, Setúbal Hospital Center, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal.
| | - Luís Madruga
- Department of Psychiatry and Mental Health, Setúbal Hospital Center, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal
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19
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Wei X, Yu L, Zhang Y, Li X, Wu H, Jiang J, Qing Y, Miao Z, Fang Q. The Role of Tet2-mediated Hydroxymethylation in Poststroke Depression. Neuroscience 2021; 461:118-129. [PMID: 33689862 DOI: 10.1016/j.neuroscience.2021.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022]
Abstract
Poststroke depression (PSD) is a common complication of stroke and has long been a serious threat to human health. PSD greatly affects neurological recovery, quality of life and mortality. Recent studies have shown that 5-hydroxymethylcytosine (5hmC), an important epigenetic modification, is enriched in the brain and associated with many neurological diseases. However, its role in PSD is still unclear. In this study, middle cerebral artery occlusion (MCAO) and spatial restraint stress were used to successfully induce a PSD mouse model and resulted in reduced 5hmC levels, which were caused by Tet2. Furthermore, genome-wide analysis of 5hmC revealed that differentially hydroxymethylated regions (DhMRs) were associated with PSD. DhMRs were enriched among genes involved in the Wnt signaling pathway, neuron development and learning or memory. In particular,DhMRs were strongly enriched in genes with lymphoid enhancer factor 1 (LEF1) binding motifs. Finally, we demonstrated that decreases in TET2 expression in the brain caused PSD by decreasing Wnt/β-catenin/LEF1 pathway signaling to promote inflammatory factor IL-18 expression. In conclusion, our data highlight the potential for 5hmC modification as a therapeutic target for PSD.
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Affiliation(s)
- Xin Wei
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Liqiang Yu
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Yujuan Zhang
- Experiment Center, Medicine College of Soochow University, Suzhou City, China
| | - Xiaojing Li
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu, China; Department of Neurology, Suzhou Science and Technology Town Hospital, Suzhou, Jiangsu, China
| | - Hainan Wu
- College of Forestry, Nanjing Forestry University, Nanjing City, Jiangsu, China
| | - Jianhua Jiang
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Yiren Qing
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Zhigang Miao
- Institute of Neuroscience, Soochow University, Suzhou City, China; Jiangsu Key Laboratory of Neuropsychiatric Diseases, Soochow University, Suzhou, Jiangsu 215123, China.
| | - Qi Fang
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou City, China.
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20
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Sarkar A, Sarmah D, Datta A, Kaur H, Jagtap P, Raut S, Shah B, Singh U, Baidya F, Bohra M, Kalia K, Borah A, Wang X, Dave KR, Yavagal DR, Bhattacharya P. Post-stroke depression: Chaos to exposition. Brain Res Bull 2020; 168:74-88. [PMID: 33359639 DOI: 10.1016/j.brainresbull.2020.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022]
Abstract
Cerebral ischemia contributes to significant disabilities worldwide, impairing cognitive function and motor coordination in affected individuals. Stroke has severe neuropsychological outcomes, the major one being a stroke. Stroke survivors begin to show symptoms of depression within a few months of the incidence that overtime progresses to become a long-term ailment. As the pathophysiology for the progression of the disease is multifactorial and complex, it limits the understanding of the disease mechanism completely. Meta-analyses and randomized clinical trials have shown that intervening early with tricyclic antidepressants and selective serotonin receptor inhibitors can be effective. However, these pharmacotherapies possess several limitations that have given rise to newer approaches such as brain stimulation, psychotherapy and rehabilitation therapy, which in today's time are gaining attention for their beneficial results in post-stroke depression (PSD). The present review highlights numerous factors like lesion location, inflammatory mediators and genetic abnormalities that play a crucial role in the development of depression in stroke patients. Further, we have also discussed various mechanisms involved in post-stroke depression (PSD) and strategies for early detection and diagnosis using biomarkers that may revolutionize treatment for the affected population. Towards the end, along with the preclinical scenario, we have also discussed the various treatment approaches like pharmacotherapy, traditional medicines, psychotherapy, electrical stimulation and microRNAs being utilized for effectively managing PSD.
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Affiliation(s)
- Ankan Sarkar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Deepaneeta Sarmah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Aishika Datta
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Harpreet Kaur
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Priya Jagtap
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Swapnil Raut
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Birva Shah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Upasna Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Falguni Baidya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Mariya Bohra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Kiran Kalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India
| | - Anupom Borah
- Cellular and Molecular Neurobiology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, Assam, India
| | - Xin Wang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Kunjan R Dave
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pallab Bhattacharya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India.
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21
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Interleukin-18 from neurons and microglia mediates depressive behaviors in mice with post-stroke depression. Brain Behav Immun 2020; 88:411-420. [PMID: 32272223 DOI: 10.1016/j.bbi.2020.04.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/23/2020] [Accepted: 04/04/2020] [Indexed: 02/07/2023] Open
Abstract
Post-stroke depression (PSD) is a common and serious complication that is affecting one thirds of stroke patients which leaves them with a poor quality of life, high mortality rate, high recurrent rate, and slow recovery. Recent studies showed that serum interleukin-18 (IL-18) level is a biomarker for patients with PSD. However, the role of IL-18 in the pathology of PSD is still unclear. In this study, we demonstrated that the IL-18 level in the ischemic brain significantly increased in mice with depression-like behaviors that were caused by the combined use of chronic spatial restraint stress and middle cerebral artery occlusion. Interestingly, IL-18 expression was mainly found in neurons at early phase and in microglia at a later phase. Injection of the exogenous IL-18 into the amygdala, but not the hippocampus or the striatum caused severe depression-like behaviors. On the contrary, the blockage of endogenous IL-18 by IL-18 binding protein, a specific antagonist of IL-18, repressed depressive phenotypes in SIR mice. IL-18 KO mice exhibited the resistance to spatial restraint stress and cerebral ischemia injury. Finally, we found that IL-18 mediated depressive behaviors by the interaction of IL-18 receptor and NKCC1, a sodium-potassium chloride co-transporter that is related to GABAergic inhibition. Administration of NKCC1 antagonist bumetanide exerted a therapeutic effect on the in IL-18-induced depressive mice. In conclusion, we demonstrated that increased IL-18 in the brain causes depression-like behaviors by promoting the IL-18 receptor/NKCC1 signaling pathway. Targeting IL-18 and its downstream pathway is a promising strategy for the prevention and treatment of PSD.
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22
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23
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Chen Y, Pu J, Liu Y, Tian L, Chen X, Gui S, Xu S, Song X, Xie P. Pro-inflammatory cytokines are associated with the development of post-stroke depression in the acute stage of stroke: A meta-analysis. Top Stroke Rehabil 2020; 27:620-629. [PMID: 32316861 DOI: 10.1080/10749357.2020.1755813] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Pro-inflammatory cytokines may be associated with post-stroke depression (PSD); however, results from different studies are inconsistent.Objectives: To investigate whether pro-inflammatory cytokines are associated with the development of PSD in acute stroke.Methods: PubMed, Embase, and Web of science were searched for relevant literature. Meta-analyzes were performed to determine whether the baseline blood concentrations of pro-inflammatory cytokines differed between acute stroke patients with and without depression. Sensitivity analyzes and regression analyzes were conducted to explore sources of heterogeneity.Results: We included 889 acute stroke patients from eight original studies, 312 of whom developed PSD and 577 did not. The serum concentrations of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were higher in the PSD group, compared with the non-PSD group (IL-6: SMD = 1.26, 95% CI = [0.55, 1.97], P < 0.001; TNF-α: SMD = 0.61, 95% CI = [0.13, 1.10], P = 0.010).Conclusions: This study indicates IL-6 and TNF-α as potential biomarkers of PSD in the acute stage of stroke and provides theoretical support for the early prevention and treatment of PSD.
