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Viola TW, Danzer C, Mardini V, Szobot C, Chrusciel JH, Stertz L, Schmitz JM, Walss-Bass C, Fries GR, Grassi-Oliveira R. Prenatal cocaine exposure and its influence on pediatric epigenetic clocks and epigenetic scores in humans. Sci Rep 2024; 14:1946. [PMID: 38253635 PMCID: PMC10803757 DOI: 10.1038/s41598-024-52433-5] [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: 10/09/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
The investigation of the effects of prenatal cocaine exposure (PCE) on offspring has been inconsistent, with few studies investigating biological outcomes in humans. We profiled genome-wide DNA methylation (DNAm) of umbilical cord blood (UCB) from newborns with (n = 35) and without (n = 47) PCE. We used DNAm data to (1) assess pediatric epigenetic clocks at birth and (2) to estimate epigenetic scores (ES) for lifetime disorders. We generated gestational epigenetic age estimates (DNAmGA) based on Knight and Bohlin epigenetic clocks. We also investigated the association between DNAmGA and UCB serum brain-derived neurotrophic factor (BDNF) levels. Considering the large-scale DNAm data availability and existing evidence regarding PCE as a risk for health problems later in life, we generated ES for tobacco smoking, psychosis, autism, diabetes, and obesity. A gene ontology (GO) analysis on the CpGs included in the ES with group differences was performed. PCE was associated with lower DNAmGA in newborns, and this effect remained significant when controlling for potential confounders, such as blood cell type composition predicted by DNAm and obstetric data. DNAmGA was negatively correlated with BDNF levels in the serum of UCB. Higher tobacco smoking, psychosis, and diabetes ES were found in the PCE group. The GO analysis revealed GABAergic synapses as a potential pathway altered by PCE. Our findings of decelerated DNAmGA and ES for adverse phenotypes associated with PCE, suggest that the effects of gestational cocaine exposure on the epigenetic landscape of human newborns are detectable at birth.
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Affiliation(s)
- Thiago Wendt Viola
- School of Medicine, Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Christina Danzer
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, A701-129, 8200, Aarhus, Denmark
| | - Victor Mardini
- Clinical Hospital of Porto Alegre, Porto Alegre, RS, Brazil
| | - Claudia Szobot
- Clinical Hospital of Porto Alegre, Porto Alegre, RS, Brazil
| | - João Henrique Chrusciel
- School of Medicine, Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Laura Stertz
- Faillace Department of Psychiatry and Behavioral Sciences, Translational Psychiatry Program, The University of Texas Health Science Center at Houston, Houston, USA
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, Translational Psychiatry Program, The University of Texas Health Science Center at Houston, Houston, USA
| | - Consuelo Walss-Bass
- Faillace Department of Psychiatry and Behavioral Sciences, Translational Psychiatry Program, The University of Texas Health Science Center at Houston, Houston, USA
| | - Gabriel R Fries
- Faillace Department of Psychiatry and Behavioral Sciences, Translational Psychiatry Program, The University of Texas Health Science Center at Houston, Houston, USA
| | - Rodrigo Grassi-Oliveira
- School of Medicine, Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, RS, Brazil.
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, A701-129, 8200, Aarhus, Denmark.
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Kim EB, Song JH, Le LNH, Kim H, Koh JW, Seo Y, Jeong HR, Kim HT, Ryu S. Characterization of exosomal microRNAs in preterm infants fed with breast milk and infant formula. Front Nutr 2024; 11:1339919. [PMID: 38304545 PMCID: PMC10830786 DOI: 10.3389/fnut.2024.1339919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Abstract
Breastfeeding not only reduces infection-related morbidity, but also increases growth of preterm infants. Advantages of breast milk (BM) for preterm infants are significant. They continue to be studied. However, because not all preterm infants can receive breastfeeding, bovine-based infant formula (IF) is used as an alternative, which may increase the risk of several preterm complications. Exosomes isolated from biofluids are emerging as biomarkers in research of various diseases. Here, we characterized miRNA contents of exosomes in urine and serum samples of preterm infants who were BM and IF fed and performed transcriptomic analysis of small RNA libraries. We identified significantly up-regulated 6 miRNAs and 10 miRNAs, respectively. Gene Ontology (GO) analysis revealed that target genes of these miRNAs might participate in neuronal development, immunity modulation, detoxification of reactive oxygen species, and transmembrane exchange. Our data suggest that exosome-based systemic screening for preterm infants with breastfeeding might be a screening tool for identifying target molecules involved in therapy for preterm infants in neonatal intensive care unit (NICU) and for future application as nutraceutical formulations or pharmaceuticals.
