1
|
Polis B, Cuda CM, Putterman C. Animal models of neuropsychiatric systemic lupus erythematosus: deciphering the complexity and guiding therapeutic development. Autoimmunity 2024; 57:2330387. [PMID: 38555866 DOI: 10.1080/08916934.2024.2330387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/10/2024] [Indexed: 04/02/2024]
Abstract
Systemic lupus erythematosus (SLE) poses formidable challenges due to its multifaceted etiology while impacting multiple tissues and organs and displaying diverse clinical manifestations. Genetic and environmental factors contribute to SLE complexity, with relatively limited approved therapeutic options. Murine models offer insights into SLE pathogenesis but do not always replicate the nuances of human disease. This review critically evaluates spontaneous and induced animal models, emphasizing their validity and relevance to neuropsychiatric SLE (NPSLE). While these models undoubtedly contribute to understanding disease pathophysiology, discrepancies persist in mimicking some NPSLE intricacies. The lack of literature addressing this issue impedes therapeutic progress. We underscore the urgent need for refining models that truly reflect NPSLE complexities to enhance translational fidelity. We encourage a comprehensive, creative translational approach for targeted SLE interventions, balancing scientific progress with ethical considerations to eventually improve the management of NPSLE patients. A thorough grasp of these issues informs researchers in designing experiments, interpreting results, and exploring alternatives to advance NPSLE research.
Collapse
Affiliation(s)
- Baruh Polis
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Research Institute, Galilee Medical Center, Nahariya, Israel
| | - Carla M Cuda
- Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chaim Putterman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Research Institute, Galilee Medical Center, Nahariya, Israel
- Division of Rheumatology and Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
2
|
Adkins AM, Luyo ZNM, Gibbs AJ, Boden AF, Heerbrandt RS, Gotthold JD, Britten RA, Wellman LL, Sanford LD. Alterations in Blood-Brain Barrier Integrity and Lateral Ventricle Differ in Rats Exposed to Space Radiation and Social Isolation. Life (Basel) 2024; 14:636. [PMID: 38792656 PMCID: PMC11122575 DOI: 10.3390/life14050636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The proposed Mars missions will expose astronauts to long durations of social isolation (SI) and space radiation (SR). These stressors have been shown to alter the brain's macrostructure and microenvironment, including the blood-brain barrier (BBB). Breakdown of the BBB is linked to impaired executive functions and physical deficits, including sensorimotor and neurocognitive impairments. However, the precise mechanisms mediating these effects remain unknown. Additionally, the synergistic effects of combined exposure to SI and SR on the structural integrity of the BBB and brain remain unknown. We assessed the BBB integrity and morphology in the brains of male rats exposed to ground-based analogs of SI and SR. The rats exposed to SR had enlarged lateral ventricles and increased BBB damage associated with a loss of astrocytes and an increased number of leaky vessels. Many deficits observed in SR-treated animals were attenuated by dual exposure to SI (DFS). SI alone did not show BBB damage but did show differences in astrocyte morphology compared to the Controls. Thus, determining how single and combined inflight stressors modulate CNS structural integrity is crucial to fully understand the multiple pathways that could impact astronaut performance and health, including the alterations to the CNS structures and cell viability observed in this study.
Collapse
Affiliation(s)
- Austin M. Adkins
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA 23507, USA; (A.M.A.); (Z.N.M.L.); (A.F.B.); (R.S.H.); (J.D.G.); (L.L.W.)
| | - Zachary N. M. Luyo
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA 23507, USA; (A.M.A.); (Z.N.M.L.); (A.F.B.); (R.S.H.); (J.D.G.); (L.L.W.)
| | - Alayna J. Gibbs
- Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA 23507, USA;
| | - Alea F. Boden
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA 23507, USA; (A.M.A.); (Z.N.M.L.); (A.F.B.); (R.S.H.); (J.D.G.); (L.L.W.)