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Affiliation(s)
- Yue Chen
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juncai Pu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yiyun Liu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Lu Tian
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiang Chen
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Siwen Gui
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Shaohua Xu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemian Song
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Liu FR, Yang LY, Zheng HF, Zhou Y, Chen BB, Xu H, Zhang YW, Shen DY. Plasma levels of Interleukin 18 but not amyloid-β or Tau are elevated in female depressive patients. Compr Psychiatry 2020; 97:152159. [PMID: 31931428 DOI: 10.1016/j.comppsych.2020.152159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/20/2019] [Accepted: 12/31/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Depression is associated with inflammation and Alzheimer's disease (AD). However, detailed molecular mechanisms linking mood, neuroinflammation and AD remain unclear. Although changes in peripheral inflammatory factors such as Interleukin 18 (IL18), and AD-associated amyloid-β (Aβ) peptides have been linked to depression, a solid relationship between these factors in depressive disorder has yet to be established. This study aims to further determine whether plasma IL18, Aβ40, Aβ42, and the AD-associated tangle component Tau, as well as IL18 single nucleotide polymorphisms (SNPs) may be biomarkers for depression. METHODS We measured plasma IL18, Aβ40, Aβ42, and Tau in 64 depressive patients and 75 healthy controls, and characterized genotypes of three IL18 SNPs (rs187238, rs1946518 and rs1946519) in these subjects. Comparisons between depressive patients and controls were carried out in males, in females or in combination. Regression analyses were conducted to examine the correlation between these parameters. RESULTS We found that none of the plasma levels of IL18, Aβ40, Aβ42, and Tau, the ratio of Aβ42/Aβ40, and the genotypes of IL18 SNPs were significantly different between combined depressive patients and combined healthy controls, or between male depressive patients and male controls. However, IL18 levels were less in females than in males in healthy people and were significantly increased in female depressive patients compared to female controls. Moreover, IL18 and standardized IL18 were correlated with standardized Aβ42/Aβ40 ratio and standardized Tau in depressive patients. CONCLUSIONS Plasma IL18 may be a potential biomarker for depression in women.
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Affiliation(s)
- Fa-Rong Liu
- Department of Psychology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China; Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Xiamen University, Xiamen, Fujian, China; Xiamen City Xianyue Hospital, Xiamen, Fujian, China
| | - Lu-Yin Yang
- Arts College of Xiamen University, Xiamen, Fujian, China
| | | | - Yunqiang Zhou
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Bin-Bin Chen
- Xiamen City Xianyue Hospital, Xiamen, Fujian, China
| | - Huaxi Xu
- Neuroscience Initiative, Sanford-Burnham-Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Yun-Wu Zhang
- Fujian Provincial Key Laboratory of Neurodegenerative Disease and Aging Research, Institute of Neuroscience, School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Dong-Yan Shen
- Center Laboratory, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China.
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Xie J, Han Y, Hong Y, Li WW, Pei Q, Zhou X, Zhang B, Wang Y. Identification of Potential Metabolite Markers for Middle-Aged Patients with Post-Stroke Depression Using Urine Metabolomics. Neuropsychiatr Dis Treat 2020; 16:2017-2024. [PMID: 32922015 PMCID: PMC7457842 DOI: 10.2147/ndt.s271990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is one of the most common complications in stroke survivors. But, there are still no objective methods to diagnose PSD. This study aims to identify potential biomarkers for diagnosing PSD in middle-aged stroke survivors. METHODS Middle-aged subjects aged 30 to 59 years (92 PSD patients and 89 stroke survivors without depression) were included in this study. Urinary metabolites were detected by gas chromatography-mass spectrometry (GC-MS). Differential urinary metabolites and potential biomarkers were screened by applying statistical analysis. RESULTS The different urinary metabolic phenotypes between PSD patients and stroke survivors without depression were identified. A total of 12 differential urinary metabolites were accurately identified by using orthogonal partial least-squares-discriminant analysis. After analyzing those 12 differential urinary metabolites by step-wise logistic regression analysis, only seven metabolites (palmitic acid, hydroxylamine, myristic acid, glyceric acid, lactic acid, tyrosine and azelaic acid) were finally selected as potential biomarkers for diagnosing PSD in middle-aged stroke survivors. A panel consisting of these potential biomarkers could effectively diagnose middle-aged PSD patients. CONCLUSION Urinary metabolic profiles were different between middle-aged PSD patients and stroke survivors without depression. Our results would be helpful in future for developing an objective method to diagnose PSD in middle-aged stroke survivors.
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Affiliation(s)
- Jing Xie
- Chongqing Emergency Medical Center, Department of Endocrinology and Nephrology, The Fourth People's Hospital of Chongqing, Central Hospital of Chongqing University, Chongqing 400014, People's Republic of China
| | - Yu Han
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Yueling Hong
- Institute of Life Sciences, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Wen-Wen Li
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Qilin Pei
- Institute of Life Sciences, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Xueyi Zhou
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Bingbing Zhang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, People's Republic of China
| | - Ying Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400000, People's Republic of China
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Lu X, Duan J, Cheng Q, Lu J. The association between serum growth differentiation factor-15 and 3-month depression after acute ischemic stroke. J Affect Disord 2020; 260:695-702. [PMID: 31561112 DOI: 10.1016/j.jad.2019.09.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/17/2019] [Accepted: 09/08/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to assess the association between serum growth differentiation factor-15(GDF-15) and 3-month depression after acute ischemic stroke. METHODS In this single-center prospective study, patients with first-ever acute ischemic stroke between March 2017 and November 2018 were included. Neurological and neuropsychological evaluations were conducted during the 3-month follow-up. The predictive value of GDF-15 to predict the post-stroke depression (PSD) within 3 months, was compared with other known predictors. RESULTS The median level of GDF-15 in 310 stroke patients was 1285(IQR, 846-1934) ng/l. During the 3-month follow-up, 76 patients were defined as depression (24.5%; 95% confidence interval [CI]: 17.9%-29.3%), and GDF-15 levels in those patients were nearly more than 1 time greater as compared with patients who were free of depression (P < 0.001). Using the ROC curves, GDF-15 serum level at 1660 ng/l predicted the PSD with the highest sensitivity and specificity [67.1% and 77.4%, respectively; AUC=0.78, 95%CI: 0.72-0.84; P < 0.001]. Interestingly, When GDF-15 was added to the model containing established significant risk factors, AUROC (standard error) was increased from 0.81(0.029) to 0.88(0.020). A significant difference in the AUC between the established risk factors alone and the addition of GDF-15 was observed (difference, 0.07[0.009]; P = 0.001). In a multivariate model using the elevated levels of GDF-15 (≥cut-off=1660 ng/l) vs. normal (<cut-off) together with the other significant clinical variables, the marker displayed predictive information (PSD: OR = 4.11 [95% CI, 2.05-6.32]; P < 0.001]). CONCLUSIONS In summary, GDF-15 serum levels at admission are associated with depression later developed in patients with ischemic stroke.
