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Phetsouphanh C, Jacka B, Ballouz S, Jackson KJL, Wilson DB, Manandhar B, Klemm V, Tan HX, Wheatley A, Aggarwal A, Akerman A, Milogiannakis V, Starr M, Cunningham P, Turville SG, Kent SJ, Byrne A, Brew BJ, Darley DR, Dore GJ, Kelleher AD, Matthews GV. Improvement of immune dysregulation in individuals with long COVID at 24-months following SARS-CoV-2 infection. Nat Commun 2024; 15:3315. [PMID: 38632311 PMCID: PMC11024141 DOI: 10.1038/s41467-024-47720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
This study investigates the humoral and cellular immune responses and health-related quality of life measures in individuals with mild to moderate long COVID (LC) compared to age and gender matched recovered COVID-19 controls (MC) over 24 months. LC participants show elevated nucleocapsid IgG levels at 3 months, and higher neutralizing capacity up to 8 months post-infection. Increased spike-specific and nucleocapsid-specific CD4+ T cells, PD-1, and TIM-3 expression on CD4+ and CD8+ T cells were observed at 3 and 8 months, but these differences do not persist at 24 months. Some LC participants had detectable IFN-γ and IFN-β, that was attributed to reinfection and antigen re-exposure. Single-cell RNA sequencing at the 24 month timepoint shows similar immune cell proportions and reconstitution of naïve T and B cell subsets in LC and MC. No significant differences in exhaustion scores or antigen-specific T cell clones are observed. These findings suggest resolution of immune activation in LC and return to comparable immune responses between LC and MC over time. Improvement in self-reported health-related quality of life at 24 months was also evident in the majority of LC (62%). PTX3, CRP levels and platelet count are associated with improvements in health-related quality of life.
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Affiliation(s)
| | - Brendan Jacka
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sara Ballouz
- Garvan Institute for Medical research, Sydney, NSW, Australia
- School of Computer Science and Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
| | | | - Daniel B Wilson
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Bikash Manandhar
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Vera Klemm
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Hyon-Xhi Tan
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, VIC, Australia
| | - Adam Wheatley
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, VIC, Australia
| | - Anupriya Aggarwal
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anouschka Akerman
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Mitchell Starr
- NSW State Reference Laboratory for HIV, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Phillip Cunningham
- NSW State Reference Laboratory for HIV, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Stuart G Turville
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, VIC, Australia
| | - Anthony Byrne
- Heart Lung Clinic, St. Vincent's Hospital Sydney and Faculty of Medicine and Health (UNSW), Sydney, NSW, Australia
| | - Bruce J Brew
- Peter Duncan Neurosciences Unit- St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | | | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Anthony D Kelleher
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
- St. Vincent's Hospital, Darlinghurst, NSW, Australia.
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
- St. Vincent's Hospital, Darlinghurst, NSW, Australia.
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2
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Cysique LA, Brew BJ, Bruning J, Byrd D, Costello J, Daken K, Ellis RJ, Fazeli PL, Goodkin K, Gouse H, Heaton RK, Letendre S, Levin J, Aung HL, Mindt MR, Moore D, Mullens AB, de Almeida SM, Muñoz-Moreno JA, Power C, Robbins RN, Rule J, Rajasuriar R, Savin MJ, Taylor J, Trunfio M, Vance DE, Wong PL, Woods SP, Wright EJ, Rourke SB. Cognitive criteria in HIV: greater consensus is needed. Nat Rev Neurol 2024; 20:127-128. [PMID: 38228906 DOI: 10.1038/s41582-024-00927-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Lucette A Cysique
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital (Unity Health Toronto), Toronto, Ontario, Canada.
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia.
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
- Sydney St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
| | - Bruce J Brew
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Jane Bruning
- Positive Women Inc., Auckland, Aotearoa New Zealand
| | - Desiree Byrd
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Queens College and the Graduate Center, City University of New York, New York, NY, USA
| | - Jane Costello
- Positive Life New South Wales, Sydney, New South Wales, Australia
| | - Kirstie Daken
- School of Psychology & Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Ronald J Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karl Goodkin
- Department of Psychiatry and Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Hetta Gouse
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Scott Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Jules Levin
- National AIDS Treatment Advocacy Project, New York, NY, USA
| | - Htein Linn Aung
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Monica Rivera Mindt
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Latin American Latino Studies, and African and African American Studies, Fordham University, New York, NY, USA
| | - David Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Amy B Mullens
- School of Psychology & Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | - Jose A Muñoz-Moreno
- Infectious Diseases Department, Germans Trias Hospital, Spain Open University of Catalonia, Barcalona, Spain
| | - Chrispher Power
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - John Rule
- National Association of People with HIV Australia, Newtown, New South Wales, Australia
| | - Reena Rajasuriar
- Department of Medicine and Centre of Excellence for Research in AIDS, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Micah J Savin
- Mailman Department of Public Health, Columbia University, New York, NY, USA
| | - Jeff Taylor
- HIV+Aging Research Project-Palm Springs, Palm Springs, CA, USA
| | - Mattia Trunfio
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Infectious Diseases Unit, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pui Li Wong
- Department of Medicine and Centre of Excellence for Research in AIDS, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Steven P Woods
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Edwina J Wright
- Department of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia
- Burnet Institute, HIV Elimination Program, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Victoria, Australia
- The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital (Unity Health Toronto), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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3
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Brew BJ, Clifford DB. Antiretroviral therapy intensification for HIV-associated neurocognitive disorder? AIDS 2023; 37:2095-2096. [PMID: 37755427 DOI: 10.1097/qad.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Bruce J Brew
- Departments of Neurology and HIV Medicine and Peter Duncan Neurosciences Unit St Vincent's Hospital, University of New South Wales and Notre Dame, Sydney, New South Wales, Australia
| | - David B Clifford
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA
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Angelovich TA, Cochrane CR, Zhou J, Tumpach C, Byrnes SJ, Jamal Eddine J, Waring E, Busman-Sahay K, Deleage C, Jenkins TA, Hearps AC, Turville S, Gorry PR, Lewin SR, Brew BJ, Estes JD, Roche M, Churchill MJ. Regional Analysis of Intact and Defective HIV Proviruses in the Brain of Viremic and Virally Suppressed People with HIV. Ann Neurol 2023; 94:798-802. [PMID: 37493435 PMCID: PMC10914117 DOI: 10.1002/ana.26750] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 07/27/2023]
Abstract
Here, we provide the first regional analysis of intact and defective HIV reservoirs within the brain. Brain tissue from both viremic and virally suppressed people with HIV (PWH) harbored HIV pol DNA in all regions tested, with lower levels present in basal ganglia and cerebellum relative to frontal white matter. Intact proviruses were primarily found in the frontal white matter but also detected in other brain regions of PWH, demonstrating frontal white matter as a major brain reservoir of intact, potentially replication competent HIV DNA that persists despite antiretroviral therapy. ANN NEUROL 2023;94:798-802.
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Affiliation(s)
- Thomas A Angelovich
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
- Life Sciences Discipline, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Catherine R Cochrane
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jingling Zhou
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Carolin Tumpach
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sarah J Byrnes
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Janna Jamal Eddine
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Emily Waring
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Kathleen Busman-Sahay
- Vaccine and Gene Therapy Institute, Oregon Health & Science University, Hillsboro, Oregon, USA
| | - Claire Deleage
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Trisha A Jenkins
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Anna C Hearps
- Life Sciences Discipline, Burnet Institute, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Stuart Turville
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Paul R Gorry
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Bruce J Brew
- Peter Duncan Neurosciences Unit, Departments of Neurology and Immunology St. Vincent's Hospital, University of New South Wales, Sydney, New South Wales, Australia
- University of Notre Dame, Sydney, New South Wales, Australia
| | - Jacob D Estes
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
- Vaccine and Gene Therapy Institute, Oregon Health & Science University, Hillsboro, Oregon, USA
| | - Michael Roche
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Melissa J Churchill
- Infectious and Inflammatory Diseases, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
- Life Sciences Discipline, Burnet Institute, Melbourne, Victoria, Australia
- Departments of Microbiology and Medicine, Monash University, Melbourne, Victoria, Australia
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5
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Chaganti J, Gates TM, Brew BJ. Reversible large-scale network disruption correlates with neurocognitive improvement in HIV-associated minor neurocognitive disorder with combined anti-retroviral therapy intensification: a prospective longitudinal resting-state functional magnetic resonance imaging study. Neurol Sci 2023; 44:3261-3269. [PMID: 37052787 DOI: 10.1007/s10072-023-06783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/23/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE HIV-associated neurocognitive disorder (HAND) affects multiple cognitive domains and currently, the neuropsychological testing is the gold standard to identify these deficits. The aim of this longitudinal 12-month pilot study is to determine the effect of intensified combination antiretroviral therapy (cART) on rs-fMRI in virally suppressed (both in CSF and blood) patients with active HAND (those who have progressive neurocognitive impairment) and correlated with neurocognitive function tests. METHODS In this pilot study, we have evaluated sixteen patients with active HAND with viral suppression in both blood and CSF to study the effect of cART on functional connectivity. Participants underwent rs-fMRI at the baseline (time point-1 (TP-1) and 12-month visits (time point-2 (TP-2)). Connectivity in the five major networks was measured at TP-1 and TP-2 using the seed-based approach. All the participants underwent a five-domain neuropsychological battery at TP-1 and TP-2. Neurocognitive scores (NC) as well as blood and CSF markers were correlated with functional connectivity (FC). RESULTS There was a significant increase in the FC between the two time points within the executive, salience, default mode, dorsal attention, and visual networks at voxel level threshold of p < 0.001 and cluster level threshold of p < 0.05 and corrected for false detection rate (FDR). The neurocognitive scores were positively correlated with all the networks at similar cluster and voxel level thresholds. CONCLUSIONS These results indicate that rs-fMRI can be potentially used as one of the biomarkers for treatment efficacy in HAND.
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Affiliation(s)
- Joga Chaganti
- Department of Medical Imaging, St Vincent's Hospital, Sydney, Australia.
| | - Thomas M Gates
- Center for Applied Medical Research Program, St Vincent's Hospital, Sydney, Australia
| | - Bruce J Brew
- Department of Neurology, Head Neuroscience Program and Peter Duncan Neuroscience Centre for Applied Medical Research, St Vincent's Hospital, University of New South Wales, Sydney, Australia
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Cysique LA, Jakabek D, Bracken SG, Allen‐Davidian Y, Heng B, Chow S, Dehhaghi M, Staats Pires A, Darley DR, Byrne A, Phetsouphanh C, Kelleher A, Dore GJ, Matthews GV, Guillemin GJ, Brew BJ. The kynurenine pathway relates to post-acute COVID-19 objective cognitive impairment and PASC. Ann Clin Transl Neurol 2023; 10:1338-1352. [PMID: 37318955 PMCID: PMC10424655 DOI: 10.1002/acn3.51825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To determine the prevalence and natural history of post-acute COVID-19 objective cognitive impairment and function, and their relationship to demographic, clinical factors, post-acute sequelae of COVID-19 (PASC), and biomarkers. METHODS A total of 128 post-acute COVID-19 patients (age = 46 ± 15; 42% women, acute disease severity: not hospitalized: 38.6% mild: 0-1 symptoms, 52% 2+ symptoms; 9.4% hospitalized) completed standard cognition, olfaction, and mental health examinations 2-, 4-, and 12-month post diagnosis. Over the same time frame, WHO-defined PASC was determined. Blood cytokines, peripheral neurobiomarkers, and kynurenine pathway (KP) metabolites were measured. Objective cognitive function was demographically/practice corrected, and impairment prevalence was determined using the evidence-based Global Deficit Score method to detect at least mild cognitive impairment (GDS > 0.5). Linear mixed effect regression models with time effect (month post diagnosis) evaluated the relationships to cognition. RESULTS Across the 12-month study period, mild to moderate cognitive impairment ranged from 16% to 26%, and 46.5% were impaired at least once. Impairment associated with poorer work capacity (p < 0.05), and 2-month objectively tested anosmia (p < 0.05). PASC with (p = 0.01) and without disability (p < 0.03) associated with acute COVID-19 severity. KP measures showed prolonged activation (2 to 8 months) (p < 0.0001) linked to IFN-beta in those with PASC. Of the blood analytes, only the KP metabolites (elevated quinolinic acid, 3-hydroxyanthranilic acid, kynurenine, the kynurenine/tryptophan ratio) associated (p < 0.001) with poorer cognitive performance and greater likelihood of impairment. PASC, independent of disability associated with abnormal kynurenine/tryptophan (p < 0.03). INTERPRETATION The kynurenine pathway relates to post-acute COVID-19 objective cognitive impairment and PASC, thereby enabling biomarker and therapeutic possibilities.
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Affiliation(s)
- Lucette A. Cysique
- Peter Duncan Neuroscience Research UnitSt. Vincent's Centre for Applied Medical ResearchDarlinghurstNew South WalesAustralia
- School of PsychologyUNSWSydneyNew South WalesAustralia
| | - David Jakabek
- Neurology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | | | - Yasmin Allen‐Davidian
- Peter Duncan Neuroscience Research UnitSt. Vincent's Centre for Applied Medical ResearchDarlinghurstNew South WalesAustralia
- School of PsychologyMacquarie UniversitySydneyNew South WalesAustralia
| | - Benjamin Heng
- Macquarie Medical SchoolMacquarie UniversitySydneyNew South WalesAustralia
- PANDIS.orgSydneyNew South WalesAustralia
| | - Sharron Chow
- Macquarie Medical SchoolMacquarie UniversitySydneyNew South WalesAustralia
| | - Mona Dehhaghi
- Macquarie Medical SchoolMacquarie UniversitySydneyNew South WalesAustralia
- PANDIS.orgSydneyNew South WalesAustralia
| | | | - David R. Darley
- Faculty of MedicineUNSWSydneyNew South WalesAustralia
- Respiratory Medicine DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Anthony Byrne
- Faculty of MedicineUNSWSydneyNew South WalesAustralia
- Respiratory Medicine DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | | | - Anthony Kelleher
- Kirby InstituteUNSWSydneyNew South WalesAustralia
- Infectious Disease and Immunology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Gregory J. Dore
- Kirby InstituteUNSWSydneyNew South WalesAustralia
- Infectious Disease and Immunology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Gail V. Matthews
- Kirby InstituteUNSWSydneyNew South WalesAustralia
- Infectious Disease and Immunology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Gilles J. Guillemin
- Macquarie Medical SchoolMacquarie UniversitySydneyNew South WalesAustralia
- PANDIS.orgSydneyNew South WalesAustralia
| | - Bruce J. Brew
- Peter Duncan Neuroscience Research UnitSt. Vincent's Centre for Applied Medical ResearchDarlinghurstNew South WalesAustralia
- Neurology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
- Faculty of MedicineUNSWSydneyNew South WalesAustralia
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Braidy N, Brew BJ, Inestrosa NC, Chung R, Sachdev P, Guillemin GJ. Retraction Note to: Changes in Cathepsin D and Beclin-1 mRNA and protein expression by the excitotoxin quinolinic acid in human astrocytes and neurons. Metab Brain Dis 2023:10.1007/s11011-023-01241-3. [PMID: 37273082 DOI: 10.1007/s11011-023-01241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Nady Braidy
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Bruce J Brew
- Peter Duncan Neuroscience Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Nibaldo C Inestrosa
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
- Centro de Envejecimiento Y Regeneración (CARE), Departamento de Biologìa Celular Y Molecular, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roger Chung
- Neuro Pharmacology Group, MND and Neurodegenerative Diseases Research Centre, Macquarie University, Balaclava Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Barker Street, Randwick, NSW, 2013, Australia
| | - Gilles J Guillemin
- Neuro Pharmacology Group, MND and Neurodegenerative Diseases Research Centre, Macquarie University, Balaclava Rd, North Ryde, Sydney, NSW, 2109, Australia.