| | - Riley S. Heerbrandt
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA 23507, USA; (A.M.A.); (Z.N.M.L.); (A.F.B.); (R.S.H.); (J.D.G.); (L.L.W.)
| | - Justin D. Gotthold
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA 23507, USA; (A.M.A.); (Z.N.M.L.); (A.F.B.); (R.S.H.); (J.D.G.); (L.L.W.)
| | - Richard A. Britten
- Center for Integrative Neuroscience and Inflammatory Diseases, Radiation Oncology, Eastern Virginia Medical School, Norfolk, VA 23507, USA;
| | - Laurie L. Wellman
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA 23507, USA; (A.M.A.); (Z.N.M.L.); (A.F.B.); (R.S.H.); (J.D.G.); (L.L.W.)
| | - Larry D. Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA 23507, USA; (A.M.A.); (Z.N.M.L.); (A.F.B.); (R.S.H.); (J.D.G.); (L.L.W.)
| |
Collapse
|
3
|
der Heijden HV, Rameh V, Golden E, Ronen I, Sundel RP, Knight A, Chang JC, Upadhyay J. Implications of Inflammatory Processes on a Developing Central Nervous System in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Rheumatol 2024; 76:332-344. [PMID: 37901986 PMCID: PMC10922196 DOI: 10.1002/art.42736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/20/2023] [Accepted: 10/25/2023] [Indexed: 10/31/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that is increasingly affecting pediatric and adult populations. Neuropsychiatric manifestations (ie, cognitive dysfunction and mood disorders) appear to occur with greater severity and poorer prognosis in childhood-onset SLE (cSLE) versus adult-onset SLE, negatively impacting school function, self-management, and psychosocial health, as well as lifelong health-related quality of life. In this review, we describe pathogenic mechanisms active in cSLE, such as maladaptive inflammatory processes and ischemia, which are hypothesized to underpin central phenotypes in patients with cSLE, and the role of alterations in protective central nervous system (CNS) barriers (ie, the blood-brain barrier) are also discussed. Recent findings derived from novel neuroimaging approaches are highlighted because the methods employed in these studies hold potential for identifying CNS abnormalities that would otherwise remain undetected with conventional multiple resonance imaging studies (eg, T2-weighted or fluid-attenuated inversion recovery sequences). Furthermore, we propose that a more robust presentation of neuropsychiatric symptoms in cSLE is in part due to the harmful impact of a chronic inflammatory insult on a developing CNS. Although the immature status of the CNS may leave patients with cSLE more vulnerable to harboring neuropsychiatric manifestations, the same property may represent a greater urgency to reverse the maladaptive effects associated with a proneuroinflammatory state, provided that effective diagnostic tools and treatment strategies are available. Finally, considering the crosstalk among the CNS and other organ systems affected in cSLE, we postulate that a finer understanding of this interconnectivity and its role in the clinical presentation in cSLE is warranted.