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Affiliation(s)
- Xiurong Lu
- Department of Neurology, Central Hospital of Zhoukou, No. 26, Renmin Road, Zhoukou, 646000, Henan Province, PR China.
| | - Jinfeng Duan
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Qian Cheng
- Department of Neurology, Central Hospital of Zhoukou, No. 26, Renmin Road, Zhoukou, 646000, Henan Province, PR China
| | - Junli Lu
- Department of Anus and Bowel, Central Hospital of Zhoukou, Zhoukou, PR China
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Chen MX, Liu Q, Cheng S, Lei L, Lin AJ, Wei R, K Hui TC, Li Q, Ao LJ, Sham PC. Interleukin-18 levels in the hippocampus and behavior of adult rat offspring exposed to prenatal restraint stress during early and late pregnancy. Neural Regen Res 2020; 15:1748-1756. [PMID: 32209782 PMCID: PMC7437598 DOI: 10.4103/1673-5374.276358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Exposure to maternal stress during prenatal life is associated with an increased risk of neuropsychiatric disorders, such as depression and anxiety, in offspring. It has also been increasingly observed that prenatal stress alters the phenotype of offspring via immunological mechanisms and that immunological dysfunction, such as elevated interleukin-18 levels, has been reported in cultures of microglia. Prenatal restraint stress (PRS) in rats permits direct experimental investigation of the link between prenatal stress and adverse outcomes. However, the majority of studies have focused on the consequences of PRS delivered in the second half of pregnancy, while the effects of early prenatal stress have rarely been examined. Therefore, pregnant rats were subjected to PRS during early/middle and late gestation (days 8-14 and 15-21, respectively). PRS comprised restraint in a round plastic transparent cylinder under bright light (6500 lx) three times per day for 45 minutes. Differences in interleukin-18 expression in the hippocampus and in behavior were compared between offspring rats and control rats on postnatal day 75. We found that adult male offspring exposed to PRS during their late prenatal periods had higher levels of anxiety-related behavior and depression than control rats, and both male and female offspring exhibited higher levels of depression-related behavior, impaired recognition memory and diminished exploration of novel objects. Moreover, an elevated level of interleukin-18 was observed in the dorsal and ventral hippocampus of male and female early- and late-PRS offspring rats. The results indicate that PRS can cause anxiety and depression-related behaviors in adult offspring and affect the expression of interleukin-18 in the hippocampus. Thus, behavior and the molecular biology of the brain are affected by the timing of PRS exposure and the sex of the offspring. All experiments were approved by the Animal Experimentation Ethics Committee at Kunming Medical University, China (approval No. KMMU2019074) in January 2019.
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Affiliation(s)
- Mo-Xian Chen
- School of Rehabilitation, Kunming Medical University, Kunming, Yunnan Province, China
| | - Qiang Liu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shu Cheng
- Department of Rehabilitation, China Resources & WISCO General Hospital, Wuhan, Hubei Province, China
| | - Lei Lei
- Department of Rehabilitation Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Ai-Jin Lin
- School of Rehabilitation, Kunming Medical University, Kunming, Yunnan Province, China
| | - Ran Wei
- Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Tomy C K Hui
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Qi Li
- Department of Psychiatry; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Li-Juan Ao
- School of Rehabilitation, Kunming Medical University, Kunming, Yunnan Province, China
| | - Pak C Sham
- Department of Psychiatry; State Key Laboratory of Brain and Cognitive Sciences; Centre for Genomic Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Kozak HH, Uğuz F, Kılınç İ, Uca AU, Tokgöz OS, Güney F, Özer N. A cross-sectional study to assess the association between major depression and inflammatory markers in patients with acute ischemic stroke. Indian J Psychiatry 2019; 61:283-289. [PMID: 31142907 PMCID: PMC6532476 DOI: 10.4103/psychiatry.indianjpsychiatry_175_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Increased interest in the relationship between affective disorder and long-term health consequences has generated recent examinations of depression and stroke. Observations suggest that depressive disorder is associated with abnormal physiological and immunological responses and a resultant increase in inflammatory markers. Given the high prevalence of stroke and associated costs for the community, it is important to understand the mechanisms that may impact on the outcome to achieve the best possible prognosis. AIMS The view that inflammatory factors contribute to depression is predicated on findings that circulating cytokines and other inflammatory factors are increased in depressed patients. Therefore, it has been hypothesized that inflammation could be one of the mechanisms by which depression increases risk for ischemic stroke. Our aim was to determine whether there is any relationship between major depression and tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-18, brain-derived neurotrophic factor (BDNF), and neuron-specific enolase (NSE) in patients with acute ischemic stroke (AIS). STUDY DESIGN This was as a cross-sectional design. MATERIALS AND METHODS This study has a cross-sectional design, and it was conducted in Necmettin Erbakan University, the Meram Faculty of Medicine in Konya, Turkey, between 2014 and 2015. Fifty-three AIS patients admitted to the hospital within the first 24 h after stroke onset were recruited. Major depression was ascertained by means of the structured clinical interview for the diagnostic and statistical manual of mental disorders, Fourth Edition/Clinical Version. The enzyme-linked immunosorbent assay was used to measure the serum levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE at admission. RESULTS A total of 53 patients with a mean age of 65.9 years were recruited. Of these patients, 17 (32.1%) had major depression. Depressive and nondepressive patients had similar demographical and clinical features. There was no significant statistical difference between depressive and nondepressive patients with AIS with respect to levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE. CONCLUSION This study suggests that in patients who have experienced AIS, there is no significant relationship between major depression and basal proinflammatory cytokines (TNF-α, IL-1 β, IL-18), BDNF, and NSE.
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Affiliation(s)
- Hasan Hüseyin Kozak
- Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Faruk Uğuz
- Department of Pyschiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - İbrahim Kılınç
- Department of Clinical Biochemistry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Ulvi Uca
- Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Osman Serhat Tokgöz
- Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Figen Güney
- Department of Neurology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Nejla Özer
- Department of Clinical Biochemistry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Huang G, Chen H, Wang Q, Hong X, Hu P, Xiao M, Shu M, He J. High platelet-to-lymphocyte ratio are associated with post-stroke depression. J Affect Disord 2019; 246:105-111. [PMID: 30578944 DOI: 10.1016/j.jad.2018.12.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/26/2018] [Accepted: 12/08/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Post-stroke depression (PSD) is the most common psychological consequence among stroke patients, and inflammatory cytokines have cited as risk factors in PSD. We aimed to evaluate the predictive value of stratification of PLR (platelet-to-lymphocyte ratio), an inflammatory marker, in PSD patients. METHODS A total of 363 acute ischemic stroke (AIS) patients were screened in the study and received 1-month follow-up. All of the patients were categorized into equal tertiles according to the number of patients and the distribution of PLR. PSD status was evaluated by 17-item Hamilton Depression Rating Scale at 1 month after stroke RESULTS: The optimal cut-off points of PLR were: (T1) 42.15-99.60, (T2) 99.72-127.92, (T3) 127.93-259.84. A total of 77 patients (21.2%) were diagnosed with PSD at 1-month follow-up. Significant differences were found between the PSD and non-PSD groups in PLR tertiles of patients (P < 0.001). After adjustment for conventional confounding factors, the odds ratio of PSD was 5.154 (95% CI, 1.933-13.739) for the highest tertile of PLR compared with the lowest tertile. In multiple-adjusted spline regression, continuously PLR showed linear relation with PSD risk after 95 (P < 0.001 for linearity). LIMITATIONS We excluded patients with severe aphasia or serious conditions. In addition, the PLR was recorded only at admission, which limited us explore the correlation of the change of PLR over time with PSD CONCLUSIONS: Increased PLR at admission is a significant and independent biomarker to predict the development of PSD, and stratified PLR could strengthen the predictive power for PSD patients.