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Goodkin K, Evering TH, Anderson AM, Ragin A, Monaco CL, Gavegnano C, Avery RJ, Rourke SB, Cysique LA, Brew BJ. The comorbidity of depression and neurocognitive disorder in persons with HIV infection: call for investigation and treatment. Front Cell Neurosci 2023; 17:1130938. [PMID: 37206666 PMCID: PMC10190964 DOI: 10.3389/fncel.2023.1130938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/07/2023] [Indexed: 05/21/2023] Open
Abstract
Depression and neurocognitive disorder continue to be the major neuropsychiatric disorders affecting persons with HIV (PWH). The prevalence of major depressive disorder is two to fourfold higher among PWH than the general population (∼6.7%). Prevalence estimates of neurocognitive disorder among PWH range from 25 to over 47% - depending upon the definition used (which is currently evolving), the size of the test battery employed, and the demographic and HIV disease characteristics of the participants included, such as age range and sex distribution. Both major depressive disorder and neurocognitive disorder also result in substantial morbidity and premature mortality. However, though anticipated to be relatively common, the comorbidity of these two disorders in PWH has not been formally studied. This is partly due to the clinical overlap of the neurocognitive symptoms of these two disorders. Both also share neurobehavioral aspects - particularly apathy - as well as an increased risk for non-adherence to antiretroviral therapy. Shared pathophysiological mechanisms potentially explain these intersecting phenotypes, including neuroinflammatory, vascular, and microbiomic, as well as neuroendocrine/neurotransmitter dynamic mechanisms. Treatment of either disorder affects the other with respect to symptom reduction as well as medication toxicity. We present a unified model for the comorbidity based upon deficits in dopaminergic transmission that occur in both major depressive disorder and HIV-associated neurocognitive disorder. Specific treatments for the comorbidity that decrease neuroinflammation and/or restore associated deficits in dopaminergic transmission may be indicated and merit study.
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Affiliation(s)
- Karl Goodkin
- Department of Psychiatry, School of Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, United States
- Institute of Neuroscience, School of Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, United States
| | - Teresa H. Evering
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Albert M. Anderson
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Ann Ragin
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia L. Monaco
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Del Monte Institute of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Christina Gavegnano
- Department of Pathology, Emory School of Medicine, Emory University, Atlanta, GA, United States
- Department of Pharmacology, Emory School of Medicine, Emory University, Atlanta, GA, United States
- Department of Chemical Biology, Emory School of Medicine, Emory University, Atlanta, GA, United States
- Center for the Study of Human Health, Emory College of Arts and Sciences, Emory University, Atlanta, GA, United States
- Atlanta Veteran’s Affairs Medical Center, Atlanta, GA, United States
- Center for Bioethics, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Ryan J. Avery
- Division of Nuclear Medicine, Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sean B. Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lucette A. Cysique
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - Bruce J. Brew
- Department of Neurology, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, Faculty of Medicine, University of Notre Dame, Sydney, NSW, Australia
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9
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Speck P, Mackenzie J, Bull RA, Slobedman B, Drummer H, Fraser J, Herrero L, Helbig K, Londrigan S, Moseley G, Prow N, Hansman G, Edwards R, Ahlenstiel C, Abendroth A, Tscharke D, Hobson-Peters J, Kriiger-Loterio R, Parry R, Marsh G, Harding E, Jacques DA, Gartner MJ, Lee WS, McAuley J, Vaz P, Sainsbury F, Tate MD, Sinclair J, Imrie A, Rawlinson S, Harman A, Carr JM, Monson EA, Hibma M, Mahony TJ, Tu T, Center RJ, Shrestha LB, Hall R, Warner M, Ward V, Anderson DE, Eyre NS, Netzler NE, Peel AJ, Revill P, Beard M, Legione AR, Spencer AJ, Idris A, Forwood J, Sarker S, Purcell DFJ, Bartlett N, Deerain JM, Brew BJ, Asgari S, Farrell H, Khromykh A, Enosi Tuipulotu D, Anderson D, Mese S, Tayyar Y, Edenborough K, Uddin JM, Hussain A, Daymond CJI, Agius J, Johnson KN, Shirmast P, Abedinzadeshahri M, MacDiarmid R, Ashley CL, Laws J, Furfaro LL, Burton TD, Johnson SMR, Telikani Z, Petrone M, Roby JA, Samer C, Suhrbier A, Van Der Kamp A, Cunningham A, Donato C, Mahar J, Black WD, Vasudevan S, Lenchine R, Spann K, Rawle DJ, Rudd P, Neil J, Kingston R, Newsome TP, Kim KW, Mak J, Lowry K, Bryant N, Meers J, Roberts JA, McMillan N, Labzin LI, Slonchak A, Hugo LE, Henzeler B, Newton ND, David CT, Reading PC, Esneau C, Briody T, Nasr N, McNeale D, McSharry B, Fakhri O, Horsburgh BA, Logan G, Howley P, Young P. Statement in Support of: "Virology under the Microscope-a Call for Rational Discourse". mBio 2023:e0081523. [PMID: 37097032 DOI: 10.1128/mbio.00815-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Peter Speck
- Flinders University, Bedford Park, South Australia
| | - Jason Mackenzie
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Rowena A Bull
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | - Lara Herrero
- Griffith University, Southport, Queensland, Australia
| | - Karla Helbig
- La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Londrigan
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie Prow
- Hull York Medical School, University of York, York, United Kingdom
| | - Grant Hansman
- Griffith University, Southport, Queensland, Australia
| | | | | | | | - David Tscharke
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Rhys Parry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Glenn Marsh
- Commonwealth Scientific and Industrial Research Organisation, Geelong, Victoria, Australia
| | - Emma Harding
- University of New South Wales, Sydney, New South Wales, Australia
| | - David A Jacques
- University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew J Gartner
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Wen Shi Lee
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Julie McAuley
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Paola Vaz
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michelle D Tate
- Monash University, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jane Sinclair
- University of Queensland, St. Lucia, Queensland, Australia
| | - Allison Imrie
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Andrew Harman
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | | | | | - Thomas Tu
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | - Robyn Hall
- Ausvet Pty Ltd., Canberra, Australian Capital Territory, Australia
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | - Morgyn Warner
- University of Adelaide, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
| | | | - Danielle E Anderson
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie E Netzler
- University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre of Research Excellence, Auckland, New Zealand
| | | | - Peter Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael Beard
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Adi Idris
- Griffith University, Southport, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jade Forwood
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Subir Sarker
- La Trobe University, Melbourne, Victoria, Australia
| | - Damian F J Purcell
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Nathan Bartlett
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joshua M Deerain
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Bruce J Brew
- University of New South Wales, Sydney, New South Wales, Australia
- University of Notre Dame, Sydney, New South Wales, Australia
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sassan Asgari
- University of Queensland, St. Lucia, Queensland, Australia
| | - Helen Farrell
- University of Queensland, St. Lucia, Queensland, Australia
| | | | | | | | - Sevim Mese
- University of Queensland, St. Lucia, Queensland, Australia
- Istanbul University, Istanbul, Turkey
| | - Yaman Tayyar
- Griffith University, Southport, Queensland, Australia
- Prorenata Biotech, Moledinar, Queensland, Australia
| | | | | | - Abrar Hussain
- Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Connor J I Daymond
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | | | | | - Robin MacDiarmid
- The New Zealand Institute for Plant & Food Research Limited, Auckland, New Zealand
| | | | - Jay Laws
- La Trobe University, Melbourne, Victoria, Australia
| | - Lucy L Furfaro
- University of Western Australia, Perth, Western Australia, Australia
| | | | | | | | - Mary Petrone
- The University of Sydney, New South Wales, Australia
| | - Justin A Roby
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Carolyn Samer
- The University of Sydney, New South Wales, Australia
| | - Andreas Suhrbier
- University of Queensland, St. Lucia, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Anthony Cunningham
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Celeste Donato
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jackie Mahar
- The University of Sydney, New South Wales, Australia
| | - Wesley D Black
- Biotopia Environmental Assessment Pty Ltd., Melbourne, Victoria, Australia
| | | | | | - Kirsten Spann
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel J Rawle
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Penny Rudd
- Griffith University, Southport, Queensland, Australia
| | - Jessica Neil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | - Ki Wook Kim
- University of New South Wales, Sydney, New South Wales, Australia
| | - Johnson Mak
- Griffith University, Southport, Queensland, Australia
| | - Kym Lowry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Nathan Bryant
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joanne Meers
- University of Queensland, St. Lucia, Queensland, Australia
| | - Jason A Roberts
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | | | | | - Leon E Hugo
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | | | - Patrick C Reading
- University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia
| | - Camille Esneau
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tatiana Briody
- University of Queensland, St. Lucia, Queensland, Australia
| | - Najla Nasr
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | - Brian McSharry
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Omid Fakhri
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | | | - Grant Logan
- Children's Medical Research Institute, Westmead, NSW, Australia
| | - Paul Howley
- Vaxmed Pty Ltd., Berwick, Victoria, Australia
| | - Paul Young
- University of Queensland, St. Lucia, Queensland, Australia
| |
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10
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Speck P, Mackenzie J, Bull RA, Slobedman B, Drummer H, Fraser J, Herrero L, Helbig K, Londrigan S, Moseley G, Prow N, Hansman G, Edwards R, Ahlenstiel C, Abendroth A, Tscharke D, Hobson-Peters J, Kriiger-Loterio R, Parry R, Marsh G, Harding E, Jacques DA, Gartner MJ, Lee WS, McAuley J, Vaz P, Sainsbury F, Tate MD, Sinclair J, Imrie A, Rawlinson S, Harman A, Carr JM, Monson EA, Hibma M, Mahony TJ, Tu T, Center RJ, Shrestha LB, Hall R, Warner M, Ward V, Anderson DE, Eyre NS, Netzler NE, Peel AJ, Revill P, Beard M, Legione AR, Spencer AJ, Idris A, Forwood J, Sarker S, Purcell DFJ, Bartlett N, Deerain JM, Brew BJ, Asgari S, Farrell H, Khromykh A, Enosi Tuipulotu D, Anderson D, Mese S, Tayyar Y, Edenborough K, Uddin JM, Hussain A, Daymond CJI, Agius J, Johnson KN, Shirmast P, Abedinzadeshahri M, MacDiarmid R, Ashley CL, Laws J, Furfaro LL, Burton TD, Johnson SMR, Telikani Z, Petrone M, Roby JA, Samer C, Suhrbier A, Van Der Kamp A, Cunningham A, Donato C, Mahar J, Black WD, Vasudevan S, Lenchine R, Spann K, Rawle DJ, Rudd P, Neil J, Kingston R, Newsome TP, Kim KW, Mak J, Lowry K, Bryant N, Meers J, Roberts JA, McMillan N, Labzin LI, Slonchak A, Hugo LE, Henzeler B, Newton ND, David CT, Reading PC, Esneau C, Briody T, Nasr N, McNeale D, McSharry B, Fakhri O, Horsburgh BA, Logan G, Howley P, Young P. Statement in Support of: "Virology under the Microscope-a Call for Rational Discourse". mSphere 2023:e0016523. [PMID: 37097028 DOI: 10.1128/msphere.00165-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Peter Speck
- Flinders University, Bedford Park, South Australia
| | - Jason Mackenzie
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Rowena A Bull
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | - Lara Herrero
- Griffith University, Southport, Queensland, Australia
| | - Karla Helbig
- La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Londrigan
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie Prow
- Hull York Medical School, University of York, York, United Kingdom
| | - Grant Hansman
- Griffith University, Southport, Queensland, Australia
| | | | | | | | - David Tscharke
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Rhys Parry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Glenn Marsh
- Commonwealth Scientific and Industrial Research Organisation, Geelong, Victoria, Australia
| | - Emma Harding
- University of New South Wales, Sydney, New South Wales, Australia
| | - David A Jacques
- University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew J Gartner
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Wen Shi Lee
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Julie McAuley
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Paola Vaz
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michelle D Tate
- Monash University, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jane Sinclair
- University of Queensland, St. Lucia, Queensland, Australia
| | - Allison Imrie
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Andrew Harman
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | | | | | - Thomas Tu
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | - Robyn Hall
- Ausvet Pty Ltd., Canberra, Australian Capital Territory, Australia
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | - Morgyn Warner
- University of Adelaide, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
| | | | - Danielle E Anderson
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie E Netzler
- University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre of Research Excellence, Auckland, New Zealand
| | | | - Peter Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael Beard
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Adi Idris
- Griffith University, Southport, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jade Forwood
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Subir Sarker
- La Trobe University, Melbourne, Victoria, Australia
| | - Damian F J Purcell
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Nathan Bartlett
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joshua M Deerain
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Bruce J Brew
- University of New South Wales, Sydney, New South Wales, Australia
- University of Notre Dame, Sydney, New South Wales, Australia
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sassan Asgari
- University of Queensland, St. Lucia, Queensland, Australia
| | - Helen Farrell
- University of Queensland, St. Lucia, Queensland, Australia
| | | | | | | | - Sevim Mese
- University of Queensland, St. Lucia, Queensland, Australia
- Istanbul University, Istanbul, Turkey
| | - Yaman Tayyar
- Griffith University, Southport, Queensland, Australia
- Prorenata Biotech, Moledinar, Queensland, Australia
| | | | | | - Abrar Hussain
- Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Connor J I Daymond
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | | | | | - Robin MacDiarmid
- The New Zealand Institute for Plant & Food Research Limited, Auckland, New Zealand
| | | | - Jay Laws
- La Trobe University, Melbourne, Victoria, Australia
| | - Lucy L Furfaro
- University of Western Australia, Perth, Western Australia, Australia
| | | | | | | | - Mary Petrone
- The University of Sydney, New South Wales, Australia
| | - Justin A Roby
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Carolyn Samer
- The University of Sydney, New South Wales, Australia
| | - Andreas Suhrbier
- University of Queensland, St. Lucia, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Anthony Cunningham
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Celeste Donato
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jackie Mahar
- The University of Sydney, New South Wales, Australia
| | - Wesley D Black
- Biotopia Environmental Assessment Pty Ltd., Melbourne, Victoria, Australia
| | | | | | - Kirsten Spann
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel J Rawle
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Penny Rudd
- Griffith University, Southport, Queensland, Australia
| | - Jessica Neil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | - Ki Wook Kim
- University of New South Wales, Sydney, New South Wales, Australia
| | - Johnson Mak
- Griffith University, Southport, Queensland, Australia
| | - Kym Lowry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Nathan Bryant
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joanne Meers