Collapse
Affiliation(s)
- Hanne Van der Heijden
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
- Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Vanessa Rameh
- Division of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Emma Golden
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Itamar Ronen
- Clinical Imaging Science Center, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Robert P. Sundel
- Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Andrea Knight
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joyce C. Chang
- Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA USA
| |
Collapse
|
4
|
Tay SH, Stephenson MC, Allameen NA, Ngo RYS, Ismail NAB, Wang VCC, Totman JJ, Cheong DLH, Narayanan S, Lee BTK, Mak A. Combining multimodal magnetic resonance brain imaging and machine learning to unravel neurocognitive function in non-neuropsychiatric systemic lupus erythematosus. Rheumatology (Oxford) 2024; 63:414-422. [PMID: 37184855 DOI: 10.1093/rheumatology/kead221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE To study whether multimodal brain MRI comprising permeability and perfusion measures coupled with machine learning can predict neurocognitive function in young patients with SLE without neuropsychiatric manifestations. METHODS SLE patients and healthy controls (HCs) (≤40 years of age) underwent multimodal structural brain MRI that comprised voxel-based morphometry (VBM), magnetization transfer ratio (MTR) and dynamic contrast-enhanced (DCE) MRI in this cross-sectional study. Neurocognitive function assessed by Automated Neuropsychological Assessment Metrics was reported as the total throughput score (TTS). Olfactory function was assessed. A machine learning-based model (i.e. glmnet) was constructed to predict TTS. RESULTS Thirty SLE patients and 10 HCs were studied. Both groups had comparable VBM, MTR, olfactory bulb volume (OBV), olfactory function and TTS. While after correction for multiple comparisons the uncorrected increase in the blood-brain barrier (BBB) permeability parameters compared with HCs did not remain evident in SLE patients, DCE-MRI perfusion parameters, notably an increase in right amygdala perfusion, was positively correlated with TTS in SLE patients (r = 0.636, false discovery rate P < 0.05). A machine learning-trained multimodal MRI model comprising alterations of VBM, MTR, OBV and DCE-MRI parameters mainly in the limbic system regions predicted TTS in SLE patients (r = 0.644, P < 0.0005). CONCLUSION Multimodal brain MRI demonstrated increased right amygdala perfusion that was associated with better neurocognitive performance in young SLE patients without statistically significant BBB leakage and microstructural abnormalities. A machine learning-constructed multimodal model comprising microstructural, perfusion and permeability parameters accurately predicted neurocognitive performance in SLE patients.
Collapse
Affiliation(s)
- Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Nur Azizah Allameen
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Raymond Yeow Seng Ngo
- Department of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore
- Department of Otolaryngology, National University of Singapore, Singapore, Singapore
- Department of Otolaryngology - Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | | | - Victor Chun Chieh Wang
- Department of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - John James Totman
- Academic Radiology, National University of Singapore, Singapore, Singapore
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dennis Lai-Hong Cheong
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sriram Narayanan
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Bernett Teck Kwong Lee
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
- Centre for Biomedical Informatics, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
5
|
Devinney MJ, Wong MK, Wright MC, Marcantonio ER, Terrando N, Browndyke JN, Whitson HE, Cohen HJ, Nackley AG, Klein ME, Ely EW, Mathew JP, Berger M. Role of Blood-Brain Barrier Dysfunction in Delirium following Non-cardiac Surgery in Older Adults. Ann Neurol 2023; 94:1024-1035. [PMID: 37615660 PMCID: PMC10841407 DOI: 10.1002/ana.26771] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/21/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Although animal models suggest a role for blood-brain barrier dysfunction in postoperative delirium-like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood-brain barrier dysfunction in postoperative delirium and hospital length of stay among older surgery patients. METHODS Cognitive testing, delirium assessment, and cerebrospinal fluid and blood sampling were prospectively performed before and after non-cardiac, non-neurologic surgery. Blood-brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio (CPAR). RESULTS Of 207 patients (median age = 68 years, 45% female) with complete CPAR and delirium data, 26 (12.6%) developed postoperative delirium. Overall, CPAR increased from before to 24 hours after surgery (median change = 0.28, interquartile range [IQR] = -0.48 to 1.24, Wilcoxon p = 0.001). Preoperative to 24 hours postoperative change in CPAR was greater among patients who developed delirium versus those who did not (median [IQR] = 1.31 [0.004 to 2.34] vs 0.19 [-0.55 to 1.08], p = 0.003). In a multivariable model adjusting for age, baseline cognition, and surgery type, preoperative to 24 hours postoperative change in CPAR was independently associated with delirium occurrence (per CPAR increase of 1, odds ratio = 1.30, 95% confidence interval [CI] = 1.03-1.63, p = 0.026) and increased hospital length of stay (incidence rate ratio = 1.15, 95% CI = 1.09-1.22, p < 0.001). INTERPRETATION Postoperative increases in blood-brain barrier permeability are independently associated with increased delirium rates and postoperative hospital length of stay. Although these findings do not establish causality, studies are warranted to determine whether interventions to reduce postoperative blood-brain barrier dysfunction would reduce postoperative delirium rates and hospital length of stay. ANN NEUROL 2023;94:1024-1035.