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Affiliation(s)
- Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Huijun Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Qiongzhang Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Xianchai Hong
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Pinglang Hu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Meijuan Xiao
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Meichun Shu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China.
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Baccaro A, Wang YP, Candido M, Conforto AB, Brunoni AR, Leite CDC, Busatto Filho G, Lotufo PA, Benseñor IM, Goulart AC. Post-stroke depression and cognitive impairment: Study design and preliminary findings in a Brazilian prospective stroke cohort (EMMA study). J Affect Disord 2019; 245:72-81. [PMID: 30368073 DOI: 10.1016/j.jad.2018.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 09/13/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Post-stroke depression (PSD) and cognitive impairment (PCI) are common conditions. This study aims to describe the protocol and preliminary findings of an investigation into factors associated with PSD and PCI 1-3 months after stroke (subacute phase) in survivors from the Study of Stroke Mortality and Morbidity (EMMA study). METHODS Stroke patients underwent to clinical and neurological evaluations on admission to hospital. Cerebral magnetic resonance and biomarkers (serotonin, BDNF, IL-6 and IL-18) were carried out in the subacute phase. DSM-IV major depression for the diagnosis of PSD, cognitive functioning for the diagnosis of PCI and functional disability were also recorded at same time. RESULTS Of the 103 eligible patients, 85.4% had ischemic stroke and 73.7% had first-ever stroke. In the subacute phase, 27.2% had PCI and 13.6% had current PSD (5.8% with 'first episode' and 7.8% with 'recurrent' depression). PCI was associated with low education (0-7 years of formal education: 75%) and ageing (median age: 70; interquartile range: 59-75 y-old). Left-sided stroke was more frequently associated with increased PCI than right-sided stroke (71.4% vs. 28.4%, p = 0.005). PSD was neither associated with stroke laterality nor tentorial area. Overall, biomarkers levels were not alterated in patients with PSD and PCI. LIMITATIONS Findings are based on small sample and less disabled stroke participants, e.g. those without aphasia and deafness. CONCLUSIONS Findings reinforce the need of early recognition and rehabilitation of PCI and PSD, mainly among those less educated and with left-sided stroke. PSD might occur through a pathophysiological pathway other than classical depression.
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Affiliation(s)
- Alessandra Baccaro
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Laboratory of Psychiatric Neuroimaging (LIM21), Departamento de Psiquiatria, Universidade de Sao Paulo, Medical School, Brazil.
| | - Yuan-Pang Wang
- Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil; Laboratory of Medical Investigations of Psychopharmacology and Clinical Psychophysiology (LIM23), Universidade de Sao Paulo, Medical School, Brazil
| | - Miriam Candido
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil
| | - Adriana Bastos Conforto
- Department of Neurology, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil
| | - André Russowsky Brunoni
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil
| | - Claudia da Costa Leite
- Medical School, Universidade de Sao Paulo, Brazil; Nucleo de Apoio a Pesquisa em Neurociencia Aplicada (NAPNA), Universidade de Sao Paulo, Brazil; Institute of Radiology and Oncology, Hospital das Clinicas, Universidade de Sao Paulo, Brazil
| | - Geraldo Busatto Filho
- Laboratory of Psychiatric Neuroimaging (LIM21), Departamento de Psiquiatria, Universidade de Sao Paulo, Medical School, Brazil; Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil; Medical School, Universidade de Sao Paulo, Brazil; Nucleo de Apoio a Pesquisa em Neurociencia Aplicada (NAPNA), Universidade de Sao Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Medical School, Universidade de Sao Paulo, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Medical School, Universidade de Sao Paulo, Brazil
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil.
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Cai W, Ma W, Wang GT, Li YJ, Shen WD. Antidepressant, anti-inflammatory, and antioxidant effects of electroacupuncture through sonic hedgehog-signaling pathway in a rat model of poststroke depression. Neuropsychiatr Dis Treat 2019; 15:1403-1411. [PMID: 31190842 PMCID: PMC6536134 DOI: 10.2147/ndt.s205033] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/24/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Poststroke depression (PSD) is the most frequent psychological sequela after stroke. Electroacupuncture (EA) treatment is effective for PSD. The study aimed at clarifying the mechanisms of EA's antidepressant effects in a PSD rat model. Methods: We used middle cerebral artery occlusion to establish the rat model of PSD. Tests of sucrose preference and locomotor activity were performed to examine depressive-like behaviors. We measured malondialdehyde, GSH, SOD, IL6, IL1β, TNFα, and 5HT with ELISA. The hippocampal Shh-signaling pathway was assessed by Western blot. Results: EA significantly decreased sucrose preference and locomotor activities of PSD rats, reduced IL6, TNFα, increased GSH, and upregulated 5HT, and also slightly reduced IL1β and malondialdehyde, all of which were measured with ELISA. The Shh-signaling pathway assessed by Western blotting was activated by EA. Those changes were inhibited by the Shh-pathway inhibitor cyclopamine. Conclusion: EA effectively alleviated depressive-like behaviors in PSD by suppressing inflammation and oxidative stress through activation of the Shh-signaling pathway.
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Affiliation(s)
- Wa Cai
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Wen Ma
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Guan-Tao Wang
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yi-Jing Li
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Wei-Dong Shen
- Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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32
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Bränn E, Fransson E, White RA, Papadopoulos FC, Edvinsson Å, Kamali-Moghaddam M, Cunningham JL, Sundström-Poromaa I, Skalkidou A. Inflammatory markers in women with postpartum depressive symptoms. J Neurosci Res 2018; 98:1309-1321. [PMID: 30252150 DOI: 10.1002/jnr.24312] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 12/30/2022]
Abstract
Postpartum depression (PPD) is a devastating disorder affecting not only more than 10% of all women giving birth, but also the baby, the family, and the society. Compiling evidence suggests the involvement of the immune system in the pathophysiology of major depression; yet, the immune response in perinatal depression is not as well studied. The aim of this study was to investigate the alterations in peripheral levels of inflammatory biomarkers in 169 Swedish women with and without depressive symptoms according to the Edinburgh postnatal depression scale or the M.I.N.I neuropsychiatric interview at eight weeks postpartum. Among the 70 markers analyzed with multiplex proximity extension assay, five were significantly elevated in women with postpartum depressive symptoms in the adjusted LASSO logistic regression analysis: Tumor necrosis factor ligand superfamily member (TRANCE) (OR-per 1 SD increase = 1.20), Hepatocyte growth factor (HGF) (OR = 1.17) Interleukin (IL)-18 (OR = 1.06), Fibroblast growth factor 23 (FGF-23) (OR = 1.25), and C-X-C motif chemokine 1 (CXCL1) (OR 1.11). These results indicate that women with PPD have elevated levels of some inflammatory biomarkers. It is, therefore, plausible that PPD is associated with a compromised adaptability of the immune system.
