Executives functions in co-occuring adult attention deficit hyperactivity disorder and alcohol use disorder

Introduction

Executives functions (EF) are cognitive processes mediating the ability to successfully regulate thoughts and behaviours in order to fulfil a goal. EF impairment has been found both in the Attention Deficit Hyperactivity Disorder (ADHD) and in the Alcohol Use Disorder (AUD). Deficits in EF may have a major impact on patients’ everyday life.

Objectives

The aim of this study was to evaluate EF in a population with a dual diagnosis of Adult ADHD et AUD. We also evaluated the correlation between EF and the dimensions of quality of life.

Methods

For this observational multicentric study, we included patients with AUD starting long-term residential treatment. We used ASRS v.1.1 to screen for Adult ADHD and DIVA to confirm the diagnosis. We assess EF with BRIEF-A. WHOQoL-BREF was used to evaluate quality of life.

Results

Our population consists of 49 patients. Adult ADHD prevalence was 24,49%. Impairment score of all EF explored (Inhibition, Shifting, Emotional Control, Self-Monitoring, Initiative, Working Memory, Planning/Organizing, Organization of materials, Task Monitoring) was higher in patients with co-occuring Adult ADHD and AUD than in patients without Adult ADHD (p<0,001). We found strong negative correlation between Psychological Health and impairment score of Inhibition (p<0,001), Emotion Control (p<0,001), Self-Monitoring (p<0,001) and planning/Organizing (p<0,001). The other dimensions of quality of life were poorly correlated to EF impairment.

Conclusions

The prevalence of Adult ADHD in AUD patients is high. When AUD and Adult ADHD coexist, EF impairment is stronger and quality of life is poorer. Psychological health and EF impairment are strongly associated.

Chaperone-mediated autophagy sustains haematopoietic stem-cell function

The activation of mostly quiescent haematopoietic stem cells (HSCs) is a prerequisite for life-long production of blood cells¹. This process requires major molecular adaptations to allow HSCs to meet the regulatory and metabolic requirements for cell division^2-4. The mechanisms that govern cellular reprograming upon stem-cell activation, and the subsequent return of stem cells to quiescence, have not been fully characterized. Here we show that chaperone-mediated autophagy (CMA)⁵, a selective form of lysosomal protein degradation, is involved in sustaining HSC function in adult mice. CMA is required for protein quality control in stem cells and for the upregulation of fatty acid metabolism upon HSC activation. We find that CMA activity in HSCs decreases with age and show that genetic or pharmacological activation of CMA can restore the functionality of old mouse and human HSCs. Together, our findings provide mechanistic insights into a role for CMA in sustaining quality control, appropriate energetics and overall long-term HSC function. Our work suggests that CMA may be a promising therapeutic target for enhancing HSC function in conditions such as ageing or stem-cell transplantation.

Specific dyspeptic symptoms are associated with poor response to therapy in patients with gastroesophageal reflux disease

INTRODUCTION

In patients with gastroesophageal reflux disease (GORD), co-existence of functional dyspepsia (FD) is known to be associated with poor response to proton pump inhibitors (PPIs), but the contribution of specific dyspepsia symptoms has not yet been systematically investigated.

OBJECTIVE

We aimed to characterize the impact of dyspepsia symptoms on response to PPIs in patients with GORD.

METHODS

The enrolled subjects were consecutive patients with a diagnosis of GORD. All patients underwent a 24 hour pH-impedance test, while on PPI therapy. Patients were divided into two groups, refractory and responders, according to the persistence of GORD symptoms. A standardized questionnaire for FD was also administered to assess presence of dyspepsia symptoms.

RESULTS

In the subgroup of refractory patients FD was more prevalent than in responders, with post-prandial fullness, nausea, vomiting, early satiation and epigastric pain being significantly prevalent in refractory GORD patients. In the multivariate analysis only early satiation and vomiting were significantly associated with poor response to PPIs.

CONCLUSION

Co-existence of FD is associated with refractory GORD. We showed that only early satiation and vomiting are risk factors for poor response to therapy with PPIs. Our findings suggest that symptoms of early satiation and vomiting would help to identify the subset of PPI-refractory GORD patients.

Enteric glia: A new player in inflammatory bowel diseases

In addition to the well-known involvement of macrophages and neutrophils, other cell types have been recently reported to substantially contribute to the onset and progression of inflammatory bowel diseases (IBD). Enteric glial cells (EGC) are the equivalent cell type of astrocyte in the central nervous system (CNS) and share with them many neurotrophic and neuro-immunomodulatory properties. This short review highlights the role of EGC in IBD, describing the role played by these cells in the maintenance of gut homeostasis, and their modulation of enteric neuronal activities. In pathological conditions, EGC have been reported to trigger and support bowel inflammation through the specific over-secretion of S100B protein, a pivotal neurotrophic factor able to induce chronic inflammatory changes in gut mucosa. New pharmacological tools that may improve the current therapeutic strategies for inflammatory bowel diseases (IBD), lowering side effects (i.e. corticosteroids) and costs (i.e. anti-TNFα monoclonal antibodies) represent a very important challenge for gastroenterologists and pharmacologists. Novel drugs capable to modulate enteric glia reactivity, limiting the pro-inflammatory release of S100B, may thus represent a significant innovation in the field of pharmacological interventions for inflammatory bowel diseases.