- University of Queensland, St. Lucia, Queensland, Australia
| | - Jason A Roberts
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | | | | | - Leon E Hugo
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | | | - Patrick C Reading
- University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia
| | - Camille Esneau
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tatiana Briody
- University of Queensland, St. Lucia, Queensland, Australia
| | - Najla Nasr
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | - Brian McSharry
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Omid Fakhri
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | | | - Grant Logan
- Children's Medical Research Institute, Westmead, NSW, Australia
| | - Paul Howley
- Vaxmed Pty Ltd., Berwick, Victoria, Australia
| | - Paul Young
- University of Queensland, St. Lucia, Queensland, Australia
| |
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11
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Speck P, Mackenzie J, Bull RA, Slobedman B, Drummer H, Fraser J, Herrero L, Helbig K, Londrigan S, Moseley G, Prow N, Hansman G, Edwards R, Ahlenstiel C, Abendroth A, Tscharke D, Hobson-Peters J, Kriiger-Loterio R, Parry R, Marsh G, Harding E, Jacques DA, Gartner MJ, Lee WS, McAuley J, Vaz P, Sainsbury F, Tate MD, Sinclair J, Imrie A, Rawlinson S, Harman A, Carr JM, Monson EA, Hibma M, Mahony TJ, Tu T, Center RJ, Shrestha LB, Hall R, Warner M, Ward V, Anderson DE, Eyre NS, Netzler NE, Peel AJ, Revill P, Beard M, Legione AR, Spencer AJ, Idris A, Forwood J, Sarker S, Purcell DFJ, Bartlett N, Deerain JM, Brew BJ, Asgari S, Farrell H, Khromykh A, Enosi Tuipulotu D, Anderson D, Mese S, Tayyar Y, Edenborough K, Uddin JM, Hussain A, Daymond CJI, Agius J, Johnson KN, Shirmast P, Abedinzadeshahri M, MacDiarmid R, Ashley CL, Laws J, Furfaro LL, Burton TD, Johnson SMR, Telikani Z, Petrone M, Roby JA, Samer C, Suhrbier A, Van Der Kamp A, Cunningham A, Donato C, Mahar J, Black WD, Vasudevan S, Lenchine R, Spann K, Rawle DJ, Rudd P, Neil J, Kingston R, Newsome TP, Kim KW, Mak J, Lowry K, Bryant N, Meers J, Roberts JA, McMillan N, Labzin LI, Slonchak A, Hugo LE, Henzeler B, Newton ND, David CT, Reading PC, Esneau C, Briody T, Nasr N, McNeale D, McSharry B, Fakhri O, Horsburgh BA, Logan G, Howley P, Young P. Statement in Support of: "Virology under the Microscope-a Call for Rational Discourse". J Virol 2023; 97:e0045123. [PMID: 37097023 DOI: 10.1128/jvi.00451-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Peter Speck
- Flinders University, Bedford Park, South Australia
| | - Jason Mackenzie
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Rowena A Bull
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | - Lara Herrero
- Griffith University, Southport, Queensland, Australia
| | - Karla Helbig
- La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Londrigan
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie Prow
- Hull York Medical School, University of York, York, United Kingdom
| | - Grant Hansman
- Griffith University, Southport, Queensland, Australia
| | | | | | | | - David Tscharke
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Rhys Parry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Glenn Marsh
- Commonwealth Scientific and Industrial Research Organisation, Geelong, Victoria, Australia
| | - Emma Harding
- University of New South Wales, Sydney, New South Wales, Australia
| | - David A Jacques
- University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew J Gartner
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Wen Shi Lee
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Julie McAuley
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Paola Vaz
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michelle D Tate
- Monash University, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jane Sinclair
- University of Queensland, St. Lucia, Queensland, Australia
| | - Allison Imrie
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Andrew Harman
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | | | | | - Thomas Tu
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | - Robyn Hall
- Ausvet Pty Ltd., Canberra, Australian Capital Territory, Australia
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | - Morgyn Warner
- University of Adelaide, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
| | | | - Danielle E Anderson
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie E Netzler
- University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre of Research Excellence, Auckland, New Zealand
| | | | - Peter Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael Beard
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Adi Idris
- Griffith University, Southport, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jade Forwood
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Subir Sarker
- La Trobe University, Melbourne, Victoria, Australia
| | - Damian F J Purcell
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Nathan Bartlett
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joshua M Deerain
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Bruce J Brew
- University of New South Wales, Sydney, New South Wales, Australia
- University of Notre Dame, Sydney, New South Wales, Australia
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sassan Asgari
- University of Queensland, St. Lucia, Queensland, Australia
| | - Helen Farrell
- University of Queensland, St. Lucia, Queensland, Australia
| | | | | | | | - Sevim Mese
- University of Queensland, St. Lucia, Queensland, Australia
- Istanbul University, Istanbul, Turkey
| | - Yaman Tayyar
- Griffith University, Southport, Queensland, Australia
- Prorenata Biotech, Moledinar, Queensland, Australia
| | | | | | - Abrar Hussain
- Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Connor J I Daymond
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | | | | | - Robin MacDiarmid
- The New Zealand Institute for Plant & Food Research Limited, Auckland, New Zealand
| | | | - Jay Laws
- La Trobe University, Melbourne, Victoria, Australia
| | - Lucy L Furfaro
- University of Western Australia, Perth, Western Australia, Australia
| | | | | | | | - Mary Petrone
- The University of Sydney, New South Wales, Australia
| | - Justin A Roby
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Carolyn Samer
- The University of Sydney, New South Wales, Australia
| | - Andreas Suhrbier
- University of Queensland, St. Lucia, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Anthony Cunningham
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Celeste Donato
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jackie Mahar
- The University of Sydney, New South Wales, Australia
| | - Wesley D Black
- Biotopia Environmental Assessment Pty Ltd., Melbourne, Victoria, Australia
| | | | | | - Kirsten Spann
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel J Rawle
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Penny Rudd
- Griffith University, Southport, Queensland, Australia
| | - Jessica Neil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | - Ki Wook Kim
- University of New South Wales, Sydney, New South Wales, Australia
| | - Johnson Mak
- Griffith University, Southport, Queensland, Australia
| | - Kym Lowry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Nathan Bryant
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joanne Meers
- University of Queensland, St. Lucia, Queensland, Australia
| | - Jason A Roberts
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | | | | | - Leon E Hugo
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | | | - Patrick C Reading
- University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia
| | - Camille Esneau
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tatiana Briody
- University of Queensland, St. Lucia, Queensland, Australia
| | - Najla Nasr
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | - Brian McSharry
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Omid Fakhri
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | | | - Grant Logan
- Children's Medical Research Institute, Westmead, NSW, Australia
| | - Paul Howley
- Vaxmed Pty Ltd., Berwick, Victoria, Australia
| | - Paul Young
- University of Queensland, St. Lucia, Queensland, Australia
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12
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Sen MK, Hossain MJ, Mahns DA, Brew BJ. Validity of serum neurofilament light chain as a prognostic biomarker of disease activity in multiple sclerosis. J Neurol 2023; 270:1908-1930. [PMID: 36520240 DOI: 10.1007/s00415-022-11507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
Multiple sclerosis (MS) is a chronic demyelinating and neuroinflammatory disease of the human central nervous system with complex pathoetiology, heterogeneous presentations and an unpredictable course of disease progression. There remains an urgent need to identify and validate a biomarker that can reliably predict the initiation and progression of MS as well as identify patient responses to disease-modifying treatments/therapies (DMTs). Studies exploring biomarkers in MS and other neurodegenerative diseases currently focus mainly on cerebrospinal fluid (CSF) analyses, which are invasive and impractical to perform on a repeated basis. Recent studies, replacing CSF with peripheral blood samples, have revealed that the elevation of serum neurofilament light chain (sNfL) in the clinical stages of MS is, potentially, an ideal prognostic biomarker for predicting disease progression and for possibly guiding treatment decisions. However, there are unresolved factors (the definition of abnormal values of sNfL concentration, the standardisation of measurement and the amount of change in sNfL concentration that is significant) that are preventing its use as a biomarker in routine clinical practice for MS. This updated review critiques these recent findings and highlights areas for focussed work to facilitate the use of sNfL as a prognostic biomarker in MS management.
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Affiliation(s)
- Monokesh K Sen
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, 2010, Australia
- Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Md Jakir Hossain
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - David A Mahns
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Bruce J Brew
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, 2010, Australia.
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia.
- Department of Neurology, St Vincent's Hospital, Darlinghurst, 2010, Australia.
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13
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Chaganti J, Zeng G, Tun N, Lockart I, Abdelshaheed C, Cysique L, Montagnese S, Brew BJ, Danta M. Novel magnetic resonance KTRANS measurement of blood-brain barrier permeability correlated with covert HE. Hepatol Commun 2023; 7:02009842-202304010-00018. [PMID: 36972380 PMCID: PMC10043555 DOI: 10.1097/hc9.0000000000000079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/22/2022] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Using dynamic contrast-enhanced (DCE) MR perfusion and MR spectroscopy this study aimed to characterize the blood-brain barrier permeability and metabolite changes in patients with cirrhosis and without covert HE. METHODS Covert HE was defined using psychometric HE score (PHES). The participants were stratified into 3 groups: cirrhosis with covert HE (CHE) (PHES<-4); cirrhosis without HE (NHE) (PHES≥-4); and healthy controls (HC). Dynamic contrast-enhanced MRI and MRS were performed to assess KTRANS, a metric derivative of blood-brain barrier disruption, and metabolite parameters. Statistical analysis was performed using IBM SPSS (v25). RESULTS A total of 40 participants (mean age 63 y; male 71%) were recruited as follows: CHE (n=17); NHE (n=13); and HC (n=10). The KTRANS measurement in the frontoparietal cortex demonstrated increased blood-brain barrier permeability, where KTRANS was 0.01±0.02 versus 0.005±0.005 versus 0.004±0.002 in CHE, NHE, and HC patients, respectively (p = 0.032 comparing all 3 groups). Relative to HC with a value of 0.28, the parietal glutamine/creatine (Gln/Cr) ratio was significantly higher in both CHE 1.12 mmoL (p < 0.001); and NHE 0.49 (p = 0.04). Lower PHES scores correlated with higher glutamine/Cr (Gln/Cr) (r=-0.6; p < 0.001) and lower myo-inositol/Cr (mI/Cr) (r=0.6; p < 0.001) and lower choline/Cr (Cho/Cr) (r=0.47; p = 0.004). CONCLUSION The dynamic contrast-enhanced MRI KTRANS measurement revealed increased blood-brain barrier permeability in the frontoparietal cortex. The MRS identified a specific metabolite signature with increased glutamine, reduced myo-inositol, and choline, which correlated with CHE in this region. The MRS changes were identifiable in the NHE cohort.
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Affiliation(s)
- Joga Chaganti
- Department of Medical Imaging, St Vincent's Hospital, Sydney, Australia
- School of Clinical Medicine, St Vincent's Healthcare Campus, Faculty of Medicine, UNSW, Sydney, Australia
| | - Georgia Zeng
- School of Clinical Medicine, St Vincent's Healthcare Campus, Faculty of Medicine, UNSW, Sydney, Australia
- Department of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney, Australia
| | - Nway Tun
- School of Clinical Medicine, St Vincent's Healthcare Campus, Faculty of Medicine, UNSW, Sydney, Australia
- Department of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney, Australia
| | - Ian Lockart
- School of Clinical Medicine, St Vincent's Healthcare Campus, Faculty of Medicine, UNSW, Sydney, Australia
- Department of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney, Australia
| | | | - Lucette Cysique
- Faculty of Science, School of Psychology, UNSW, Sydney, Australia
| | | | - Bruce J Brew
- School of Clinical Medicine, St Vincent's Healthcare Campus, Faculty of Medicine, UNSW, Sydney, Australia
- Departments of Neurology and Immunology, St Vincent's Hospital, Sydney, Australia
- Peter Duncan Neurosciences Unit Applied Medical Research Centre, St Vincent's Hospital, Sydney, Australia
| | - Mark Danta
- School of Clinical Medicine, St Vincent's Healthcare Campus, Faculty of Medicine, UNSW, Sydney, Australia
- Department of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney, Australia
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14
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Cysique LA, Brew BJ. Is neurocognitive ageing accelerated in virally suppressed people with HIV and multimorbidity? Brain 2023; 146:801-802. [PMID: 36748199 DOI: 10.1093/brain/awad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 02/08/2023] Open
Abstract
This scientific commentary refers to ‘Twelve-year neurocognitive decline in HIV is associated with comorbidities, not age: a CHARTER study’ by Heaton et al. (https://doi.org/10.1093/brain/awac465).
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Affiliation(s)
- Lucette A Cysique
- Peter Duncan Neuroscience Research Unit, St. Vincent's Centre for Applied Medical Research, Darlinghurst, Australia.,Neurology and Immunology Departments St. Vincent's Hospital, Darlinghurst, Australia.,School of Psychology, UNSW, Sydney, Australia
| | - Bruce J Brew
- Peter Duncan Neuroscience Research Unit, St. Vincent's Centre for Applied Medical Research, Darlinghurst, Australia.,Neurology and Immunology Departments St. Vincent's Hospital, Darlinghurst, Australia.,Faculty of Medicine, UNSW, Sydney, Australia
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15
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Byrnes SJ, Busman-Sahay K, Angelovich TA, Younger S, Taylor-Brill S, Nekorchuk M, Bondoc S, Dannay R, Terry M, Cochrane CR, Jenkins TA, Roche M, Deleage C, Bosinger SE, Paiardini M, Brew BJ, Estes JD, Churchill MJ. Chronic immune activation and gut barrier dysfunction is associated with neuroinflammation in ART-suppressed SIV+ rhesus macaques. PLoS Pathog 2023; 19:e1011290. [PMID: 36989320 PMCID: PMC10085024 DOI: 10.1371/journal.ppat.1011290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 04/10/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
HIV-associated neurocognitive disorders (HAND) affect ~40% of virally suppressed people with HIV (PWH), however, the precise viral dependent and independent changes to the brain are unclear. Here we characterized the CNS reservoir and immune environment of SIV-infected (SIV+) rhesus macaques during acute (n = 4), chronic (n = 12) or ART-suppressed SIV infection (n = 11). Multiplex immunofluorescence for markers of SIV infection (vRNA/vDNA) and immune activation was performed on frontal cortex and matched colon tissue. SIV+ animals contained detectable viral DNA+ cells that were not reduced in the frontal cortex or the gut by ART, supporting the presence of a stable viral reservoir in these compartments. SIV+ animals had impaired blood brain barrier (BBB) integrity and heightened levels of astrocytes or myeloid cells expressing antiviral, anti-inflammatory or oxidative stress markers which were not abrogated by ART. Neuroinflammation and BBB dysfunction correlated with measures of viremia and immune activation in the gut. Furthermore, SIV-uninfected animals with experimentally induced gut damage and colitis showed a similar immune activation profile in the frontal cortex to those of SIV-infected animals, supporting the role of chronic gut damage as an independent source of neuroinflammation. Together, these findings implicate gut-associated immune activation/damage as a significant contributor to neuroinflammation in ART-suppressed HIV/SIV infection which may drive HAND pathogenesis.