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Affiliation(s)
- Emma Bränn
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Åsa Edvinsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Masood Kamali-Moghaddam
- Department of Immunology, Genetics & Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Janet L Cunningham
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | | | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Liu X, Jin X, Chen B, Liu X, Liang X, Fang X, Wu H, Fu X, Zheng H, Ding X, Duan N, Zhang Y. Effects of Kudiezi Injection on Serum Inflammatory Biomarkers in Patients with Acute Cerebral Infarction. DISEASE MARKERS 2018; 2018:7936736. [PMID: 30245755 PMCID: PMC6139219 DOI: 10.1155/2018/7936736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/28/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Kudiezi injection is a traditional Chinese medicine for acute cerebral infarction, but the exact mechanisms are poorly understood. OBJECTIVE To investigate the mechanisms of Kudiezi injection on the inflammatory response in the treatment of acute cerebral infarction. METHODS This was a prospective study of patients with acute cerebral infarction within 48 h of onset and treated between July 2012 and July 2016 at three hospitals in China. The patients were randomized to routine treatments (control group) versus routine treatments and Kudiezi injection (Kudiezi group). The National Institutes of Health Stroke Score was assessed on days 1, 3, 5, 7, and 14. The patients were tested for serum levels of pro- and anti-inflammatory cytokines (S100 calcium-binding protein B, neuron-specific enolase, interleukin-6, interleukin-10, interleukin-18, and matrix metaloproteinase-9; by enzyme-linked immunosorbent assay) immediately after admission and on days 3, 5, and 14. RESULTS Stroke scores were improved in both groups from days 1 to 14. On days 5 and 7, stroke scores in the Kudiezi group were lower than in the control group (P < 0.05). Compared with controls, the Kudiezi group had lower serum S100 calcium-binding protein B on day 14; higher interleukin-6 and interleukin-10 on day 3; lower interleukin-6 and interleukin-18 on day 5; and lower interleukin-18 and matrix metaloproteinase-9 on day 14. CONCLUSION Kudiezi injection could lead to early reduction of interleukin-6, interleukin-18, matrix metaloproteinase-9, neuron-specific enolase, and S100 calcium-binding protein B levels and increases of interleukin-10 levels in patients with acute ischemic stroke. This trial is registered with ClinicalTrials.gov NCT01636154.
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Affiliation(s)
- Xuemei Liu
- Central Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xianglan Jin
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Baoxin Chen
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohan Liu
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Liang
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiaolei Fang
- Department of Emergency, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongyun Wu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoyu Fu
- Department of Neurology, Beijing Huairou District Hospital of Chinese Medicine, Beijing, China
| | - Hong Zheng
- Central Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Ding
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Na Duan
- Department of Neurology, Beijing Huairou District Hospital of Chinese Medicine, Beijing, China
| | - Yunling Zhang
- Central Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Cheon SY, Kim EJ, Kim SY, Kim JM, Kam EH, Park JK, Koo BN. Apoptosis Signal-regulating Kinase 1 Silencing on Astroglial Inflammasomes in an Experimental Model of Ischemic Stroke. Neuroscience 2018; 390:218-230. [PMID: 30172704 DOI: 10.1016/j.neuroscience.2018.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/14/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
Abstract
Activation of the inflammasome complex contributes to the inflammatory response and cell death under pathologic conditions. The nucleotide-binding oligomerization domain-like receptor pyrin domain-containing 2 (NLRP2) inflammasome is activated in astrocytes after cerebral ischemia, which can aggravate ischemic damage. Apoptosis signal-regulating kinase 1 (ASK1) is an early activator and immune-regulator after ischemic injury, that can lead to cell death. The objective of the present study was to evaluate the role of ASK1 in controlling NLRP2 inflammasomes in astrocytes after cerebral ischemia. In a mouse model of ischemic stroke, the levels of NLRP2 inflammasome components, and interleukin (IL)-1β and IL-18, were quantified in different brain regions. In addition, an astrocyte cell line was subjected to oxygen-glucose deprivation and reperfusion (OGD/R) injury, and the levels of NLRP2 inflammasome factors, IL-1β and IL-18 were evaluated. Ischemic brain injury activated astrocytes. The levels of NLRP2 inflammasome components, IL-1β and IL-18 productions, and cell death increased in the cortex and striatum after ischemic injury. In cultured astrocytes, NLRP2 inflammasome components, IL-1β and IL-18 levels were upregulated after OGD/R. ASK1 silencing or inhibition efficiently reduced NLRP2 inflammasome components and pro-inflammatory cytokine levels in mice and cultured astrocytes. Our findings identify a key role for ASK1 in regulating astroglial inflammasomes after cerebral ischemia. We suggest ASK1 as one of the main targets for astroglial inflammasomes in ischemic stroke.
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Affiliation(s)
- So Yeong Cheon
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Jung Kim
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Kim
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Hee Kam
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Kwang Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bon-Nyeo Koo
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Villa RF, Ferrari F, Moretti A. Post-stroke depression: Mechanisms and pharmacological treatment. Pharmacol Ther 2018; 184:131-144. [DOI: 10.1016/j.pharmthera.2017.11.005] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wang Z, Shi Y, Liu F, Jia N, Gao J, Pang X, Deng F. Diversiform Etiologies for Post-stroke Depression. Front Psychiatry 2018; 9:761. [PMID: 30728786 PMCID: PMC6351464 DOI: 10.3389/fpsyt.2018.00761] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
After the onset of stroke, many patients suffer from emotional behavior changes. Approximately, one-third of stroke survivors are affected by post-stroke depression (PSD), making it a serious social and public health problem. Post-stroke depression (PSD) has an important impact on the course, recovery, and prognosis of stroke. The pathogenesis of PSD is very complex, involving many factors such as biological mechanism and social psychological mechanisms. This article provides a brief review of the hot issues related to etiologies of PSD.
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Affiliation(s)
- Zan Wang
- Department of Neurology and Neuroscience Center, The First Bethune Hospital of Jilin University, Changchun, China
| | - Yanmin Shi
- Department of Neurology and Neuroscience Center, The First Bethune Hospital of Jilin University, Changchun, China
| | - Fangfang Liu
- Department of Neurology and Neuroscience Center, The First Bethune Hospital of Jilin University, Changchun, China
| | - Nan Jia
- Department of Neurology and Neuroscience Center, The First Bethune Hospital of Jilin University, Changchun, China
| | - Junya Gao
- Department of Neurology and Neuroscience Center, The First Bethune Hospital of Jilin University, Changchun, China
| | - Xiaomin Pang
- Department of Neurology and Neuroscience Center, The First Bethune Hospital of Jilin University, Changchun, China
| | - Fang Deng
- Department of Neurology and Neuroscience Center, The First Bethune Hospital of Jilin University, Changchun, China
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Kim JM, Kang HJ, Kim JW, Bae KY, Kim SW, Kim JT, Park MS, Cho KH. Associations of Tumor Necrosis Factor-α and Interleukin-1β Levels and Polymorphisms with Post-Stroke Depression. Am J Geriatr Psychiatry 2017; 25:1300-1308. [PMID: 28844626 DOI: 10.1016/j.jagp.2017.07.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Proinflammatory cytokines have been implicated in the pathophysiology of post-stroke depression (PSD), and their production levels are influenced by the transcriptional activity of genetic polymorphisms. The present study aimed to investigate the roles of tumor necrosis factor (TNF)-α and interleukin (IL)-1β in the serum on the risk of PSD while taking into account the TNF-α -850C/T and -308G/A polymorphisms and the IL-1β -511C/T and +3953C/T polymorphisms. METHODS A total of 286 patients were evaluated at 2 weeks post stroke and 222 (78%) of these patients were followed up 1 year later. Depressive (major or minor) disorders were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria during both examinations; evaluations of cytokine concentrations and polymorphisms and demographic and clinical covariates were performed at 2 weeks. The effects of TNF-α and IL-1β concentrations and genotypes on PSD status were investigated using multivariate logistic regression models. RESULTS Higher TNF-α levels were associated with PSD at 2 weeks in the presence of the -850T allele with a significant interaction term; higher IL-1β levels were associated with PSD at 2 weeks in the presence of the -511T allele with a borderline significant interaction term and with any +3953C/T polymorphism without a significant interaction term. No associations were found with PSD at 1 year. CONCLUSIONS These findings indicate the important roles that TNF-α and IL-1β serum levels play regarding the risk of PSD, particularly during the acute phase of stroke and in patients with genetic susceptibility.