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Affiliation(s)
- Eun-Bit Kim
- Soonchunhyang Institute of Med-bio Science (SIMS), Soonchunhyang University, Cheonan, Republic of Korea
| | - Jun Hwan Song
- Soonchunhyang University Cheonan Hospital, College of Medicine, Soon-chunhyang University, Cheonan, Republic of Korea
| | - Linh Nguy-Hoang Le
- Department of Integrated Biomedical Science, Soonchunhyang University, Cheonan, Republic of Korea
| | - Ho Kim
- Soonchunhyang University Cheonan Hospital, College of Medicine, Soon-chunhyang University, Cheonan, Republic of Korea
| | - Ji Won Koh
- Soonchunhyang University Cheonan Hospital, College of Medicine, Soon-chunhyang University, Cheonan, Republic of Korea
| | - Yekyeng Seo
- Soonchunhyang University Cheonan Hospital, College of Medicine, Soon-chunhyang University, Cheonan, Republic of Korea
| | - Hwal Rim Jeong
- Department of Pediatrics, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Hyun-Taek Kim
- Soonchunhyang Institute of Med-bio Science (SIMS), Soonchunhyang University, Cheonan, Republic of Korea
| | - Seongho Ryu
- Department of Integrated Biomedical Science, Soonchunhyang University, Cheonan, Republic of Korea
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Machairiotis N, Vrachnis D, Antonakopoulos N, Loukas N, Fotiou A, Pergialiotis V, Stavros S, Mantzou A, Maroudias G, Iavazzo C, Kanaka-Gantenbein C, Drakakis P, Troupis T, Vlasis K, Vrachnis N. Detection and Quantification of Neurotrophin-3 (NT-3) and Nerve Growth Factor (NGF) Levels in Early Second Trimester Amniotic Fluid: Investigation into a Possible Correlation with Abnormal Fetal Growth Velocity Patterns. J Clin Med 2023; 12:4131. [PMID: 37373824 DOI: 10.3390/jcm12124131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Abnormal fetal growth is associated with adverse perinatal and long-term outcomes. The pathophysiological mechanisms underlying these conditions are still to be clarified. Nerve growth factor (NGF) and neurotrophin-3 (NT-3) are two neurotrophins that are mainly involved in the neuroprotection process, namely promotion of growth and differentiation, maintenance, and survival of neurons. During pregnancy, they have been correlated with placental development and fetal growth. In this study, we aimed to determine the early 2nd trimester amniotic fluid levels of NGF and NT-3 and to investigate their association with fetal growth. METHODS This is a prospective observational study. A total of 51 amniotic fluid samples were collected from women undergoing amniocentesis early in the second trimester and were stored at -80 °C. Pregnancies were followed up until delivery and birth weight was recorded. Based on birth weight, the amniotic fluid samples were divided into three groups: appropriate for gestational age (AGA), small for gestational age (SGA), and large for gestational age (LGA). NGF and NT-3 levels were determined by using Elisa kits. RESULTS NGF concentrations were similar between the studied groups; median values were 10.15 pg/mL, 10.15 pg/mL, and 9.14 pg/mL in SGA, LGA, and AGA fetuses, respectively. Regarding NT-3, a trend was observed towards increased NT-3 levels as fetal growth velocity decreased; median concentrations were 11.87 pg/mL, 15.9 pg/mL, and 23.5 pg/mL in SGA, AGA, and LGA fetuses, respectively, although the differences among the three groups were not statistically significant. CONCLUSIONS Our findings suggest that fetal growth disturbances do not induce increased or decreased production of NGF and NT-3 in early second trimester amniotic fluid. The trend observed towards increased NT-3 levels as fetal growth velocity decreased shows that there may be a compensatory mechanism in place that operates in conjunction with the brain-sparing effect. Further associations between these two neurotrophins and fetal growth disturbances are discussed.