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Affiliation(s)
- Sarah J. Byrnes
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Kathleen Busman-Sahay
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Portland, Oregon, United States of America
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Thomas A. Angelovich
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- Life Science, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Skyler Younger
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Sol Taylor-Brill
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Michael Nekorchuk
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Stephen Bondoc
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Rachel Dannay
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Margaret Terry
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | | | - Trisha A. Jenkins
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Michael Roche
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Claire Deleage
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Steven E. Bosinger
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Mirko Paiardini
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Bruce J. Brew
- Peter Duncan Neurosciences Unit, Departments of Neurology and Immunology St Vincent’s Hospital, University of New South Wales and University of Notre Dame, Sydney, New South Wales, Australia
| | - Jacob D. Estes
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- Vaccine & Gene Therapy Institute, Oregon Health & Science University, Portland, Oregon, United States of America
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Melissa J. Churchill
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- Life Science, Burnet Institute, Melbourne, Australia
- Departments of Microbiology and Medicine, Monash University, Clayton, Australia
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16
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Aung HL, Siefried KJ, Gates TM, Brew BJ, Mao L, Carr A, Cysique LA. Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are not. EClinicalMedicine 2023; 56:101792. [PMID: 36618901 PMCID: PMC9813694 DOI: 10.1016/j.eclinm.2022.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND High antiretroviral therapy (ART) coverage and viral suppression among people with HIV (PWH) in Australia provide a unique context to study individual cognitive trajectories, cognitive aging and factors associated with longitudinal cognitive function during chronic and stable HIV disease. METHODS Participants from the Predictors of Adherence to Antiretroviral Therapy study (n = 457, recruited between September 2013 and November 2015, median age = 52 years, and all with HIV RNA <50 copies mL) completed a cognitive assessment with CogState Computerized Battery (CCB) at baseline, Month-12, and Month-24. Demographics, psycho-social and socioeconomic factors, healthcare seeking behaviors, HIV disease characteristics and comorbidities were assessed. The CCB data were corrected for age, sex and practice effect and averaged into a global z-score (GZS). Cognitive impairment was defined with the global deficit score method (GDS>0.5). Meaningful cognitive change was statistically defined (decline or improvement versus stability, i.e., 90% CI, that is p < 0.05, 2-tailed) using a novel evidence-based change score: the linear mixed-effect regression (LMER)-based GZS change score. A separate LMER model with a top-down variable selection approach identified the independent effects of age and other demographic, HIV disease characteristics, socioeconomic and health-related factors on the demographically corrected GZS. The combined definitions of change and cross-sectional impairment enabled the identification of cognitive trajectories. FINDINGS At Month-12 and Month-24, 6% and 7% showed meaningful cognitive decline and 4% and 3% improved respectively. Only 1% showed sustained decline. Incident impairment due to subtle cognitive decline (i.e., below the threshold of meaningful cognitive decline) was 31% and 25% at Month-12 and Month-24, while 14% showed sustained impairment (i.e., cognitively impaired at all study visits). Older age (≥50 years) and time interaction was associated with lower demographically corrected GZS (β = -0.31, p < 0.001). Having a regular relationship, excellent English proficiency, and perceived stigma (avoidance) were associated with higher GZS (all p < 0.05). Relying on government subsidy, severe depression, and lower belief in ART necessity and higher concerns were associated with lower GZS (all p < 0.05). No HIV disease characteristics had a significant effect. INTERPRETATIONS Meaningful cognitive decline was not different from normal expectation in chronic stable HIV disease. Despite this, subtle cognitive decline, sustained cognitive impairment, and greater than normative-age cognitive aging were evident. FUNDING Funding for the PAART study was provided in part by unrestricted educational grants from Gilead Sciences (www.gilead.com) (Grant Number: IN-AU-264- 0131), the Balnaves Foundation (www.balnavesfoundation.com), the Victorian Department of Health and Human Services (Australia) (www.dhs.vic.gov.au/home), Western Australia Health (www.health.wa.gov.au), the ACT Ministry of Health (Australia) (www.health.act.gov.au), and in-kind support from the Queensland Department of Health (Australia) (www.health.qld.gov.au), and NHMRC Partnership grant APP1058474 (PI: Carr, Andrew).
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Affiliation(s)
- Htein Linn Aung
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, UNSW, Australia
| | - Krista J. Siefried
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Immunology and HIV Unit, St Vincent's Hospital, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs, Sydney, Australia
| | - Thomas M. Gates
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Australia
| | - Bruce J. Brew
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, UNSW, Australia
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Australia
- Faculty of Medicine, University of Notre Dame, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Andrew Carr
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Immunology and HIV Unit, St Vincent's Hospital, Sydney, Australia
| | - Lucette A. Cysique
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Corresponding author. School of Psychology, The University of New South Wales, Matthews Building, Room 1012, 11 Botany Street, Sydney, NSW, 2052, Australia.
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17
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Cochrane CR, Angelovich TA, Byrnes SJ, Waring E, Guanizo AC, Trollope GS, Zhou J, Vue J, Senior L, Wanicek E, Eddine JJ, Gartner MJ, Jenkins TA, Gorry PR, Brew BJ, Lewin SR, Estes JD, Roche M, Churchill MJ. Intact HIV Proviruses Persist in the Brain Despite Viral Suppression with ART. Ann Neurol 2022; 92:532-544. [PMID: 35867351 PMCID: PMC9489665 DOI: 10.1002/ana.26456] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Human immunodeficiency virus (HIV) persistence in blood and tissue reservoirs, including the brain, is a major barrier to HIV cure and possible cause of comorbid disease. However, the size and replication competent nature of the central nervous system (CNS) reservoir is unclear. Here, we used the intact proviral DNA assay (IPDA) to provide the first quantitative assessment of the intact and defective HIV reservoir in the brain of people with HIV (PWH). METHODS Total, intact, and defective HIV proviruses were measured in autopsy frontal lobe tissue from viremic (n = 18) or virologically suppressed (n = 12) PWH. Total or intact/defective proviruses were measured by detection of HIV pol or the IPDA, respectively, through use of droplet digital polymerase chain reaction (ddPCR). HIV-seronegative individuals were included as controls (n = 6). RESULTS Total HIV DNA was present at similar levels in brain tissues from untreated viremic and antiretroviral (ART)-suppressed individuals (median = 22.3 vs 26.2 HIV pol copies/106 cells), reflecting a stable CNS reservoir of HIV that persists despite therapy. Furthermore, 8 of 10 viremic and 6 of 9 virally suppressed PWH also harbored intact proviruses in the CNS (4.63 vs 12.7 intact copies/106 cells). Viral reservoirs in CNS and matched lymphoid tissue were similar in the composition of intact and/or defective proviruses, albeit at lower levels in the brain. Importantly, CNS resident CD68+ myeloid cells in virally suppressed individuals harbored HIV DNA, directly showing the presence of a CNS resident HIV reservoir. INTERPRETATION Our results demonstrate the first evidence for an intact, potentially replication competent HIV reservoir in the CNS of virally suppressed PWH. ANN NEUROL 2022;92:532-544.
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Affiliation(s)
- Catherine R. Cochrane
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia,Department of MedicineThe Royal Melbourne Hospital, The University of MelbourneMelbourneVICAustralia
| | - Thomas A. Angelovich
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia,Life SciencesBurnet InstituteMelbourneVICAustralia,Department of Infectious DiseasesThe University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneVICAustralia
| | - Sarah J. Byrnes
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia
| | - Emily Waring
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia,Department of MedicineThe Royal Melbourne Hospital, The University of MelbourneMelbourneVICAustralia
| | - Aleks C. Guanizo
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia
| | - Gemma S. Trollope
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia,Department of MedicineThe Royal Melbourne Hospital, The University of MelbourneMelbourneVICAustralia
| | - Jingling Zhou
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia
| | - Judith Vue
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia
| | - Lachlan Senior
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia
| | - Emma Wanicek
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia
| | - Janna Jamal Eddine
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia
| | - Matthew J. Gartner
- Department of Infectious DiseasesThe University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneVICAustralia
| | - Trisha A. Jenkins
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia
| | - Paul R. Gorry
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia,Department of Infectious DiseasesAlfred Hospital and Monash UniversityMelbourneVICAustralia,Department of Microbiology and ImmunologyThe University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneVICAustralia
| | - Bruce J. Brew
- Peter Duncan Neurosciences Unit, Departments of Neurology and Immunology St Vincent's HospitalSydney, University of New South Wales and University of Notre DameSydneyNew South WalesAustralia
| | - Sharon R. Lewin
- Department of Infectious DiseasesThe University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneVICAustralia,Department of Infectious DiseasesAlfred Hospital and Monash UniversityMelbourneVICAustralia,Victorian Infectious Diseases ServiceRoyal Melbourne Hospital at the Peter Doherty Institute for Infection and ImmunityMelbourneVICAustralia
| | - Jacob D. Estes
- Vaccine and Gene Therapy Institute, Oregon National Primate Research CentreOregon Health & Science UniversityPortlandORUSA
| | - Michael Roche
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia,Department of Infectious DiseasesThe University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneVICAustralia
| | - Melissa J. Churchill
- Emerging Infections Program, School of Health and Biomedical SciencesRMIT UniversityMelbourneVICAustralia,Life SciencesBurnet InstituteMelbourneVICAustralia,Departments of Microbiology and MedicineMonash UniversityMelbourneVICAustralia
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18
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Ulfhammer G, Edén A, Antinori A, Brew BJ, Calcagno A, Cinque P, De Zan V, Hagberg L, Lin A, Nilsson S, Oprea C, Pinnetti C, Spudich S, Trunfio M, Winston A, Price RW, Gisslén M. Cerebrospinal Fluid Viral Load Across the Spectrum of Untreated Human Immunodeficiency Virus Type 1 (HIV-1) Infection: A Cross-Sectional Multicenter Study. Clin Infect Dis 2022; 75:493-502. [PMID: 34747481 PMCID: PMC9427147 DOI: 10.1093/cid/ciab943] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The aim of this large multicenter study was to determine variations in cerebrospinal fluid (CSF) HIV-RNA in different phases of untreated human immunodeficiency virus type 1 (HIV-1) infection and its associations with plasma HIV-RNA and other biomarkers. METHODS Treatment naive adults with available CSF HIV-RNA quantification were included and divided into groups representing significant disease phases. Plasma HIV-RNA, CSF white blood cell count (WBC), neopterin, and albumin ratio were included when available. RESULTS In total, 1018 patients were included. CSF HIV-RNA was in median (interquartile range [IQR]) 1.03 log10 (0.37-1.86) copies/mL lower than in plasma, and correlated with plasma HIV-RNA (r = 0.44, P < .01), neopterin concentration in CSF (r = 0.49, P < .01) and in serum (r = 0.29, P < .01), CSF WBC (r = 0.34, P < .01) and albumin ratio (r = 0.25, P < .01). CSF HIV-RNA paralleled plasma HIV-RNA in all groups except neuroasymptomatic patients with advanced immunodeficiency (CD4 < 200) and patients with HIV-associated dementia (HAD) or opportunistic central nervous system (CNS) infections. Patients with HAD had the highest CSF HIV-RNA (in median [IQR] 4.73 (3.84-5.35) log10 copies/mL). CSF > plasma discordance was found in 126 of 972 individuals (13%) and varied between groups, from 1% in primary HIV, 11% in neuroasymptomatic groups, up to 30% of patients with HAD. CONCLUSIONS Our study confirms previous smaller observations of variations in CSF HIV-RNA in different stages of HIV disease. Overall, CSF HIV-RNA was approximately 1 log10 copies/mL lower in CSF than in plasma, but CSF discordance was found in a substantial minority of subjects, most commonly in patients with HAD, indicating increasing CNS compartmentalization paralleling disease progression.
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Affiliation(s)
- Gustaf Ulfhammer
- Correspondence: G. Ulfhammer, Dept. of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, SE-416 85 Gothenburg, Sweden ()
| | - Arvid Edén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | | | - Bruce J Brew
- Departments of Neurology and Immunology, Peter Duncan Neurosciences Unit St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, University of New South Wales and University of Notre Dame, Australia
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | | | - Lars Hagberg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Amy Lin
- Stanford University School of Medicine, Department of Biomedical Data Science, Palo Alto, California, USA
| | - Staffan Nilsson
- Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Cristiana Oprea
- Carol Davila University of Medicine and Pharmacy, Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - Carmela Pinnetti
- National Institute of Infectious Diseases L. Spallanzani, Rome, Italy
| | | | - Mattia Trunfio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Richard W Price
- University of California at San Francisco, San Francisco, California, USA
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
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19
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Sundaram G, Bessede A, Gilot D, Staats Pires A, Sherman LS, Brew BJ, Guillemin GJ. Prophylactic and Therapeutic Effect of Kynurenine for Experimental Autoimmune Encephalomyelitis (EAE) Disease. Int J Tryptophan Res 2022; 15:11786469221118657. [PMID: 36004319 PMCID: PMC9393931 DOI: 10.1177/11786469221118657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background The essential amino acid, tryptophan, is predominantly metabolised through the kynurenine pathway (KP) to generate kynurenine, an aryl-hydrocarbon receptor (AhR) pro-ligand that exerts its effects in a ligand-dependent manner. Interaction between kynurenine and the AhR is an effector mechanism of immunosuppression. We previously found that the KP is involved in multiple sclerosis (MS) disease progression. We postulated that AhR activation by kynurenine might be neuroprotective by encouraging differentiation of Tregs. In this study, we assess both the prophylactic and therapeutic efficiency of kynurenine on disease severity and progression in mice with experimental autoimmune encephalomyelitis (EAE), an MS model. Methods Myelin oligodendrocyte glycoprotein induced EAE mice (n = 6 per group) were treated with 200 mg/kg L-kynurenine once daily for 10 days beginning on either day 1 of EAE induction (prophylactic) or once they demonstrated motor weakness (therapeutic). Clinical disease severity measured by disease score, time on rotarod, and body weight. Results The prophylactic kynurenine treatment significantly (P < .0001) prevented the development of a more severe disease course with mice demonstrating diminished relapse rate and improved clinical and behavioural outcomes. However, therapeutic kynurenine did not significantly (P = .4463) decrease the clinical signs until 36 days following induction of disease; after 36 days, it also significantly (P = .0479) reduced disease relapse. Mean body weight measurements only correlated with time on rotarod (r = -.6410; P = .0007) but not clinical scores (r = .1925; P = .3674). Conclusions Kynurenine ameliorates EAE disease progression prophylactically and reduces relapses therapeutically. Further investigations are needed to elucidate the molecular mechanism explaining the therapeutic role of kynurenine for MS.
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Affiliation(s)
- Gayathri Sundaram
- Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - David Gilot
- INSERM U1242, University of Rennes I, Rennes, France
| | - Ananda Staats Pires
- Neuroinflammation Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.,Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Larry S Sherman
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, USA.,Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA
| | - Bruce J Brew
- Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology, St Vincent's Hospital, Sydney, NSW, Australia.,University of Notre Dame, Sydney, NSW, Australia
| | - Gilles J Guillemin
- Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.,Neuroinflammation Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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20
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Anesten B, Zetterberg H, Nilsson S, Brew BJ, Fuchs D, Price RW, Gisslen M, Yilmaz A. Correction: Effect of antiretroviral treatment on blood-brain barrier integrity in HIV-1 infection. BMC Neurol 2022; 22:197. [PMID: 35624414 PMCID: PMC9137192 DOI: 10.1186/s12883-022-02725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Birgitta Anesten
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE-415 50, Gothenburg, Sweden. .,Department of Infectious Diseases, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Molndal, Sweden.,Clinical Neurochemistry Laboratory Sahlgrenska University Hospital, Molndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Hong Kong Center for Neurodegenerative Disease, Hong Kong, China
| | - Staffan Nilsson
- Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Bruce J Brew
- Department of Neurology, St.Vincent's Hospital, Sydney, NSW, Australia.,Department of HIV Medicine and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Richard W Price
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Magnus Gisslen
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE-415 50, Gothenburg, Sweden.,Department of Infectious Diseases, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE-415 50, Gothenburg, Sweden.,Department of Infectious Diseases, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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21
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Abstract
OBJECTIVE We aimed to examine the relative contributions of HIV infection, age, and cardiovascular risk factors to subcortical brain atrophy in people with HIV (PWH). DESIGN Longitudinal observational study. METHODS Virally suppressed PWH with low neuropsychological confounds (n = 75) and demographically matched HIV-negative controls (n = 31) completed baseline and 18-month follow-up MRI scans, neuropsychological evaluation, cardiovascular assessments, and HIV laboratory tests. PWH were evaluated for HIV-associated neurocognitive disorder (HAND). Subcortical volumes were extracted with Freesurfer after removal of white matter hyperintensities. Volumetric and shape analyses were conducted using linear mixed-effect models incorporating interactions between age, time, and each of HIV status, HAND status, HIV disease factors, and cardiovascular markers. RESULTS Across baseline and follow-up PWH had smaller volumes of most subcortical structures compared with HIV-negative participants. In addition, over time older PWH had a more rapid decline in caudate volumes (P = 0.041), predominantly in the more severe HAND subgroups (P = 0.042). Higher CD4+ cell counts had a protective effect over time on subcortical structures for older participants with HIV. Increased cardiovascular risk factors were associated with smaller volumes across baseline and follow-up for most structures, although a more rapid decline over time was observed for striatal volumes. There were no significant shape analyses findings. CONCLUSION The study demonstrates a three-hit model of general (as opposed to localized) subcortical injury in PWH: HIV infection associated with smaller volumes of most subcortical structures, HIV infection and aging synergy in the striatum, and cardiovascular-related injury linked to early and more rapid striatal atrophy.