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Affiliation(s)
- Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
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Meng G, Ma X, Li L, Tan Y, Liu X, Liu X, Zhao Y. Predictors of early-onset post-ischemic stroke depression: a cross-sectional study. BMC Neurol 2017; 17:199. [PMID: 29149884 PMCID: PMC5693521 DOI: 10.1186/s12883-017-0980-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/13/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) seriously affects the rehabilitation of nerve function and quality of life. However, the pathogenesis of PSD is still not clear. This study aimed to investigate the demographic, clinical, and biochemical factors in patients with PSD. METHODS Patients with an acute ischemic stroke, who met the inclusion criteria at Shanghai Tenth People's Hospital from April 2016 to September 2016, were recruited for this study. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and the mental state was assessed using Mini-Mental State Examination (MMSE), Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA) at 1 week of admission. The patients were divided into PSD and non-PSD groups. The demographic and clinical characteristics, as well as the biochemical factors, were compared between the two groups. A logistic regression analysis was performed to identify the risk factors for depression following stroke. RESULTS A total of 83 patients with acute ischemic stroke were recruited. Of these, 36 (43.4%) developed depression. The multivariate logistic regression analysis indicated that high NIHSS [odds ratio (OR): 1.84, 95% confidence interval (CI): 1.09-3.12, P = 0.023] and high HAMD scores (OR: 2.38, 95% CI: 1.61-3.50, P < 0.001) were independent risk predictors for PSD and so were lower dopamine level (OR: 0.64, 95% CI: 0.45-0.91, P = 0.014), lower 5-hydroxytryptamine level (OR: 0.99, 95% CI: 0.98-1.00, P = 0.046), higher tumor necrosis factor-α level (OR: 1.05, 95% CI: 1.00-1.09, P = 0.044), and lower nerve growth factor level (OR: 0.06, 95% CI: 0.01-0.67, P = 0.022). CONCLUSIONS The identification of higher NIHSS scores, higher HAMD scores, lower dopamine level, lower 5-hydroxytryptamine level, higher tumor necrosis factor-α level, and lower nerve growth factor level might be useful for clinicians in recognizing and treating depression in patients after a stroke.
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Affiliation(s)
- Guilin Meng
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
| | - Xiaoye Ma
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Lei Li
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yan Tan
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiaohui Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yanxin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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Abstract
A significant number of patients with major depression do not respond optimally to current antidepressant drugs. As depression is likely to be a heterogeneous disorder, it is possible that existing neurotransmitter-based antidepressant drugs do not fully address other pathologies that may exist in certain cases. Biological pathologies related to depression that have been proposed and studied extensively include inflammation and immunology, hypercortisolemia, oxidative stress, and impaired angiogenesis. Such pathologies may induce neurodegeneration, which in turn causes cognitive impairment, a symptom increasingly being recognized in depression. A neurotoxic brain hypothesis unifying all these factors may explain the heterogeneity of depression as well as cognitive decline and antidepressant drug resistance in some patients. Compared with neurotransmitter-based antidepressant drugs, many botanical compounds in traditional medicine used for the treatment of depression and its related symptoms have been discovered to be anti-inflammatory, immunoregulatory, anti-infection, antioxidative, and proangiogenic. Some botanical compounds also exert actions on neurotransmission. This multitarget nature of botanical medicine may act through the amelioration of the neurotoxic brain environment in some patients resistant to neurotransmitter-based antidepressant drugs. A multitarget multidimensional approach may be a reasonable solution for patients resistant to neurotransmitter-based antidepressant drugs.
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40
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MacIntosh BJ, Edwards JD, Kang M, Cogo-Moreira H, Chen JL, Mochizuki G, Herrmann N, Swardfager W. Post-stroke Fatigue and Depressive Symptoms Are Differentially Related to Mobility and Cognitive Performance. Front Aging Neurosci 2017; 9:343. [PMID: 29163127 PMCID: PMC5671553 DOI: 10.3389/fnagi.2017.00343] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/12/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Fatigue and depressive symptoms are common and often inter-related stroke sequelae. This study investigates how they are related, directly or indirectly, to mobility and cognitive outcomes within 6 months of stroke. Methods: Participants were recruited from 4 stroke centers in Ontario, Canada. Post-stroke fatigue was assessed using the Fatigue Assessment Scale (FAS). Depressive symptoms were screened using the Center for Epidemiological Studies Scale for Depression (CES-D). Factor analyses were used to construct scores from mobility (distance traveled during a 2-min walk test, Chedoke-McMaster Stroke Assessment leg score, and Berg Balance Scale total score) and cognitive (Montreal Cognitive Assessment, Trail-Making Tests A and B, and five-word free recall) tests. Direct associations were assessed in linear regression models and indirect effects were assessed in path models. Covariates were age, sex, education, antidepressant use, days since stroke, and stroke severity (National Institute of Health Stroke Severity Scale score). Results: Fatigue and depressive symptoms were highly correlated (r > 0.51, p < 0.0001). Depressive symptoms were associated with cognition (β = −0.184, p = 0.04) and indirectly with mobility, mediated by fatigue (indirect effect = −0.0142, 95% CI: −0.0277 to −0.0033). Fatigue was associated with mobility (β = −0.253, p = 0.01), and indirectly with cognition, mediated by depressive symptoms (indirect effect = −0.0113, 95% CI: −0.0242 to −0.0023). Conclusions: Fatigue and depressive symptoms are related distinctly to cognitive and mobility impairments post-stroke. Fatigue was associated with poorer lower limb motor function, and with cognition indirectly via depressive symptoms.
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Affiliation(s)
- Bradley J MacIntosh
- Sunnybrook Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - Jodi D Edwards
- Sunnybrook Research Institute, Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mani Kang
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | - Joyce L Chen
- Sunnybrook Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - George Mochizuki
- Sunnybrook Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - Walter Swardfager
- Sunnybrook Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada.,University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada
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Fan N, Luo Y, Ou Y, He H. Altered serum levels of TNF-α, IL-6, and IL-18 in depressive disorder patients. Hum Psychopharmacol 2017; 32. [PMID: 28582802 DOI: 10.1002/hup.2588] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/28/2017] [Accepted: 03/10/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Depressive disorder is associated with abnormal changes in cytokines levels. This study aimed to assess serum concentrations of tumor necrosis factor (TNF) α, interleukin (IL) 6, and IL-18 in depressive patients. The correlations between these three cytokine concentrations and the patients' clinical characteristics were also assessed. METHODS Serum TNF-α, IL-6, and IL-18 concentrations were assessed using enzyme-linked immunosorbent assay from 64 depressive patients and 80 healthy control subjects. Depressive symptoms of patients were assessed using Hamilton Depression Scale-17. RESULTS Depressive patients had increased serum TNF-α and IL-6 concentrations but decreased IL-18 concentrations than controls. TNF-α and IL-6 concentrations were significantly positively associated with Hamilton Depression Scale-17 scores in depressive patients. CONCLUSION These findings provided additional evidence that altered TNF-α, IL-6, and IL-18 activities may contribute to the pathophysiology of depressive disorder.