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Affiliation(s)
- Nikolaos Machairiotis
- Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dionysios Vrachnis
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Nikolaos Antonakopoulos
- Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Department of Obstetrics and Gynecology, University Hospital of Patras, Medical School, University of Patras, 26500 Patra, Greece
| | - Nikolaos Loukas
- Department of Obstetrics and Gynecology, Tzaneio General Hospital, 18536 Piraeus, Greece
| | - Alexandros Fotiou
- Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Aimilia Mantzou
- First Department of Pediatrics, "Aghia Sophia" Children's Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Georgios Maroudias
- Department of Obstetrics and Gynecology, Tzaneio General Hospital, 18536 Piraeus, Greece
| | - Christos Iavazzo
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 18537 Piraeus, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, "Aghia Sophia" Children's Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Petros Drakakis
- Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Theodore Troupis
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 18537 Piraeus, Greece
| | - Konstantinos Vlasis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Manti S, Xerra F, Spoto G, Butera A, Gitto E, Di Rosa G, Nicotera AG. Neurotrophins: Expression of Brain-Lung Axis Development. Int J Mol Sci 2023; 24:ijms24087089. [PMID: 37108250 PMCID: PMC10138985 DOI: 10.3390/ijms24087089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Neurotrophins (NTs) are a group of soluble growth factors with analogous structures and functions, identified initially as critical mediators of neuronal survival during development. Recently, the relevance of NTs has been confirmed by emerging clinical data showing that impaired NTs levels and functions are involved in the onset of neurological and pulmonary diseases. The alteration in NTs expression at the central and peripheral nervous system has been linked to neurodevelopmental disorders with an early onset and severe clinical manifestations, often named "synaptopathies" because of structural and functional synaptic plasticity abnormalities. NTs appear to be also involved in the physiology and pathophysiology of several airway diseases, neonatal lung diseases, allergic and inflammatory diseases, lung fibrosis, and even lung cancer. Moreover, they have also been detected in other peripheral tissues, including immune cells, epithelium, smooth muscle, fibroblasts, and vascular endothelium. This review aims to provide a comprehensive description of the NTs as important physiological and pathophysiological players in brain and lung development.
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Affiliation(s)
- Sara Manti
- Pediatric Unit, Department of Human and Pediatric Pathology "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Federica Xerra
- Pediatric Unit, Department of Human and Pediatric Pathology "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Giulia Spoto
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
| | - Ambra Butera
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
| | - Eloisa Gitto
- Intensive Pediatric Unit, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
| | - Gabriella Di Rosa
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
| | - Antonio Gennaro Nicotera
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, "Gaetano Barresi" University of Messina, 98124 Messina, Italy
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De Nardo MC, Petrella C, Di Chiara M, Di Mario C, Deli G, Travaglia E, Baldini L, Russo A, Parisi P, Fiore M, Terrin G. Early nutritional intake influences the serum levels of nerve growth factor (NGF) and brain-derived neurotrophic factor in preterm newborns. Front Neurol 2022; 13:988101. [PMID: 36324384 PMCID: PMC9620475 DOI: 10.3389/fneur.2022.988101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Parenteral nutrition (PN) may have detrimental effects on neurodevelopment in preterm newborns. Moreover, enteral nutrition (EN) seems to be protective. To understand the mechanisms of how neurological development can be influenced by the route of administration of nutritional intake, we investigated the relationship between the serum levels of the nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) and nutritional intake received in early life by preterm newborns. Materials and methods Specimens of blood were obtained at 28 days of life (DOL) for NGF/BDNF determination in neonates <32 weeks of gestation and/or with birth weight <1,500 g, consecutively observed in the neonatal intensive care unit. We analyzed the relation between amino acid content and energy intake and NGF/BDNF measurements at 28 DOL. PN protein intake was referred to as the total amounts of amino acid intake received daily. Results We enrolled 20 newborns (gestational age 30.45 ± 1.76 weeks, birth weight 1,340 ± 352.63 g). Serum NGF value at 28 DOL was positively correlated with enteral protein and energy intake (r = 0.767; r = 0.746, p < 0.001), whereas, negatively correlated with parenteral amino acid and energy intake (r = −0.652, p < 0.001; r = −0.466, p < 0.05). Similar significant correlations were described between BDNF level at 28 DOL and enteral energy intake (r = 0.493, p < 0.05). Multivariate regression analysis showed that NGF level at 28 DOL depends on enteral protein and energy intake administrated in the 1st week of life. Conclusion Neurotrophin values varied according to the route of nutrition administration in preterm newborns. NGF/BDNF serum levels are influenced positively and negatively by EN and PN, respectively.