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Affiliation(s)
- David Jakabek
- Faculty of Medicine, University of New South Wales
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, & Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research
- Neuroscience Research Australia
| | - Caroline D Rae
- Neuroscience Research Australia
- UNSW Psychology, Sydney, New South Wales, Australia
| | - Bruce J Brew
- Faculty of Medicine, University of New South Wales
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, & Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research
- Faculty of Medicine, University of Notre Dame
| | - Lucette A Cysique
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, & Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research
- Neuroscience Research Australia
- UNSW Psychology, Sydney, New South Wales, Australia
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22
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Brew BJ. Is HIV Brain Disease Preventable? Neurol Neuroimmunol Neuroinflamm 2022; 9:9/2/e1145. [PMID: 35140143 PMCID: PMC8904082 DOI: 10.1212/nxi.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Bruce J Brew
- From the Faculty of Medicine (B.J.B.), University of New South Wales, and University of Notre Dame Sydney; and Departments of Neurology and HIV Medicine (B.J.B.), St Vincent's Hospital, and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia.
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23
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Anesten B, Zetterberg H, Nilsson S, Brew BJ, Fuchs D, Price RW, Gisslén M, Yilmaz A. Effect of antiretroviral treatment on blood-brain barrier integrity in HIV-1 infection. BMC Neurol 2021; 21:494. [PMID: 34937542 PMCID: PMC8693475 DOI: 10.1186/s12883-021-02527-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background Blood-brain barrier (BBB) injury is prevalent in patients with HIV-associated dementia (HAD) and is a frequent feature of HIV encephalitis. Signs of BBB damage are also sometimes found in neuroasymptomatic HIV-infected individuals without antiretroviral therapy (ART). The aim of this study was to investigate the integrity of the BBB before and after initiation of ART in both neuroasymptomatic HIV infection and in patients with HAD. Methods We determined BBB integrity by measuring cerebrospinal fluid (CSF)/plasma albumin ratios in archived CSF samples prior to and after initiation of ART in longitudinally-followed neuroasymptomatic HIV-1-infected individuals and patients with HAD. We also analyzed HIV RNA in blood and CSF, IgG Index, CSF WBC counts, and CSF concentrations of β2-micoglobulin, neopterin, and neurofilament light chain protein (NfL). Results We included 159 HIV-infected participants; 82 neuroasymptomatic individuals and 77 with HAD. All neuroasymptomatic individuals (82/82), and 10/77 individuals with HAD, were longitudinally followed with a median (interquartile range, IQR) follow-up of 758 (230–1752) days for the neuroasymptomatic individuals, and a median (IQR) follow-up of 241 (50–994) days for the individuals with HAD. Twelve percent (10/82) of the neuroasymptomatic individuals and 80% (8/10) of the longitudinally-followed individuals with HAD had elevated albumin ratios at baseline. At the last follow-up, 9% (7/82) of the neuroasymptomatic individuals and 20% (2/10) of the individuals with HAD had elevated albumin ratios. ART significantly decreased albumin ratios in both neuroasymptomatic individuals and in patients with HAD. Conclusion These findings indicate that ART improves and possibly normalizes BBB integrity in both neuroasymptomatic HIV-infected individuals and in patients with HAD.
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Affiliation(s)
- Birgitta Anesten
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE-415 50, Gothenburg, Sweden. .,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Hong Kong Center for Neurodegenerative Disease, Hong Kong, China
| | - Staffan Nilsson
- Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Bruce J Brew
- Department of Neurology, St.Vincent's Hospital, Sydney, NSW, Australia.,Department of HIV Medicine and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Richard W Price
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE-415 50, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, SE-415 50, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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24
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Clarke L, Arnett S, Bukhari W, Khalilidehkordi E, Jimenez Sanchez S, O'Gorman C, Sun J, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Abernethy DA, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Fabis-Pedrini MJ, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Ramanathan S, Reddel SW, Shaw CP, Spies JM, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AGK, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Brilot F, Vincent A, Waters P, Broadley SA. MRI Patterns Distinguish AQP4 Antibody Positive Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis. Front Neurol 2021; 12:722237. [PMID: 34566866 PMCID: PMC8458658 DOI: 10.3389/fneur.2021.722237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the CNS. Overlap in the clinical and MRI features of NMOSD and MS means that distinguishing these conditions can be difficult. With the aim of evaluating the diagnostic utility of MRI features in distinguishing NMOSD from MS, we have conducted a cross-sectional analysis of imaging data and developed predictive models to distinguish the two conditions. NMOSD and MS MRI lesions were identified and defined through a literature search. Aquaporin-4 (AQP4) antibody positive NMOSD cases and age- and sex-matched MS cases were collected. MRI of orbits, brain and spine were reported by at least two blinded reviewers. MRI brain or spine was available for 166/168 (99%) of cases. Longitudinally extensive (OR = 203), "bright spotty" (OR = 93.8), whole (axial; OR = 57.8) or gadolinium (Gd) enhancing (OR = 28.6) spinal cord lesions, bilateral (OR = 31.3) or Gd-enhancing (OR = 15.4) optic nerve lesions, and nucleus tractus solitarius (OR = 19.2), periaqueductal (OR = 16.8) or hypothalamic (OR = 7.2) brain lesions were associated with NMOSD. Ovoid (OR = 0.029), Dawson's fingers (OR = 0.031), pyramidal corpus callosum (OR = 0.058), periventricular (OR = 0.136), temporal lobe (OR = 0.137) and T1 black holes (OR = 0.154) brain lesions were associated with MS. A score-based algorithm and a decision tree determined by machine learning accurately predicted more than 85% of both diagnoses using first available imaging alone. We have confirmed NMOSD and MS specific MRI features and combined these in predictive models that can accurately identify more than 85% of cases as either AQP4 seropositive NMOSD or MS.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Sofia Jimenez Sanchez
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | | | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas, QLD, Australia
| | - Karyn Boundy
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce J Brew
- Centre for Applied Medical Research, St. Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Cella Chen
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Russell C Dale
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - David Gillis
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Robert Heard
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, New Zealand
| | - John D Pollard
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.,Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Cameron P Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Judith M Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ian Sutton
- Department of Neurology, St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Michael Walsh
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Richard C Wong
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Allan G K Kermode
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - John D E Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Mark Slee
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Fabienne Brilot
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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25
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Brouillette MJ, Koski L, Forcellino L, Gasparri J, Brew BJ, Fellows LK, Mayo NE, Cysique LA. Predicting occupational outcomes from neuropsychological test performance in older people with HIV. AIDS 2021; 35:1765-1774. [PMID: 33927088 DOI: 10.1097/qad.0000000000002927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The ability to work is amongst the top concerns of people living with well treated HIV. Cognitive impairment has been reported in many otherwise asymptomatic persons living with HIV and even mild impairment is associated with higher rates of occupational difficulties. There are several classification algorithms for HIV-associated neurocognitive disorder (HAND) as well as overall scoring methods available to summarize neuropsychological performance. We asked which method best explained work status and productivity. DESIGN Participants (N = 263) drawn from a longitudinal Canadian cohort underwent neuropsychological testing. METHODS : Several classification algorithms were applied to establish a HAND diagnosis and two summary measures (NPZ and Global Deficit Score) were computed. Self-reported work status and productivity was assessed at each study visit (four visits, 9 months apart). The association of work status with each diagnostic classification and summary measure was estimated using logistic regression. For those working, the value on the productivity scale was regressed within individuals over time, and the slopes were regressed on each neuropsychological outcome. RESULTS The application of different classification algorithms to the neuropsychological data resulted in rates of impairment that ranged from 28.5 to 78.7%. Being classified as impaired by any method was associated with a higher rate of unemployment. None of the diagnostic classifications or summary methods predicted productivity, at time of testing or over the following 36 months. CONCLUSION Neuropsychological diagnostic classifications and summary scores identified participants who were more likely to be unemployed, but none explained productivity. New methods of assessing cognition are required to inform optimal workforce engagement.
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Affiliation(s)
- Marie-Josée Brouillette
- Department of Psychiatry, McGill University
- Chronic Viral Illness Service, McGill University Health Centre (MUHC)
- Infectious Diseases and Immunity in Global Health Program, MUHC-RI, Montreal, QC
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, BC
| | - Lisa Koski
- Department of Psychology, McGill University
| | | | - Joséphine Gasparri
- Bachelor of Behavioral Neuroscience, Concordia University, Montreal, QC, Canada
| | - Bruce J Brew
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit
- Faculty of Medicine, University of Notre Dame, and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lesley K Fellows
- Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, BC
- Department of Neurology and Neurosurgery
- Montreal Neurological Hospital and Institute
| | - Nancy E Mayo
- Department of Medicine, School of Physical and Occupational Therapy, McGill University
- Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Center for Outcomes Research and Evaluation
- Division of Geriatrics, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Lucette A Cysique
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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26
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Gates TM, Kamminga J, Jayewardene A, Vincent T, Quan D, Brew BJ, Bloch M, Cysique LA. Erratum to: An examination of reliable change methods for measuring cognitive change with the Cogstate Computerized Battery: Research and clinical implications. Arch Clin Neuropsychol 2021; 36:859. [PMID: 33367511 DOI: 10.1093/arclin/acaa127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/26/2020] [Accepted: 08/26/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Thomas M Gates
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Sydney, Australia.,Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | | | - Trina Vincent
- Holdsworth House Medical Practice, Sydney, Australia
| | - Dick Quan
- Holdsworth House Medical Practice, Sydney, Australia
| | - Bruce J Brew
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Sydney, Australia.,Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Lucette A Cysique
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Sydney, Australia.,Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
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Aung HL, Aghvinian M, Gouse H, Robbins RN, Brew BJ, Mao L, Cysique LA. Is There Any Evidence of Premature, Accentuated and Accelerated Aging Effects on Neurocognition in People Living with HIV? A Systematic Review. AIDS Behav 2021; 25:917-960. [PMID: 33025390 PMCID: PMC7886778 DOI: 10.1007/s10461-020-03053-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/24/2022]
Abstract
Despite evidence of premature, accentuated and accelerated aging for some age-related conditions such as cardiovascular diseases in people living with HIV (PLHIV), the evidence for these abnormal patterns of aging on neurocognition remains unclear. Further, no systematic review has been dedicated to this issue. Using PRISMA guidelines, we searched standard databases (PubMed, EMBASE, CINAHL and PsycINFO). Articles were included if they analyzed and reported the effect of age on neurocognition among PLHIV as one of their major findings, if they were conducted in the combination anti-retroviral therapy era (after 1996) and published in a peer-reviewed journal in English. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) appraisal tools. To systematically target the abnormal patterns of neurocognitive aging, we define premature cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive test performance covering both the normal and abnormal performance range; accentuated cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive impairment (NCI) rate, thus covering the abnormal performance range only; accelerated cognitive aging as significant interaction effect of HIV status and age on longitudinal neurocognitive test performance or incidence of NCI. Because these definitions require an age-comparable HIV-negative (HIV-) control group, when no controls were included, we determined the range of the age effect on neurocognitive test performance or NCI among PLHIV. A total of 37 studies originating from the US (26), UK (2), Italy (2), Poland (2), China (2), Japan (1), Australia (1), and Brazil (1) were included. Six studies were longitudinal and 14 included HIV- controls. The quality appraisal showed that 12/37 studies neither used an age-matched HIV- controls nor used demographically corrected cognitive scores. A meta-analysis was not possible because study methods and choice of neurocognitive measurement methods and outcomes were heterogeneous imposing a narrative synthesis. In studies with an HIV- control sample, premature neurocognitive aging was found in 45% of the cross-sectional analyses (9/20), while accelerated neurocognitive aging was found in 75% of the longitudinal analyses (3/4). There was no evidence for accentuated aging, but this was tested only in two studies. In studies without an HIV- control sample, the age effect was always present but wide (NCI OR = 1.18-4.8). While large sample size (> 500) was associated with abnormal patterns of cognitive aging, most of the studies were under powered. Other study characteristics such as longitudinal study design and higher proportion of older participants were also associated with the findings of abnormal cognitive aging. There is some support for premature and accelerated cognitive aging among PLHIV in the existing literature especially among large and longitudinal studies and those with higher proportion of older samples. Future HIV and cognitive aging studies need to harmonize neuropsychological measurement methods and outcomes and use a large sample from collaborative multi-sites to generate more robust evidences.
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Affiliation(s)
- Htein Linn Aung
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia.
- Neuroscience Research Australia, Sydney, Australia.
- Faculty of Medicine, UNSW, Sydney, Australia.
| | | | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Bruce J Brew
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
- Faculty of Medicine, University of Notre Dame, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Lucette A Cysique
- Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research (AMR), Level 8, Lowy Packer Building, 405 Liverpool St, Darlinghurst, Sydney, NSW, 2010, Australia
- Neuroscience Research Australia, Sydney, Australia
- Faculty of Medicine, UNSW, Sydney, Australia
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Nir TM, Fouche JP, Ananworanich J, Ances BM, Boban J, Brew BJ, Chaganti JR, Chang L, Ching CRK, Cysique LA, Ernst T, Faskowitz J, Gupta V, Harezlak J, Heaps-Woodruff JM, Hinkin CH, Hoare J, Joska JA, Kallianpur KJ, Kuhn T, Lam HY, Law M, Lebrun-Frénay C, Levine AJ, Mondot L, Nakamoto BK, Navia BA, Pennec X, Porges EC, Salminen LE, Shikuma CM, Surento W, Thames AD, Valcour V, Vassallo M, Woods AJ, Thompson PM, Cohen RA, Paul R, Stein DJ, Jahanshad N. Association of Immunosuppression and Viral Load With Subcortical Brain Volume in an International Sample of People Living With HIV. JAMA Netw Open 2021; 4:e2031190. [PMID: 33449093 PMCID: PMC7811179 DOI: 10.1001/jamanetworkopen.2020.31190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Despite more widely accessible combination antiretroviral therapy (cART), HIV-1 infection remains a global public health challenge. Even in treated patients with chronic HIV infection, neurocognitive impairment often persists, affecting quality of life. Identifying the neuroanatomical pathways associated with infection in vivo may delineate the neuropathologic processes underlying these deficits. However, published neuroimaging findings from relatively small, heterogeneous cohorts are inconsistent, limiting the generalizability of the conclusions drawn to date. OBJECTIVE To examine structural brain associations with the most commonly collected clinical assessments of HIV burden (CD4+ T-cell count and viral load), which are generalizable across demographically and clinically diverse HIV-infected individuals worldwide. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study established the HIV Working Group within the Enhancing Neuro Imaging Genetics Through Meta Analysis (ENIGMA) consortium to pool and harmonize data from existing HIV neuroimaging studies. In total, data from 1295 HIV-positive adults were contributed from 13 studies across Africa, Asia, Australia, Europe, and North America. Regional and whole brain segmentations were extracted from data sets as contributing studies joined the consortium on a rolling basis from November 1, 2014, to December 31, 2019. MAIN OUTCOMES AND MEASURES Volume estimates for 8 subcortical brain regions were extracted from T1-weighted magnetic resonance images to identify associations with blood plasma markers of current immunosuppression (CD4+ T-cell counts) or detectable plasma viral load (dVL) in HIV-positive participants. Post hoc sensitivity analyses stratified data by cART status. RESULTS After quality assurance, data from 1203 HIV-positive individuals (mean [SD] age, 45.7 [11.5] years; 880 [73.2%] male; 897 [74.6%] taking cART) remained. Lower current CD4+ cell counts were associated with smaller hippocampal (mean [SE] β = 16.66 [4.72] mm3 per 100 cells/mm3; P < .001) and thalamic (mean [SE] β = 32.24 [8.96] mm3 per 100 cells/mm3; P < .001) volumes and larger ventricles (mean [SE] β = -391.50 [122.58] mm3 per 100 cells/mm3; P = .001); in participants not taking cART, however, lower current CD4+ cell counts were associated with smaller putamen volumes (mean [SE] β = 57.34 [18.78] mm3 per 100 cells/mm3; P = .003). A dVL was associated with smaller hippocampal volumes (d = -0.17; P = .005); in participants taking cART, dVL was also associated with smaller amygdala volumes (d = -0.23; P = .004). CONCLUSIONS AND RELEVANCE In a large-scale international population of HIV-positive individuals, volumes of structures in the limbic system were consistently associated with current plasma markers. Our findings extend beyond the classically implicated regions of the basal ganglia and may represent a generalizable brain signature of HIV infection in the cART era.