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Affiliation(s)
- Ni Fan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong Province, China
| | - Yayan Luo
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong Province, China
| | - Yufen Ou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong Province, China
| | - Hongbo He
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong Province, China
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Geng LY, Qian FY, Qian JF, Zhang ZJ. The combination of plasma glutamate and physical impairment after acute stroke as a potential indicator for the early-onset post-stroke depression. J Psychosom Res 2017; 96:35-41. [PMID: 28545791 DOI: 10.1016/j.jpsychores.2017.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 12/21/2016] [Accepted: 01/07/2017] [Indexed: 12/11/2022]
Abstract
OBJECTS The present study aimed to investigate the relationship of plasma glutamate levels with the early-onset of post-stroke depression (PSD) and to further explore the prognostic value of plasma glutamate combined with clinical characteristics for the early-onset PSD in the acute ischemic stroke patients. METHODS Seventy-four patients who admitted to the hospital within 24h of acute ischemic stroke were consecutively recruited and followed up for 2weeks. The Beck Depression Inventory (BDI) and 17-item Hamilton Depression Rating Scale (HAMD-17) were used to screen for depressive symptoms 14days after stroke. Diagnoses of depression were made in accordance with DSM-IV. Plasma glutamate levels were determined by High Performance Liquid Chromatography (HPLC) on days 1 and 14 after stroke for all patients. RESULTS Plasma glutamate levels were significantly lower in PSD patients than those of non-PSD patients on day 1 after stroke. ROC curve analyses revealed an AUC (area under the ROC curve) of 0.724 (95% CI: 0.584-0.863, p=0.004) and of 0.669 (95% CI: 0.523-0.814, p=0.030) for National Institute of Health Stroke Scale (NIHSS) scores and plasma glutamate levels on day 1 respectively. Combined ROC analyses using the two factors revealed the highest AUC of 0.804 (95% CI: 0.685-0.922, P<0.0001). CONCLUSIONS These results indicated an association between the early-onset PSD and a low plasma glutamate level following acute ischemic stroke. The combination of reduced plasma glutamate levels and physical impairment (determined by NIHSS) 1day after acute ischemic stroke was a potential diagnostic indicator for early-onset PSD.
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Affiliation(s)
- Lei-Yu Geng
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
| | - Fang-Yuan Qian
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
| | - Jun-Feng Qian
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
| | - Zhi-Jun Zhang
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
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Kong X, Yuan Z, Cheng J. The function of NOD-like receptors in central nervous system diseases. J Neurosci Res 2016; 95:1565-1573. [PMID: 28029680 DOI: 10.1002/jnr.24004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 12/17/2022]
Abstract
NOD-like receptors (NLRs) are critical cytoplasmic pattern-recognition receptors (PRRs) that play an important role in the host innate immune response and immunity homeostasis. There is a growing body of evidence that NLRs are involved in a wide range of inflammatory diseases, including cancer, metabolic diseases, and autoimmune disorders. Recent studies have indicated that the proteins of the NLR family are linked with the pathophysiology of neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS), and psychological diseases. In this review, we mainly focus on the role of NLRs and the underlying signaling pathways in central nervous system (CNS) diseases. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Xiangxi Kong
- The State Key Laboratory of Brain and Cognitive Sciences, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China.,School of Basic Medical Science, Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Zengqiang Yuan
- The State Key Laboratory of Brain and Cognitive Sciences, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China.,Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, 100069, China
| | - Jinbo Cheng
- The State Key Laboratory of Brain and Cognitive Sciences, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China.,Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, 100069, China
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Kang HJ, Bae KY, Kim SW, Kim JT, Park MS, Cho KH, Kim JM. Effects of interleukin-6, interleukin-18, and statin use, evaluated at acute stroke, on post-stroke depression during 1-year follow-up. Psychoneuroendocrinology 2016; 72:156-60. [PMID: 27428088 DOI: 10.1016/j.psyneuen.2016.07.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/31/2016] [Accepted: 07/01/2016] [Indexed: 01/10/2023]
Abstract
Proinflammatory cytokines are associated with the development of post-stroke depression (PSD). Statins are thought to possess anti-inflammatory properties but their interactions with cytokines regarding the risk of PSD have yet to be investigated. Thus, the present study aimed to determine whether interleukin (IL)-6 and IL-18 were associated with the development of depression at 2 weeks and 1year after stroke using a longitudinal post-stroke cohort. Furthermore, this study examined the potential interactions between statin use and cytokines on PSD. For this study, 286 patients were evaluated 2 weeks after stroke and 222 patients were followed-up 1year later. Depression was diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and then categorized into no PSD or any PSD, which included diagnoses of both major and minor depression. The effects of IL-6 and IL-18 on PSD as well as their interaction with a statin at both examination time-points were investigated using a multivariate logistic regression model. Higher IL-6 and IL-18 levels were independently associated with depressive disorders within 2 weeks and at 1year after stroke. When stratified by statin use, these significant associations were more evident in patients who did not use a statin. Furthermore, there was a significant interaction between statin use and IL-6 on the presence of a depressive disorder at 1year. The present findings support the cytokine hypothesis of PSD and indicate that the preventive effects of statin use against PSD may be mediated by its interactions with IL-6.
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Affiliation(s)
- Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
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Jiao JT, Cheng C, Ma YJ, Huang J, Dai MC, Jiang C, Wang C, Shao JF. Association between inflammatory cytokines and the risk of post-stroke depression, and the effect of depression on outcomes of patients with ischemic stroke in a 2-year prospective study. Exp Ther Med 2016; 12:1591-1598. [PMID: 27588080 DOI: 10.3892/etm.2016.3494] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/12/2016] [Indexed: 12/13/2022] Open
Abstract
The association between inflammatory cytokines and the risk of post-stroke depression (PSD) remains unclear. The aim of the present study was to investigate this association and the effect of PSD on the outcomes of ischemic stroke patients. A total of 355 patients who had experienced ischemic stroke participated in inflammatory cytokine detection by ELISA, in addition to depression, quality of life (QOL) and body performance testing. Cox regression was used to evaluate the associations between PSD risk, inflammatory cytokines and the outcomes of patients. Measurement data was evaluated using Student's t test, and counted data was measured by χ2 test. The incidence of PSD during the 2-year follow-up was 23.1%. The risk of PSD elevated with increased interleukin (IL)-6 expression levels [hazard ratio (HR)=3.18; 95% confidence interval (CI), 1.37-7.36] following the adjustment of confounders. However, no significant associations were identified between PSD and other inflammatory cytokines. QOL and body performance in the depressed group were significantly worse compared with those in the non-depressed group. The risk of stroke recurrence in patients with depression increased two-fold compared with patients without depression (HR=2.020; 95% CI, 1.123-3.635; Ptrend=0.019). No significant associations between PSD and the risk of mortality (HR=1.497; 95% CI, 0.547-4.098) were observed. In conclusion, depression is prevalent in patients following ischemic stroke. IL-6 is positively associated with the risk of PSD, and may predict its development in patients following ischemic stroke. PSD correlates with outcomes of patients, and the effective management of PSD may improve the prognosis of patients.