Collapse
Affiliation(s)
- Michael J. Devinney
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
| | | | - Mary Cooter Wright
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
| | - Edward R. Marcantonio
- Division of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
| | - Niccolò Terrando
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
- Department of Cell Biology, Duke University School of Medicine, Durham NC
- Department of Immunology, Duke University School of Medicine, Durham NC
| | - Jeffrey N. Browndyke
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham NC
| | - Heather E. Whitson
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
- Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham NC
| | - Harvey J. Cohen
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
- Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham NC
| | - Andrea G. Nackley
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
| | | | - E. Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN
| | - Joseph P. Mathew
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
| | - Miles Berger
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
| |
Collapse
|
6
|
Fan M, Deng F, Tang R, Cai Y, Zhang X, Li H, Xiang T, Pan J. Serum Zonula Occludens-1 and Claudin-5 Levels in Patients with Insomnia Disorder: A Pilot Study. Nat Sci Sleep 2023; 15:873-884. [PMID: 37928369 PMCID: PMC10625320 DOI: 10.2147/nss.s424756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This research aimed to investigate serum Zonula occludens-1 (ZO-1) and Claudin-5 (CLDN5) levels to show whether or not their eventual changes in patients with insomnia disorder could have etiopathogenetic importance. There was no research investigating serum ZO-1 and CLDN5 concentrations in insomnia disorder. Patients and Methods This study included 60 insomnia disorder patients and 45 normal controls. None of the patients received drugs for insomnia. The patients completed Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI), and Polysomnography (PSG) to score the insomnia disorder symptoms. Venous blood samples were collected, and serum ZO-1 and claudin-5 levels were analyzed by enzyme-linked immunosorbent assay (ELISA). Results Serum ZO-1 level was significantly higher without a significant difference between age, sex, and body mass index, whereas the difference in serum claudin-5 level between the two groups was not statistically significant. In addition, ZO-1 levels were positively correlated with ISI and PSQI and negatively with N1 and N1_perc. We also demonstrated a positive correlation between the levels of CLDN5 and HAMA, and a negative correlation with total sleep time (TST), N1 and N1_perc. Conclusion Our findings suggest an association between these intestinal and brain endothelial permeability markers and insomnia disorders. However, these remain modest and preliminary and need more extensive studies, including long-term follow-up populations and involving gut microbes, to further validate and explore the mechanisms involved.
Collapse
Affiliation(s)
- Mei Fan
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Fangyi Deng
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Rui Tang
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Yixian Cai
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Xiaotao Zhang
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Hongyao Li
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Ting Xiang
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Jiyang Pan
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| |
Collapse
|
7
|
Devinney MJ, Wong MK, Wright MC, Marcantonio ER, Terrando N, Browndyke JN, Whitson HE, Cohen HJ, Nackley AG, Klein ME, Ely EW, Mathew JP, Berger M. A Role for Blood-brain Barrier Dysfunction in Delirium following Non-Cardiac Surgery in Older adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.07.23288303. [PMID: 37214925 PMCID: PMC10197714 DOI: 10.1101/2023.04.07.23288303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Objective Although animal models suggest a role for blood-brain barrier dysfunction in postoperative delirium-like behavior, its role in postoperative delirium and postoperative recovery in humans is unclear. Thus, we evaluated the role of blood-brain barrier dysfunction in postoperative delirium and hospital length of stay among older surgery patients. Methods Cognitive testing, delirium assessment, and cerebrospinal fluid and blood sampling were prospectively performed before and after non-cardiac, non-neurologic