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Affiliation(s)
- Talia M. Nir
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Jean-Paul Fouche
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jintanat Ananworanich
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- South East Asian Research Collaboration in HIV, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- AIGHD, University of Amsterdam, Amsterdam, the Netherlands
| | - Beau M. Ances
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Jasmina Boban
- Faculty of Medicine, Department of Radiology, University of Novi Sad, Novi Sad, Serbia
| | - Bruce J. Brew
- Department of Neurology, St Vincent’s Hospital, St Vincent’s Health Australia and University of New South Wales, Sydney, New South Wales, Australia
- Department of Immunology, St Vincent’s Hospital, St Vincent’s Health Australia and University of New South Wales, Sydney, New South Wales, Australia
- Peter Duncan Neurosciences Unit, St Vincent’s Centre for Applied Medical Research, Sydney, New South Wales, Australia
| | - Joga R. Chaganti
- Department of Medical Imaging, St Vincent’s Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Linda Chang
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore
- Department of Neurology, University of Maryland School of Medicine, Baltimore
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R. K. Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Lucette A. Cysique
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Ernst
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Faskowitz
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Vikash Gupta
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington
| | | | - Charles H. Hinkin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Jacqueline Hoare
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kalpana J. Kallianpur
- Hawaii Center for AIDS, University of Hawaii, Honolulu
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, University of Hawaii, Honolulu
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Hei Y. Lam
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Meng Law
- Department of Radiology, Alfred Health, Monash University, Melbourne, Victoria, Australia
| | - Christine Lebrun-Frénay
- Neurology, UR2CA, Centre Hospitalier Universitaire Pasteur 2, Université Nice Côte d’Azur, Nice, France
| | | | - Lydiane Mondot
- Department of Radiology, UR2CA, Centre Hospitalier Universitaire Pasteur 2, Université Nice Côte d’Azur, Nice, France
| | - Beau K. Nakamoto
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
| | - Bradford A. Navia
- Infection Unit, School of Public Health, Tufts University Medical School, Boston, Massachusetts
| | - Xavier Pennec
- Cote d’Azur University, Sophia Antipolis, France
- Epione Team, Inria, Sophia Antipolis Mediterrannee, Sophia Antipolis, France
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Lauren E. Salminen
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | | | - Wesley Surento
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - April D. Thames
- Department of Psychology, University of Southern California, Los Angeles
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Global Brain Health Institute, San Francisco, California
| | - Matteo Vassallo
- Internal Medicine/Infectious Diseases, Centre Hospitalier de Cannes, Cannes, France
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Ronald A. Cohen
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Robert Paul
- Psychological Sciences, Missouri Institute of Mental Health, University of Missouri, St Louis
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
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Gates TM, Kamminga J, Jayewardene A, Vincent T, Quan D, Brew BJ, Bloch M, Cysique LA. An examination of reliable change methods for measuring cognitive change with the Cogstate Computerized Battery: Research and clinical implications. Arch Clin Neuropsychol 2020; 36:597-612. [DOI: 10.1093/arclin/acaa076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/26/2020] [Accepted: 08/26/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To compare the performance of four reliable change (RC) methods with respect to measuring cognitive change on the Cogstate Computerized Battery (CCB).
Method
We assessed cognitive change in 57 healthy, urban, well-educated males on the CCB at baseline and 6 months (Median age = 50, 65% university-educated). The study CCB version comprised seven measures covering attention, processing speed, verbal learning, and memory. Raw scores were z-score transformed using age-corrected Cogstate norms (CN) or the sample mean and standard deviation (internal standardization [IS]), and then averaged to create composite z-scores. Composite scores were entered into four RC formulae. RC was defined based on a 90% two-tailed confidence interval. Change scores were compared as continuous (z-scores) and ordinal variables (RC outcomes).
Results
CCB composite score reliability (rXY = .78–.79) was replicated in an age- and sex-matched Cogstate database sample of similar size. There was good overall agreement between the four RC methods (Bland–Altman Mdiff = .00; 95% limits of agreement with the mean—CN: z = ± .90; IS: z = ± .93), with each model adhering closely to the 10% rate of RC expected by chance alone (largest χ2 = .86, p = .99). Initial norming strategy (CN or IS) did not affect these outcomes.
Conclusions
Norming strategy and RC method choice did not significantly impact cognitive change predictions on CCB composite scores. A series of example case data are provided to practically demonstrate the steps involved in applying the longitudinal norms generated in this study. Research in more diverse normative samples is warranted.
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Affiliation(s)
- Thomas M Gates
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Sydney, Australia
- Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | | | - Trina Vincent
- Holdsworth House Medical Practice, Sydney, Australia
| | - Dick Quan
- Holdsworth House Medical Practice, Sydney, Australia
| | - Bruce J Brew
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Sydney, Australia
- Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia
- St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Lucette A Cysique
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Sydney, Australia
- Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
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30
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Braidy N, Alicajic H, Pow D, Smith J, Jugder BE, Brew BJ, Nicolazzo JA, Guillemin GJ. Potential Mechanism of Cellular Uptake of the Excitotoxin Quinolinic Acid in Primary Human Neurons. Mol Neurobiol 2020; 58:34-54. [PMID: 32894500 DOI: 10.1007/s12035-020-02046-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/28/2020] [Indexed: 01/18/2023]
Abstract
In Alzheimer's disease (AD), excessive amounts of quinolinic acid (QUIN) accumulate within the brain parenchyma and dystrophic neurons. QUIN also regulates glutamate uptake into neurons, which may be due to modulation of Na+-dependent excitatory amino acid transporters (EAATs). To determine the biological relationships between QUIN and glutamate dysfunction, we first quantified the functionality and kinetics of [3H]QUIN uptake in primary human neurons using liquid scintillation. We then measured changes in the protein expression of the glutamate transporter EAAT3 and EAAT1b in primary neurons treated with QUIN and the EAAT inhibitor L-trans-pyrrolidine-2,4-dicarboxylic acid (2,4-PDC) using western blotting and immunohistochemistry. Immunohistochemistry was further used to elucidate intracellular transport of exogenous QUIN and the lysosomal-associated membrane protein 2 (LAMP2). Structural insights into the binding between QUIN and EAAT3 were further investigated using molecular docking techniques. We report significant temperature-dependent high-affinity transport leading to neuronal uptake of [3H]QUIN with a Km of 42.2 μM, and a Vmax of 9.492 pmol/2 min/mg protein, comparable with the uptake of glutamate. We also found that QUIN increases expression of the EAAT3 monomer while decreasing the functional trimer. QUIN uptake into primary neurons was shown to involve EAAT3 as uptake was significantly attenuated following EAAT inhibition. We also demonstrated that QUIN increases the expression of aberrant EAAT1b protein in neurons further implicating QUIN-induced glutamate dysfunction. Furthermore, we demonstrated that QUIN is metabolised exclusively in lysosomes. The involvement of EAAT3 as a modulator for QUIN uptake was further confirmed using molecular docking. This study is the first to characterise a mechanism for QUIN uptake into primary human neurons involving EAAT3, opening potential targets to attenuate QUIN-induced excitotoxicity in neuroinflammatory diseases.
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Affiliation(s)
- Nady Braidy
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.
- School of Medicine, Huzhou University, Wuxing District, Huzhou, Zhejiang, China.
| | - Hayden Alicajic
- Neuropharmacology group, MND and Neurodegenerative diseases Research Centre, Macquarie University, Sydney, NSW, 2019, Australia
| | - David Pow
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason Smith
- Department of Chemistry and Biomolecular sciences, Macquarie University, Sydney, NSW, Australia
| | - Bat-Erdene Jugder
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - Bruce J Brew
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Department of Neurology and HIV Medicine, St Vincent's Hospital, Sydney, Australia
| | - Joseph A Nicolazzo
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Gilles J Guillemin
- Neuropharmacology group, MND and Neurodegenerative diseases Research Centre, Macquarie University, Sydney, NSW, 2019, Australia.
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31
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Khalilidehkordi E, Clarke L, Arnett S, Bukhari W, Jimenez Sanchez S, O'Gorman C, Sun J, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brown M, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Ramanathan S, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt J, Slee M, Taylor BV, Willoughby E, Brilot F, Vincent A, Waters P, Broadley SA. Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation. Front Neurol 2020; 11:537. [PMID: 32612571 PMCID: PMC7308484 DOI: 10.3389/fneur.2020.00537] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) show overlap in their clinical features. We performed an analysis of relapses with the aim of determining differences between the two conditions. Cases of NMOSD and age- and sex-matched MS controls were collected from across Australia and New Zealand. Demographic and clinical information, including relapse histories, were recorded using a standard questionnaire. There were 75 cases of NMOSD and 101 MS controls. There were 328 relapses in the NMOSD cases and 375 in MS controls. Spinal cord and optic neuritis attacks were the most common relapses in both NMOSD and MS. Optic neuritis (p < 0.001) and area postrema relapses (P = 0.002) were more common in NMOSD and other brainstem attacks were more common in MS (p < 0.001). Prior to age 30 years, attacks of optic neuritis were more common in NMOSD than transverse myelitis. After 30 this pattern was reversed. Relapses in NMOSD were more likely to be treated with acute immunotherapies and were less likely to recover completely. Analysis by month of relapse in NMOSD showed a trend toward reduced risk of relapse in February to April compared to a peak in November to January (P = 0.065). Optic neuritis and transverse myelitis are the most common types of relapse in NMOSD and MS. Optic neuritis tends to occur more frequently in NMOSD prior to the age of 30, with transverse myelitis being more common thereafter. Relapses in NMOSD were more severe. A seasonal bias for relapses in spring-summer may exist in NMOSD.
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Affiliation(s)
- Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Laura Clarke
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Sofia Jimenez Sanchez
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Kerri M Prain
- Division of Immunology, HSQ Pathology Queensland Central Laboratory, Herston, QLD, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, United Kingdom
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Newtown, United Kingdom
| | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mike Boggild
- Department of Neurology, Townsville University Hospital, Douglas, QLD, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Bruce J Brew
- Peter Duncan Neurosciences Unit, Centre for Applied Medical Research and Department of Neurology, St Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia
| | - Matthew Brown
- Institute of Health Biomedical Innovation, Translational Research Institute, Queensland University of Technology, Woolloongabba, QLD, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Celia Chen
- Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Russell C Dale
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - David Fulcher
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - David Gillis
- Division of Immunology, HSQ Pathology Queensland Central Laboratory, Herston, QLD, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Robert Heard
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Chris Kneebone
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | | | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, New Zealand
| | - John D Pollard
- Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Cameron Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Judith Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - James Stankovich
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Michael Walsh
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Richard C Wong
- Division of Immunology, HSQ Pathology Queensland Central Laboratory, Herston, QLD, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Mark P Marriott
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - John Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Mark Slee
- Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Fabienne Brilot
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, NSW, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
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Sundaram G, Lim CK, Brew BJ, Guillemin GJ. Kynurenine pathway modulation reverses the experimental autoimmune encephalomyelitis mouse disease progression. J Neuroinflammation 2020; 17:176. [PMID: 32505212 PMCID: PMC7276083 DOI: 10.1186/s12974-020-01844-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system characterized by demyelination, neuroinflammation, and neurodegeneration. Activation of the kynurenine pathway (KP) results from acute and chronic neuroinflammation leading to both immune suppression and neurotoxicity. However, the exact effects of KP metabolites and changes in neurodegenerative diseases over time are not fully understood. Studies, including those in MS models, have reported that short-term KP activation is beneficial through immune tolerance. However, the effects of long-term KP activation are poorly understood. We hypothesized that such chronic activation is responsible for the neurodegeneration in MS, and further, modulating the KP in EAE-induced mice could significantly decrease the EAE disease severity. METHODS We biochemically altered the KP at different stages of the disease in experimental allergic encephalomyelitis (EAE) mouse model of MS and at two different enzymatic levels of the KP (IDO-1 (indoleamine 2,3 dioxygenase)) and KMO (kynurenine monooxygenase). CNS tissue and blood samples were analyzed longitudinally using GCMS, HPLC, IHC, and RT-PCR. RESULTS We showed that the KP was steadily upregulated correlating with disease severity and associated with a shift towards increasing concentrations of the KP metabolite quinolinic acid, a neuro- and gliotoxin. KP modulation by inhibition of IDO-1 with 1-methyl tryptophan (1-MT) was dependent on the timing of treatment at various stages of EAE. IDO-1 inhibition at EAE score 2 led to significantly higher numbers of FoxP3 cells (p < 0.001) in the spleen than earlier IDO-1 inhibition (prophylactic 1-MT treatment group (p < 0.001)), 1-MT treatment after EAE induction (EAE score 0; p < 0.001), and 1-MT treatment at EAE score of 1 (p < 0.05). Significant improvement of disease severity was observed in EAE mice treated with 1-MT at EAE score 2 compared to the untreated group (p < 0.05). KP modulation by KMO inhibition with Ro 61-8048 led to significantly greater numbers of Foxp3 cells (p < 0.05) in Ro 61-8048 treated mice and even more significant amelioration of EAE disease compared to the 1-MT treatment groups. CONCLUSIONS These results provide a new mechanistic link between neuroinflammation and neurodegeneration and point to KP modulation at the KMO level to preserve immune tolerance and limit neurodegeneration in EAE. They provide the foundation for new clinical trials for MS.
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Affiliation(s)
- Gayathri Sundaram
- Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, NSW, 2010, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Chai K Lim
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Bruce J Brew
- Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, NSW, 2010, Australia.
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
- Department of Neurology, St Vincent's Hospital, Sydney, NSW, 2010, Australia.
| | - Gilles J Guillemin
- Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, NSW, 2010, Australia.
- Neuroinflammation Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
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Howdle GC, Quidé Y, Kassem MS, Johnson K, Rae CD, Brew BJ, Cysique LA. Brain amyloid in virally suppressed HIV-associated neurocognitive disorder. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/4/e739. [PMID: 32393651 PMCID: PMC7238897 DOI: 10.1212/nxi.0000000000000739] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/06/2020] [Indexed: 01/23/2023]
Abstract
Objective To determine whether virally suppressed HIV neuropathogenesis, a chronic neuroinflammatory state, promotes abnormal brain amyloid deposition. Methods A total of 10 men with virally suppressed HIV-associated neurocognitive disorder (HAND), aged 46–68 years, underwent 11C-labeled Pittsburgh compound B PET. Data from the Australian Imaging, Biomarkers and Lifestyle (AIBL), including 39 cognitively normal individuals (aged 60–74 years), 7 individuals with mild cognitive impairment (MCI) (aged 64–71 years), and 11 individuals with Alzheimer disease (AD) (aged 55–74 years), were used as reference. Apart from more women, the AIBL cohort was demographically comparable with the HIV sample. Also, the AIBL PET data did not differ by sex. Cerebellum standardized uptake value ratio amyloid values within 22 regions of interest were estimated. In the HIV sample, apolipoprotein E (APOE) was available in 80%, CSF biomarkers in 60%, and 8–10 years of long-term health outcomes in 100%. Results HAND and the AIBL group with no cognitive deficits had similar amyloid deposition, which was lower than that in both the MCI and AD groups. At the individual level, one HAND case showed high amyloid deposition consistent with AD. This case also had a CSF-AD–like profile and an E4/E4 for APOE. Clinically, this case declined over 18 years with mild HAND symptoms first, followed by progressive memory decline 8–9 years after the study PET, then progression to severe dementia within 2–3 years, and lived a further 6 years. Another HAND case showed increased amyloid deposition restricted to the hippocampi. Two other HAND cases showed abnormally decreased amyloid in subcortical areas. Conclusions Relative to cognitively normal older controls, brain amyloid burden does not differ in virally suppressed HAND at the group level. However, individual analyses show that abnormally high and low amyloid burden occur.