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Affiliation(s)
- Jian-Tong Jiao
- Department of Neurosurgery, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Chao Cheng
- Department of Neurosurgery, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Ying-Jun Ma
- Department of Neurosurgery, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Jin Huang
- Department of Neurosurgery, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Min-Chao Dai
- Department of Neurosurgery, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Chen Jiang
- Department of Neurosurgery, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Cheng Wang
- Department of Neurosurgery, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Jun-Fei Shao
- Department of Neurosurgery, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
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Bustamante A, García-Berrocoso T, Rodriguez N, Llombart V, Ribó M, Molina C, Montaner J. Ischemic stroke outcome: A review of the influence of post-stroke complications within the different scenarios of stroke care. Eur J Intern Med 2016; 29:9-21. [PMID: 26723523 DOI: 10.1016/j.ejim.2015.11.030] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/28/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022]
Abstract
Stroke remains one of the main causes of death and disability worldwide. The challenge of predicting stroke outcome has been traditionally assessed from a general point of view, where baseline non-modifiable factors such as age or stroke severity are considered the most relevant factors. However, after stroke occurrence, some specific complications such as hemorrhagic transformations or post stroke infections, which lead to a poor outcome, could be developed. An early prediction or identification of these circumstances, based on predictive models including clinical information, could be useful for physicians to individualize and improve stroke care. Furthermore, the addition of biological information such as blood biomarkers or genetic polymorphisms over these predictive models could improve their prognostic value. In this review, we focus on describing the different post-stroke complications that have an impact in short and long-term outcome across different time points in its natural history and on the clinical-biological information that might be useful in their prediction.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | - Noelia Rodriguez
- Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Victor Llombart
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain; Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Yamada MK. Angiogenesis in refractory depression: A possible phenotypic target to avoid the blood brain barrier. Drug Discov Ther 2016; 10:74-8. [DOI: 10.5582/ddt.2016.01003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lee J, Joo EJ, Lim HJ, Park JM, Lee KY, Park A, Seok A, Lee H, Kang HG. Proteomic analysis of serum from patients with major depressive disorder to compare their depressive and remission statuses. Psychiatry Investig 2015; 12:249-59. [PMID: 25866527 PMCID: PMC4390597 DOI: 10.4306/pi.2015.12.2.249] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/03/2014] [Accepted: 12/26/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Currently, there are a few biological markers to aid in the diagnosis and treatment of depression. However, it is not sufficient for diagnosis. We attempted to identify differentially expressed proteins during depressive moods as putative diagnostic biomarkers by using quantitative proteomic analysis of serum. METHODS Blood samples were collected twice from five patients with major depressive disorder (MDD) at depressive status before treatment and at remission status during treatment. Samples were individually analyzed by liquid chromatography-tandem mass spectrometry for protein profiling. Differentially expressed proteins were analyzed by label-free quantification. Enzyme-linked immunosorbent assay (ELISA) results and receiver-operating characteristic (ROC) curves were used to validate the differentially expressed proteins. For validation, 8 patients with MDD including 3 additional patients and 8 matched normal controls were analyzed. RESULTS The quantitative proteomic studies identified 10 proteins that were consistently upregulated or downregulated in 5 MDD patients. ELISA yielded results consistent with the proteomic analysis for 3 proteins. Expression levels were significantly different between normal controls and MDD patients. The 3 proteins were ceruloplasmin, inter-alpha-trypsin inhibitor heavy chain H4 and complement component 1qC, which were upregulated during the depressive status. The depressive status could be distinguished from the euthymic status from the ROC curves for these proteins, and this discrimination was enhanced when all 3 proteins were analyzed together. CONCLUSION This is the first proteomic study in MDD patients to compare intra-individual differences dependent on mood. This technique could be a useful approach to identify MDD biomarkers, but requires additional proteomic studies for validation.
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Affiliation(s)
- Jiyeong Lee
- Department of Senior Healthcare, BK21 Plus Program, Graduate School, Eulji University, Daejeon, Republic of Korea
| | - Eun-Jeong Joo
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Hee-Joung Lim
- Laboratory of Stem Cell Biology, Division of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Jong-Moon Park
- College of Pharmacy, Gachon University, Incheon, Republic of Korea
| | - Kyu Young Lee
- Department of Neuropsychiatry, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Arum Park
- Department of Senior Healthcare, BK21 Plus Program, Graduate School, Eulji University, Daejeon, Republic of Korea
| | - AeEun Seok
- Department of Senior Healthcare, BK21 Plus Program, Graduate School, Eulji University, Daejeon, Republic of Korea
| | - HooKeun Lee
- College of Pharmacy, Gachon University, Incheon, Republic of Korea
| | - Hee-Gyoo Kang
- Department of Senior Healthcare, BK21 Plus Program, Graduate School, Eulji University, Daejeon, Republic of Korea
- Institute for Senior Industry, Eulji University, Seongnam, Republic of Korea
- Department of Biomedical Laboratory Science, Graduate School of Health Science, Eulji University, Seongnam, Republic of Korea
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Poststroke depression as a factor adversely affecting the level of oxidative damage to plasma proteins during a brain stroke. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:408745. [PMID: 25838867 PMCID: PMC4370103 DOI: 10.1155/2015/408745] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/20/2015] [Indexed: 11/24/2022]
Abstract
Poststroke depression, the second most serious psychosomatic complication after brain stroke, leads to delay of the rehabilitation process and is associated with an increased disability and cognitive impairment along with increase in term mortality. Research into the biochemical changes in depression is still insufficiently described. The aim of our study was therefore to evaluate the possible association between plasma protein oxidative/nitrative damages and the development of poststroke depression. We evaluated oxidative/nitrative modifications of specific proteins by measurement of 3-nitrotyrosine and carbonyl groups levels using ELISA test. Additionally, we checked differences in proteins thiol groups by spectrophotometric assay based on reaction between DTNB and thiols. We also evaluated catalase activity in erythrocytes measured as ability to decompose H2O2. Correlation analysis was performed using Spearman's rank. We observed significant (P < 0.001) differences in all oxidative/nitrative stress parameters in brain stroke patients compared to healthy group. Our research shows that oxidative damage of proteins is correlated with the degree of poststroke depression, while nitrative changes do not show any relationship. We demonstrate a positive correlation between the concentration of carbonyl groups and the Geriatric Depression Scale and a negative correlation between the degree of depression and the concentration of -SH groups or catalase activity.
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Munkholm K, Weikop P, Kessing LV, Vinberg M. Elevated levels of IL-6 and IL-18 in manic and hypomanic states in rapid cycling bipolar disorder patients. Brain Behav Immun 2015; 43:205-13. [PMID: 25451609 DOI: 10.1016/j.bbi.2014.09.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 01/17/2023] Open
Abstract
Inflammatory system dysregulation may be involved in the pathophysiology of bipolar disorder with peripheral cytokine levels varying between affective states; however, the evidence is based primarily on case-control studies and limited by methodological issues. The objectives of the present study were to assess alterations of peripheral cytokine levels between affective states in rapid cycling bipolar disorder patients and to compare these with levels in healthy control subjects. In a longitudinal design, repeated measurements of plasma levels of IL-6, IL-10, IL-18, IL-1β and TNF-α were obtained in affective states of varying polarity during 6-12 months in 37 rapid cycling bipolar disorder patients and compared with repeated measurements in 40 age- and gender matched healthy control subjects, using rigorous laboratory-, clinical- and statistical methodology. Adjusting for demographical, clinical- and lifestyle factors, levels of IL-6 (p<0.05) and IL-18 (p<0.005) were significantly elevated in rapid cycling bipolar disorder patients in a manic/hypomanic state, compared with a depressed and a euthymic state. Compared with healthy control subjects, unadjusted levels of IL-6 (p<0.05) and IL-18 (p<0.05) were elevated in manic/hypomanic bipolar disorder patients. Levels of IL-10 and IL-1β were undetectable in the majority of samples; high TNF-α assay variability was found. The results support a role for altered peripheral immune response signaling in rapid cycling bipolar disorder and suggest that IL-6 and IL-18 could be markers of manic episodes.
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Affiliation(s)
- Klaus Munkholm
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Denmark.
| | - Pia Weikop
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Denmark
| | - Maj Vinberg
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Denmark
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