surgery. Blood-brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio (CPAR). Results Of 207 patients (median age 68, 45% female) with complete CPAR and delirium data, 26 (12.6%) developed postoperative delirium. Overall, CPAR increased from before to 24-hours after surgery (median postoperative change 0.28, [IQR] [-0.48-1.24]; Wilcoxon p=0.001). Preoperative to 24-hour postoperative change in CPAR was greater among patients who developed delirium vs those who did not (median [IQR] 1.31 [0.004, 2.34] vs 0.19 [-0.55, 1.08]; p=0.003). In a multivariable model adjusting for age, baseline cognition, and surgery type, preoperative to 24-hour postoperative change in CPAR was independently associated with delirium incidence (per CPAR increase of 1, OR = 1.30, [95% CI 1.03-1.63]; p=0.026) and increased hospital length of stay (IRR = 1.15 [95% CI 1.09-1.22]; p<0.001). Interpretation Postoperative increases in blood-brain barrier permeability are independently associated with increased delirium rates and postoperative hospital length of stay. Although these findings do not establish causality, studies are warranted to determine whether interventions to reduce postoperative blood-brain barrier dysfunction would reduce postoperative delirium rates and hospital length of stay.
Collapse
Affiliation(s)
- Michael J. Devinney
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
| | | | - Mary Cooter Wright
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
| | - Edward R. Marcantonio
- Division of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston MA
| | - Niccolò Terrando
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
- Department of Cell Biology, Duke University School of Medicine, Durham NC
- Department of Immunology, Duke University School of Medicine, Durham NC
| | - Jeffrey N. Browndyke
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham NC
| | - Heather E. Whitson
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
- Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham NC
| | - Harvey J. Cohen
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
- Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham NC
| | - Andrea G. Nackley
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
| | | | - E. Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN
| | - Joseph P. Mathew
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
| | - Miles Berger
- Department of Anesthesiology, Duke University School of Medicine, Durham NC
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
- Duke/UNC Alzheimer’s Disease Research Center, Duke University and University of North Carolina at Chapel Hill, Durham/Chapel Hill NC
| | | |
Collapse
|
8
|
McMurray KMJ, Sah R. Neuroimmune mechanisms in fear and panic pathophysiology. Front Psychiatry 2022; 13:1015349. [PMID: 36523875 PMCID: PMC9745203 DOI: 10.3389/fpsyt.2022.1015349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022] Open
Abstract
Panic disorder (PD) is unique among anxiety disorders in that the emotional symptoms (e.g., fear and anxiety) associated with panic are strongly linked to body sensations indicative of threats to physiological homeostasis. For example, panic attacks often present with feelings of suffocation that evoke hyperventilation, breathlessness, or air hunger. Due to the somatic underpinnings of PD, a major focus has been placed on interoceptive signaling and it is recognized that dysfunctional body-to-brain communication pathways promote the initiation and maintenance of PD symptomatology. While body-to-brain signaling can occur via several pathways, immune and humoral pathways play an important role in communicating bodily physiological state to the brain. Accumulating evidence suggests that neuroimmune mediators play a role in fear and panic-associated disorders, although this has not been systematically investigated. Currently, our understanding of the role of immune mechanisms in the etiology and maintenance of PD remains limited. In the current review, we attempt to summarize findings that support a role of immune dysregulation in PD symptomology. We compile evidence from human studies and panic-relevant rodent paradigms that indicate a role of systemic and brain immune signaling in the regulation of fear and panic-relevant behavior and physiology. Specifically, we discuss how immune signaling can contribute to maladaptive body-to-brain communication and conditioned fear that are relevant to spontaneous and conditioned symptoms of PD and identify putative avenues warranting future investigation.