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Affiliation(s)
- Gemma C Howdle
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Yann Quidé
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Mustafa S Kassem
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Kate Johnson
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Caroline D Rae
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Bruce J Brew
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Lucette A Cysique
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia.
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Barnes SL, Brew BJ. Acute cerebellar ataxia after Epstein-Barr virus infection. Neurol Clin Pract 2020; 9:505-506. [PMID: 32042492 DOI: 10.1212/cpj.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/14/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Stephanie L Barnes
- Departments of Neurology and Immunology (SLB, BJB), St Vincent's Hospital; Peter Duncan Neurosciences Research Unit (BJB), St Vincent's Centre for Applied Medical Research; and St Vincent's Clinical School (BJB), Faculty of Medicine, University of NSW, and University of Notre Dame, Sydney, Australia
| | - Bruce J Brew
- Departments of Neurology and Immunology (SLB, BJB), St Vincent's Hospital; Peter Duncan Neurosciences Research Unit (BJB), St Vincent's Centre for Applied Medical Research; and St Vincent's Clinical School (BJB), Faculty of Medicine, University of NSW, and University of Notre Dame, Sydney, Australia
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Bukhari W, Clarke L, O'Gorman C, Khalilidehkordi E, Arnett S, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Ramanathan S, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Dear K, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Jimenez-Sanchez S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonnell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt J, Slee M, Taylor BV, Willoughby E, Wilson RJ, Brilot F, Vincent A, Waters P, Broadley SA. The clinical profile of NMOSD in Australia and New Zealand. J Neurol 2020; 267:1431-1443. [PMID: 32006158 DOI: 10.1007/s00415-020-09716-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 12/13/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are an inflammation of the central nervous system associated with autoantibodies to aquaporin-4. We have undertaken a clinic-based survey of NMOSD in the Australia and New Zealand populations with the aim of characterising the clinical features and establishing the value of recently revised diagnostic criteria. Cases of possible NMOSD and age and sex-matched controls with multiple sclerosis (MS) were referred from centres across Australia and New Zealand. Cases were classified as NMOSD if they met the 2015 IPND criteria and remained as suspected NMOSD if they did not. Clinical and paraclinical data were compared across the three groups. NMOSD was confirmed in 75 cases and 89 had suspected NMOSD. There were 101 controls with MS. Age at onset, relapse rates and EDSS scores were significantly higher in NMOSD than in MS. Lesions and symptoms referable to the optic nerve were more common in NMOSD whereas brainstem, cerebellar and cerebral lesions were more common in MS. Longitudinally extensive spinal cord lesions were seen in 48/71 (68%) of cases with NMOSD. Elevations of CSF, white cell count and protein were more common in NMOSD. We have confirmed a clinical pattern of NMOSD that has been seen in several geographical regions. We have demonstrated the clinical utility of the current diagnostic criteria. Distinct patterns of disease are evident in NMOSD and MS, but there remains a large number of patients with NMOSD-like features who do not meet the current diagnostic criteria for NMOSD and remain a diagnostic challenge.
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Affiliation(s)
- Wajih Bukhari
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Laura Clarke
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD, 4102, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD, 4102, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, OX3 9DU, UK
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, NSW, 2145, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Newtown, 6021, New Zealand
| | - Sandeep Bhuta
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas, QLD, 4814, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Bruce J Brew
- Centre for Applied Medical Research, St Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, 2010, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, 1023, New Zealand
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Celia Chen
- Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Russell C Dale
- The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, 2605, Australia
| | - Keith Dear
- Global Health Research Centre, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Marzena J Fabis-Pedrini
- Western Australian Neuroscience Research Institute, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, 6009, Australia
| | - David Fulcher
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - David Gillis
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Robert Heard
- The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, 2170, Australia
| | - Sofia Jimenez-Sanchez
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, 3010, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, 3010, Australia
| | - Chris Kneebone
- Department of Neurology, Townsville Hospital, Douglas, QLD, 4814, Australia
| | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Christopher Lynch
- School of Medicine, University of Auckland, Grafton, 1142, New Zealand
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, 8140, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, 1142, New Zealand
| | - John D Pollard
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Stephen W Reddel
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Cameron Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, 3217, Australia
| | - Judith Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Steve Vucic
- The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | - Michael Walsh
- Department of Neurology, Wellington Hospital, Newtown, 6021, New Zealand
| | - Richard C Wong
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - John Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Mark Slee
- Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia
| | - Bruce V Taylor
- School of Medicine, Deakin University, Waurn Ponds, VIC, 3217, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, 1023, New Zealand
| | - Robert J Wilson
- Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD, 4102, Australia
| | - Fabienne Brilot
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Angela Vincent
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Patrick Waters
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia. .,Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia.
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Zeng G, Penninkilampi R, Chaganti J, Montagnese S, Brew BJ, Danta M. Meta-analysis of magnetic resonance spectroscopy in the diagnosis of hepatic encephalopathy. Neurology 2020; 94:e1147-e1156. [DOI: 10.1212/wnl.0000000000008899] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
ObjectiveVarious imaging modalities have been used to explore pathogenic mechanisms and stratify the severity of hepatic encephalopathy (HE). The hypothesis of this meta-analysis was that there is a progressive identifiable derangement of imaging measures using magnetic resonance spectroscopy (MRS) related to the severity of the HE.MethodsStudies with more than 10 cases and HE diagnosis were identified from the electronic databases PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino Americana em Ciências da Saúde (LILACS), and Cochrane Central Register of Controlled Trials (CENTRAL) through July 25, 2018. Participants were stratified into healthy controls and patients with non-HE (NHE) (cirrhosis without HE), minimal HE (MHE), and overt HE (OHE). Analyses were organized by metabolite studied and brain region examined. Statistical meta-analysis was performed using the metafor package in R (v3.4.1). Pooled standardized mean differences between patient groups were calculated using a random effects model.ResultsWe identified 31 studies (1,481 patients) that included data for cirrhosis-related HE. We found the parietal region to be the most reliable in differentiating between patients with and without MHE, with standard mean differences of +0.82 (95% confidence interval [CI] +0.49 to +1.15, p < 0.0001, I2 = 37.45%) for glutamine/glutamate, −0.36 (95% CI −0.61 to −0.10, p = 0.007, I2 = 20.00%) for choline, and−0.77 (95% CI −1.19 to −0.34, p = 0.0004, I2 = 67.48%) for myo-inositol. We also found that glutamine/glutamate was the metabolite that reliably correlated with HE grade in all brain regions.ConclusionsThe meta-analysis reveals that MRS changes in glutamine/glutamate, choline, and myo-inositol, particularly in the parietal lobe, correlate with the severity of HE. MRS may be of value in the assessment of HE.
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Zhai S, McColl C, Mahajan A, Lueck CJ, Brew BJ. Recurrent HIV-associated posterior reversible encephalopathy syndrome. Neurol Clin Pract 2019; 9:478-480. [DOI: 10.1212/cpj.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/11/2018] [Indexed: 11/15/2022]
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Wilson MR, O'Donovan BD, Gelfand JM, Sample HA, Chow FC, Betjemann JP, Shah MP, Richie MB, Gorman MP, Hajj-Ali RA, Calabrese LH, Zorn KC, Chow ED, Greenlee JE, Blum JH, Green G, Khan LM, Banerji D, Langelier C, Bryson-Cahn C, Harrington W, Lingappa JR, Shanbhag NM, Green AJ, Brew BJ, Soldatos A, Strnad L, Doernberg SB, Jay CA, Douglas V, Josephson SA, DeRisi JL. Chronic Meningitis Investigated via Metagenomic Next-Generation Sequencing. JAMA Neurol 2019; 75:947-955. [PMID: 29710329 DOI: 10.1001/jamaneurol.2018.0463] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Identifying infectious causes of subacute or chronic meningitis can be challenging. Enhanced, unbiased diagnostic approaches are needed. Objective To present a case series of patients with diagnostically challenging subacute or chronic meningitis using metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) supported by a statistical framework generated from mNGS of control samples from the environment and from patients who were noninfectious. Design, Setting, and Participants In this case series, mNGS data obtained from the CSF of 94 patients with noninfectious neuroinflammatory disorders and from 24 water and reagent control samples were used to develop and implement a weighted scoring metric based on z scores at the species and genus levels for both nucleotide and protein alignments to prioritize and rank the mNGS results. Total RNA was extracted for mNGS from the CSF of 7 participants with subacute or chronic meningitis who were recruited between September 2013 and March 2017 as part of a multicenter study of mNGS pathogen discovery among patients with suspected neuroinflammatory conditions. The neurologic infections identified by mNGS in these 7 participants represented a diverse array of pathogens. The patients were referred from the University of California, San Francisco Medical Center (n = 2), Zuckerberg San Francisco General Hospital and Trauma Center (n = 2), Cleveland Clinic (n = 1), University of Washington (n = 1), and Kaiser Permanente (n = 1). A weighted z score was used to filter out environmental contaminants and facilitate efficient data triage and analysis. Main Outcomes and Measures Pathogens identified by mNGS and the ability of a statistical model to prioritize, rank, and simplify mNGS results. Results The 7 participants ranged in age from 10 to 55 years, and 3 (43%) were female. A parasitic worm (Taenia solium, in 2 participants), a virus (HIV-1), and 4 fungi (Cryptococcus neoformans, Aspergillus oryzae, Histoplasma capsulatum, and Candida dubliniensis) were identified among the 7 participants by using mNGS. Evaluating mNGS data with a weighted z score-based scoring algorithm reduced the reported microbial taxa by a mean of 87% (range, 41%-99%) when taxa with a combined score of 0 or less were removed, effectively separating bona fide pathogen sequences from spurious environmental sequences so that, in each case, the causative pathogen was found within the top 2 scoring microbes identified using the algorithm. Conclusions and Relevance Diverse microbial pathogens were identified by mNGS in the CSF of patients with diagnostically challenging subacute or chronic meningitis, including a case of subarachnoid neurocysticercosis that defied diagnosis for 1 year, the first reported case of CNS vasculitis caused by Aspergillus oryzae, and the fourth reported case of C dubliniensis meningitis. Prioritizing metagenomic data with a scoring algorithm greatly clarified data interpretation and highlighted the problem of attributing biological significance to organisms present in control samples used for metagenomic sequencing studies.
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Affiliation(s)
- Michael R Wilson
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | | | - Jeffrey M Gelfand
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Hannah A Sample
- Department of Biochemistry and Biophysics, UCSF, San Francisco
| | - Felicia C Chow
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Division of Infectious Diseases, Department of Medicine, UCSF, San Francisco
| | - John P Betjemann
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Web Editor
| | - Maulik P Shah
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Megan B Richie
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Images in Neurology Editor
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Rula A Hajj-Ali
- Department of Rheumatology/Immunology, Cleveland Clinic, Cleveland, Ohio
| | | | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, UCSF, San Francisco
| | - Eric D Chow
- Department of Biochemistry and Biophysics, UCSF, San Francisco
| | - John E Greenlee
- Neurology Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Neurology, University of Utah Health, Salt Lake City
| | | | - Gary Green
- Permanente Medical Group, Inc, Oakland, California.,Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, California
| | - Lillian M Khan
- Department of Biochemistry and Biophysics, UCSF, San Francisco
| | - Debarko Banerji
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Charles Langelier
- Division of Infectious Diseases, Department of Medicine, UCSF, San Francisco
| | - Chloe Bryson-Cahn
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Whitney Harrington
- Department of Pediatrics, University of Washington, Seattle.,Seattle Children's Hospital, Seattle, Washington
| | - Jairam R Lingappa
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle.,Department of Pediatrics, University of Washington, Seattle.,Department of Pediatric Infectious Diseases, Seattle Children's Hospital, Seattle, Washington.,Department of Global Health, University of Washington, Seattle
| | - Niraj M Shanbhag
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Ari J Green
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Associate Editor
| | - Bruce J Brew
- Department of Neurology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services Bethesda, Maryland
| | - Luke Strnad
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland
| | - Sarah B Doernberg
- Division of Infectious Diseases, Department of Medicine, UCSF, San Francisco
| | - Cheryl A Jay
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - Vanja Douglas
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco
| | - S Andrew Josephson
- UCSF (University of California, San Francisco) Weill Institute for Neurosciences, San Francisco, California.,Department of Neurology, UCSF, San Francisco.,Editor
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, UCSF, San Francisco.,Chan Zuckerberg Biohub, San Francisco, California
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Rofe CJF, Garrick R, Burke D, Brew BJ, Tomlinson SE. 089 Breaking the cycle of chronic daily headache with a low-dose subcutaneous lignocaine and ketamine infusion. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionManagement of chronic migraine includes correcting analgesic rebound headache and implementing suitable medication for prevention and acute episodes. However, in many cases this management paradigm oversimplifies the complexity of chronic migraine, particularly the entrenched central pathways that perpetuate chronic migraine. Intravenous lignocaine can curtail chronic migraine and analgesic rebound headache (1). Further, ketamine provides short-term analgesia and enables reduction in central sensitisation of pain pathways, particularly in the setting of codeine/opiod overuse (2). This paper describes use of subcutaneous lignocaine and ketamine infusion in chronic migraine.MethodsA prospective observational cohort study was undertaken in patients with chronic migraine. Patients received a prolonged subcutaneous lignocaine and ketamine infusion (mean duration 11 days) and underwent evaluation at four-time points over six months. The effects on the excitability of motor axons in the median nerve were documented using standard procedures.ResultsFourteen patients were recruited. The infusion was well tolerated; no major side effects were seen. There were no significant long-term changes in the excitability of motor axons. At six months, 13/14 patients had sustained benefit. Three of 4 patients remained free of analgesic rebound headache. One patient remained headache-free. Conversion to episodic migraine occurred in 6/14. Improvement in chronic migraine was reported by 6/14. Three of six were able to return to work, with 1 returning to studies. Benefit was greater in those with depression and history of opiod/codeine use.ConclusionSubcutaneous lignocaine and ketamine can help break entrenchment in chronic migraine as part of a structured management plan.
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Barnes SL, Brew BJ. 040 Acute cerebellar ataxia following epstein-barr virus infection. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionInfectious aetiologies such as acute Epstein-Barr virus (EBV) infection are in the differential diagnosis for acute cerebellar ataxia (ACA). This syndrome remains exceptionally rare and not well characterised in adults.e.g. 1 2MethodsA retrospective case review of a patient diagnosed with ACA following EBV infection with implications for pathogenesis and treatment.ResultsA 29-year-old Caucasian male presented with a three day history of ACA. Seven days prior he was diagnosed with infectious mononucleosis; bloodwork was consistent with acute EBV infection. These symptoms improved rapidly with oral prednisolone. He took no regular medications, drank alcohol moderately and had no significant family history.On examination, he was afebrile, ataxic and mildly dysarthric. Sensory examination was normal, particularly proprioception. Romberg’s test was negative. Remaining neurological and general examination was normal.Bloodwork showed mild liver dysfunction and positive ANA (titre 1/320, homogenous and speckled patterns). Immune screen was otherwise negative. Antineuronal antibody panel was negative in serum and CSF. CSF glucose was 3.1 mmol/L, protein 751 mg/L, albumin 523 mg/L, neopterin 24 nmol/L and B2 microglobulin 1.1 mg/L. The sample was acellular with negative EBV PCR (<500 copies/mL). Other infective serology and PCRs were also negative. MRI brain with gadolinium showed no abnormality.The patient received supportive care and was neurologically normal within three months.ConclusionsACA related to EBV is rare in adults. This report is important because it documents an adult case, other ACA causes have been rigorously excluded, resolution without antiviral therapy is detailed, and investigations support an immune-mediated pathogenesis.ReferencesMcCarthy CL, McColgan P, Martin P. Acute cerebellar ataxia due to Epstein-Barr virus. Pract Neurol 2012;12:238–240.Lascelles RG, Longson M, Johnson PJ, Chiang A. Infectious mononucleosis presenting as acute cerebellar syndrome. Lancet 1973;2:707.