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Affiliation(s)
- Maria Chiara De Nardo
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology (IBB) of the National Research Council (CNR), Rome, Italy
| | - Maria Di Chiara
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Chiara Di Mario
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Giorgia Deli
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Elisa Travaglia
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Laura Baldini
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Alessia Russo
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pasquale Parisi
- Department of Pediatrics, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology (IBB) of the National Research Council (CNR), Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
- *Correspondence: Gianluca Terrin
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Ruzok T, Schmitz-Koep B, Menegaux A, Eves R, Daamen M, Boecker H, Rieger-Fackeldey E, Priller J, Zimmer C, Bartmann P, Wolke D, Sorg C, Hedderich DM. Lower hypothalamus subunit volumes link with impaired long-term body weight gain after preterm birth. Front Endocrinol (Lausanne) 2022; 13:1057566. [PMID: 36589836 PMCID: PMC9797519 DOI: 10.3389/fendo.2022.1057566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Preterm birth is associated with an increased risk for impaired body weight gain. While it is known that in prematurity several somatic and environmental factors (e.g., endocrine factors, nutrition) modulate short- and long-term body weight gain, the contribution of potentially impaired body weight control in the brain remains elusive. We hypothesized that the structure of hypothalamic nuclei involved in body weight control is altered after preterm birth, with these alterations being associated with aberrant body weight development into adulthood. MATERIALS AND METHODS We assessed 101 very preterm (i.e., <32 weeks of gestational age) and/or very low birth weight (i.e., <1500g; VP/VLBW) and 110 full-term born (FT) adults of the population-based Bavarian Longitudinal Study with T1-weighted MRI, deep learning-based hypothalamus subunit segmentation, and multiple body weight assessments from birth into adulthood. RESULTS Volumes of the whole hypothalamus and hypothalamus subunits relevant for body weight control were reduced in VP/VLBW adults and associated with birth variables (i.e., gestational age and intensity of neonatal treatment), body weight (i.e., weight at birth and adulthood), and body weight trajectories (i.e., trajectory slopes and cluster/types such as long-term catch-up growth). Particularly, VP/VLBW subgroups, whose individuals showed catch-up growth and/or were small for gestational age, were mostly associated with volumes of distinct hypothalamus subunits such as lateral or infundibular/ventromedial hypothalamus. CONCLUSION Results demonstrate lower volumes of body weight control-related hypothalamus subunits after preterm birth that link with long-term body weight gain. Data suggest postnatal development of body weight -related hypothalamic nuclei in VP/VLBW individuals that corresponds with distinct body weight trajectories into adulthood.
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Affiliation(s)
- Tobias Ruzok
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
- *Correspondence: Tobias Ruzok,
| | - Benita Schmitz-Koep
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
| | - Aurore Menegaux
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
| | - Robert Eves
- Department of Psychology, University of Warwick, Coventry, United Kingdom
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Marcel Daamen
- Clinical Functional Imaging Group, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Henning Boecker
- Clinical Functional Imaging Group, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Esther Rieger-Fackeldey
- Department of Neonatology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Neuropsychiatry, Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- UK Dementia Research Institute, University of Edinburgh (UK DRI), Edinburgh, United Kingdom
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Christian Sorg
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dennis M. Hedderich
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
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