Collapse
Affiliation(s)
- Katherine M. J. McMurray
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, United States
- Veterans Affairs Medical Center, Cincinnati, OH, United States
| | - Renu Sah
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, United States
- Veterans Affairs Medical Center, Cincinnati, OH, United States
| |
Collapse
|
9
|
Chen J, Xu T, Wu M. Depression in systemic lupus erythematosus: Modifiable or inheritable? a two-sample mendelian randomization study. Front Genet 2022; 13:988022. [PMID: 36110211 PMCID: PMC9468706 DOI: 10.3389/fgene.2022.988022] [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: 07/06/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Observational studies have found increased incidence of depression, the leading cause of disability worldwide, in patients with systemic lupus erythematosus (SLE). However, it is not clear whether the association was genetically inheritable or caused by modifiable risk factors, such as socioeconomic factors. We investigated the causal relationship between genetically predicted SLE and depression by two-sample Mendelian randomization analysis. Single nucleotide polymorphisms (SNPs) associated with SLE were selected as instrumental variables (IVs) from a genome-wide association study (GWAS) of 14,267 European-ancestry participants. A large GWAS of depression (180,866 European-ancestry participants) and another GWAS of major depressive disorder (MDD) (173,005 European-ancestry participants) were selected as outcomes. Then we estimated the effects of IVs on the odds of depression or MDD by using the inverse-variance weighted (IVW) meta-analysis method (random-effects), which had a power of 90% to detect 4% increase of depression in SLE. Interestingly, genetically predicted SLE decreased the odds of depression [odds ratio (OR): 0.995; 95% CI: 0.990–0.999; p = 0.025] and MDD [odds ratio (OR): 0.985; 95% CI: 0.975–0.996; p = 0.009], indicating increased depression in SLE was not due to inheritable risk factors.
Collapse
|
10
|
Sim TM, Mak A, Tay SH. Insights into the role of neutrophils in neuropsychiatric systemic lupus erythematosus: Current understanding and future directions. Front Immunol 2022; 13:957303. [PMID: 36016935 PMCID: PMC9396336 DOI: 10.3389/fimmu.2022.957303] [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: 05/30/2022] [Accepted: 07/19/2022] [Indexed: 12/12/2022] Open
Abstract
Central nervous system (CNS) involvement of systemic lupus erythematosus (SLE), termed neuropsychiatric SLE (NPSLE), is a major and debilitating manifestation of the disease. While patients with SLE mostly complain of common neuropsychological symptoms such headache and mild mood disorders that may not even be technically attributed to SLE, many SLE patients present with life-threatening NPSLE syndromes such as cerebrovascular disease, seizures and psychosis that are equally challenging in terms of early diagnosis and therapy. While we are just beginning to unravel some mysteries behind the immunologic basis of NPSLE, advancements in the mechanistic understanding of the complex pathogenic processes of NPSLE have been emerging through recent murine and human studies. The pathogenic pathways implicated in NPSLE are multifarious and various immune effectors such as cell-mediated inflammation, autoantibodies and cytokines including type I interferons have been found to act in concert with the disruption of the blood-brain barrier (BBB) and other neurovascular interfaces. Beyond antimicrobial functions, neutrophils are emerging as decision-shapers during innate and adaptive immune responses. Activated neutrophils have been recognized to be involved in ischemic and infective processes in the CNS by releasing neutrophil extracellular traps (NETs), matrix metalloproteinase-9 and proinflammatory cytokines. In the context of NPSLE, these mechanisms contribute to BBB disruption, neuroinflammation and externalization of modified proteins on NETs that serve as autoantigens. Neutrophils that sediment within the peripheral blood mononuclear cell fraction after density centrifugation of blood are generally defined as low-density neutrophils (LDNs) or low-density granulocytes. LDNs are a proinflammatory subset of neutrophils that are increased with SLE disease activity and are primed to undergo NETosis and release cytokines such as interferon-α and tumor necrosis factor. This review discusses the immunopathogenesis of NPSLE with a focus on neutrophils as a core mediator of the disease and potential target for translational research in NPSLE.
Collapse
|