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Aung HL, Kootar S, Gates TM, Brew BJ, Cysique LA. How all-type dementia risk factors and modifiable risk interventions may be relevant to the first-generation aging with HIV infection? Eur Geriatr Med 2019; 10:227-238. [DOI: 10.1007/s41999-019-00164-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/09/2019] [Indexed: 11/24/2022]
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Abstract
This chapter provides an overview of the current research on the question of depression and apathy in HIV-associated neurocognitive disorders (HAND) in the era of chronic HIV infection. After presenting the epidemiology of each condition showing that depression and apathy are the two most frequent psychiatric comorbidities of HAND, we review the current research, particularly in relation to the milder forms of HAND that characterize treated HIV cohorts. Doing so, we include findings on depression and apathy in non-HIV aging population and the risk of dementia, findings that are relevant to the aging HIV cohorts carrying a high burden of psychiatric comorbidities. We then present a review of the research pertaining to the differentiation between depression and apathy. A section is dedicated to the question of suicidality in chronic HIV infection, which is underappreciated. An overview of the pharmacologic and psychosocial interventions relevant to depression and apathy in HIV cohorts treated with antiretroviral treatment is provided. The chapter concludes with future directions for the research on apathy and depression with emphasis on the question of aging and the need for longitudinal studies.
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Affiliation(s)
- Lucette A Cysique
- Neuroscience Research Australia, Randwick, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Bruce J Brew
- Neurology and HIV Departments, St. Vincent's Hospital, Sydney, NSW, Australia; Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.
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Asahchop EL, Branton WG, Krishnan A, Chen PA, Yang D, Kong L, Zochodne DW, Brew BJ, Gill MJ, Power C. HIV-associated sensory polyneuropathy and neuronal injury are associated with miRNA-455-3p induction. JCI Insight 2018; 3:122450. [PMID: 30518697 DOI: 10.1172/jci.insight.122450] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022] Open
Abstract
Symptomatic distal sensory polyneuropathy (sDSP) is common and debilitating in people with HIV/AIDS, leading to neuropathic pain, although the condition's cause is unknown. To investigate biomarkers and associated pathogenic mechanisms for sDSP, we examined plasma miRNA profiles in HIV/AIDS patients with sDSP or without sDSP in 2 independent cohorts together with assessing related pathogenic effects. Several miRNAs were found to be increased in the Discovery Cohort (sDSP, n = 29; non-DSP, n = 40) by array analyses and were increased in patients with sDSP compared with patients without sDSP. miR-455-3p displayed a 12-fold median increase in the sDSP group, which was confirmed by machine learning analyses and verified by reverse transcription PCR. In the Validation Cohort (sDSP n = 16, non-DSP n = 20, healthy controls n = 15), significant upregulation of miR-455-3p was also observed in the sDSP group. Bioinformatics revealed that miR-455-3p targeted multiple host genes implicated in peripheral nerve maintenance, including nerve growth factor (NGF) and related genes. Transfection of cultured human dorsal root ganglia with miR-455-3p showed a concentration-dependent reduction in neuronal β-III tubulin expression. Human neurons transfected with miR-455-3p demonstrated reduced neurite outgrowth and NGF expression that was reversed by anti-miR-455-3p antagomir cotreatment. miR-455-3p represents a potential biomarker for HIV-associated sDSP and might also exert pathogenic effects leading to sDSP.
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Affiliation(s)
- Eugene L Asahchop
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - William G Branton
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Anand Krishnan
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Patricia A Chen
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Dong Yang
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Linglong Kong
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas W Zochodne
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce J Brew
- Departments of Neurology and HIV, St. Vincent's Hospital, and Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Power
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Anderson AM, Croteau D, Ellis RJ, Rosario D, Potter M, Guillemin GJ, Brew BJ, Woods SP, Letendre SL. HIV, prospective memory, and cerebrospinal fluid concentrations of quinolinic acid and phosphorylated Tau. J Neuroimmunol 2018; 319:13-18. [PMID: 29685284 PMCID: PMC5918423 DOI: 10.1016/j.jneuroim.2018.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 02/03/2023]
Abstract
There is mounting evidence that prospective memory (PM) is impaired during HIV infection despite treatment. In this prospective study, 66 adults (43 HIV+ and 23 HIV negative) underwent PM assessment and cerebrospinal fluid (CSF) examination. HIV+ participants had significantly lower PM but significantly higher CSF concentrations of CXCL10 and quinolinic acid (QUIN). Higher CSF phosphorylated Tau (pTau) was associated with worse PM. In a secondary analysis excluding outliers, higher QUIN correlated with higher pTau. CSF QUIN is thus elevated during HIV infection despite antiretroviral therapy and could indirectly contribute to impaired PM by influencing the formation of pTau.
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Affiliation(s)
- Albert M Anderson
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States.
| | - David Croteau
- Department of Neurosciences, University of California at San Diego, La Jolla, CA, United States
| | - Ronald J Ellis
- Department of Neurosciences, University of California at San Diego, La Jolla, CA, United States
| | - Debra Rosario
- Department of Medicine, University of California at San Diego, La Jolla, CA, United States; Department of Psychiatry, University of California at San Diego, La Jolla, CA, United States
| | - Michael Potter
- Department of Medicine, University of California at San Diego, La Jolla, CA, United States; Department of Psychiatry, University of California at San Diego, La Jolla, CA, United States
| | - Gilles J Guillemin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Australia; Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | - Bruce J Brew
- Peter Duncan Neurosciences Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, Australia; Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Scott L Letendre
- Department of Medicine, University of California at San Diego, La Jolla, CA, United States; Department of Psychiatry, University of California at San Diego, La Jolla, CA, United States
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Wright EJ, Grund B, Robertson KR, Cysique L, Brew BJ, Collins GL, Poehlman-Roediger M, Vjecha MJ, Penalva de Oliveira AC, Standridge B, Carey C, Avihingsanon A, Florence E, Lundgren JD, Arenas-Pinto A, Mueller NJ, Winston A, Nsubuga MS, Lal L, Price RW. No neurocognitive advantage for immediate antiretroviral treatment in adults with greater than 500 CD4+ T-cell counts. AIDS 2018; 32:985-997. [PMID: 29424786 PMCID: PMC5920693 DOI: 10.1097/qad.0000000000001778] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To compare the effect of immediate versus deferred antiretroviral treatment (ART) on neuropsychological test performance in treatment-naive HIV-positive adults with more than 500 CD4 cells/μl. DESIGN Randomized trial. METHODS The START parent study randomized participants to commence immediate versus deferred ART until CD4 less than 350 cells/μl. The START Neurology substudy used eight neuropsychological tests, at baseline, months 4, 8, 12 and annually, to compare groups for changes in test performance. Test results were internally standardized to z-scores. The primary outcome was the average of the eight test z-scores (QNPZ-8). Mean changes in QNPZ-8 from baseline were compared by intent-to-treat using longitudinal mixed models. Changes from baseline to specific time points were compared using ANCOVA models. RESULTS The 592 participants had a median age of 34 years; median baseline CD4 count was 629 cells/μl; the mean follow-up was 3.4 years. ART was used for 94 and 32% of accrued person-years in the immediate and deferred groups, respectively. There was no difference between the immediate and deferred ART groups in QNPZ-8 change through follow-up [-0.018 (95% CI -0.062 to 0.027, P = 0.44)], or at any visit. However, QNPZ-8 scores increased in both arms during the first year, by 0.22 and 0.24, respectively (P < 0.001 for increase from baseline). CONCLUSION We observed substantial improvement in neurocognitive test performance during the first year in both study arms, underlining the importance of using a control group in studies assessing neurocognitive performance over time. Immediate ART neither benefitted nor harmed neurocognitive performance in individuals with CD4 cell counts above 500 cells/μl.
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Affiliation(s)
- Edwina J Wright
- Department of Infectious Diseases Alfred Health, Monash University, Burnet Institute, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Birgit Grund
- School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Kevin R Robertson
- Department of Neurology, University of North Carolina, North Carolina, USA
| | - Lucette Cysique
- Neurosciences Research Australia, St. Vincent's Hospital Sydney, Applied Medical Research Centre
| | - Bruce J Brew
- Neurosciences Program, Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Gary L Collins
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Mollie Poehlman-Roediger
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Cate Carey
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Anchalee Avihingsanon
- HIV-NAT Thai Red Cross AIDS Research Centre and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jens D Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - Alejandro Arenas-Pinto
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Alan Winston
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | | | | | - Richard W Price
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
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Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM, Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized controlled trials. Am J Clin Nutr 2018; 107:389-404. [PMID: 29566197 DOI: 10.1093/ajcn/nqx070] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 12/13/2017] [Indexed: 12/11/2022] Open
Abstract
Background Observational studies of the Mediterranean diet suggest cognitive benefits, potentially reducing dementia risk. Objective We performed the first published review to our knowledge of randomized controlled trials (RCTs) investigating Mediterranean diet effects on cognition or brain morphology and function, with an additional focus on intervention diet quality and its relation to "traditional" Mediterranean dietary patterns. Design We searched 9 databases from inception (final update December 2017) for RCTs testing a Mediterranean compared with alternate diet for cognitive or brain morphology and function outcomes. Results Analyses were based on 66 cognitive tests and 1 brain function outcome from 5 included studies (n = 1888 participants). The prescribed Mediterranean diets varied considerably between studies, particularly with regards to quantitative food advice. Only 8/66 (12.1%) of individual cognitive outcomes at trial level significantly favored a Mediterranean diet for cognitive performance, with effect sizes (ESs) ranging from small (0.32) to large (1.66), whereas 2 outcomes favored controls. Data limitations precluded a meta-analysis. Of 8 domain composite cognitive scores from 2 studies, the 3 (Memory, Frontal, and Global function) from PREDIMED (PREvención con DIeta MEDiterránea) were significant, with ESs ranging from 0.39 to 1.29. A posttest comparison at a second PREDIMED site found that the Mediterranean diet modulates the effect of several genotypes associated with dementia risk for some cognitive outcomes, with mixed results. Finally, the risk of low-plasma brain-derived neurotrophic factor was reduced by 78% (OR = 0.22; 95% CI: 0.05, 0.90) in those who consumed a Mediterranean diet compared to control diet at 3 y in this trial. There was no benefit of the Mediterranean diet for incident cognitive impairment or dementia. Conclusions Five RCTs of the Mediterranean diet and cognition have been published to date. The data are mostly nonsignificant, with small ESs. However, the significant improvements in cognitive domain composites in the most robustly designed study warrant additional research.
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Affiliation(s)
- Sue Radd-Vagenas
- Faculty of Health Sciences, Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Shantel L Duffy
- Healthy Brain Ageing Program, Brain and Mind Centre, 3Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and 4Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, 3Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and 4Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Bruce J Brew
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Peter Duncan Neurosciences Unit; St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, NSW, Australia
| | - Victoria M Flood
- Faculty of Health Sciences, Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Western Sydney Local Health District, Westmead Hospital, Westmead, NSW, Australia
| | - Maria A Fiatarone Singh
- Faculty of Health Sciences, Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre, Woolcock Institute of Medical Research, Central Clinical School, Faculty of Medicine, and Charles Perkins Centre, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
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Cysique LA, Jugé L, Gates T, Tobia M, Moffat K, Brew BJ, Rae C. Covertly active and progressing neurochemical abnormalities in suppressed HIV infection. Neurol Neuroimmunol Neuroinflamm 2018; 5:e430. [PMID: 29312999 PMCID: PMC5754644 DOI: 10.1212/nxi.0000000000000430] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/10/2017] [Indexed: 11/15/2022]
Abstract
Objective To assess whether HIV-related brain injury is progressive in persons with suppressed HIV infection. Methods Seventy-three HIV+ virally suppressed men and 35 HIV- men, screened for psychiatric and alcohol/drug use disorders, underwent neuropsychological evaluation and proton magnetic resonance spectroscopy (1H-MRS) at baseline and after and 23 ± 5 months. 1H-MRS included brain regions known to be vulnerable to HIV and aging: frontal white matter (FWM), posterior cingulate cortex (PCC), and caudate area (CA). Major brain metabolites such as creatine (Cr: marker of cellular energy), N-acetyl aspartate (NAA: marker of neuronal integrity), choline (marker of cellular membrane turnover), glutamate/glutamine (excitatory/inhibitory neurotransmitter), and myo-Inositol (mI: marker of neuroinflammation) were calculated with reference to water signal. Neurocognitive decline was corrected for practice effect and baseline HIV-associated neurocognitive disorder (HAND) status. Results Across the study period, 44% had intact cognition, 42% stable HAND (including the single case that improved), 10% progressing HAND, and 4% incident HAND. When analyzing the neurochemical data per neurocognitive trajectories, we found decreasing PCC Cr in all subgroups compared with controls (p < 0.002). In addition, relative to the HIV- group, stable HAND showed decreasing FWM Cr, incident HAND showed steep FWM Cr reduction, whereas progressing HAND had a sharply decreasing PCC NAA and reduced but stable CA NAA. When analyzing the neurochemical data at the group level (HIV+ vs HIV- groups), we found stable abnormal metabolite concentrations over the study period: decreased FWM and PCC Cr (both p < 0.001), decreased PCC NAA and CA NAA (both p < 0.05) and PCC mI increase (p < 0.05). HIV duration and historical HAND had modest effects on metabolite changes. Conclusions Our study reveals covertly active or progressing HIV-related brain injury in the majority of this virally suppressed cohort, reflecting ongoing neuropathogenic processes that are only partially worsened by historical HAND and HIV duration. Longer-term studies will be important for determining the prognosis of these slowly evolving neurochemical abnormalities.
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Affiliation(s)
- Lucette A Cysique
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Lauriane Jugé
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Thomas Gates
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Michael Tobia
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Kirsten Moffat
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Bruce J Brew
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
| | - Caroline Rae
- School of Medical Sciences (L.A.C., L.J., M.T., C.R.), Faculty of Medicine, UNSW Australia, Sydney; Neuroscience Research Australia (L.A.C., L.J., C.R.), Randwick; Peter Duncan Neuroscience Research Unit (L.A.C., T.G., B.J.B.), St. Vincent's Applied Medical Research Center, Darlinghurst; and St. Vincent's Hospital Sydney (L.A.C., T.G., K.M., B.J.B.), Darlinghurst, New South Wales, Australia
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Kamminga J, Lal L, Wright EJ, Bloch M, Brew BJ, Cysique LA. Monitoring HIV-Associated Neurocognitive Disorder Using Screenings: a Critical Review Including Guidelines for Clinical and Research Use. Curr HIV/AIDS Rep 2017; 14:83-92. [PMID: 28284004 DOI: 10.1007/s11904-017-0349-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Screening tools to identify HIV-associated neurocognitive disorder (HAND) are primarily devised to detect cognitive impairment on a single occasion. With the chronicity of HIV infection and the risk of HAND developing or progressing despite viral control, it may be pertinent to repeat HAND screening at more than one time point. Despite this, there are limited data on longitudinal use of such screening tools, particularly with regard to the role of practice effects. Additionally, no guidelines currently exist on the timeframe between testing intervals, or recommendation of the magnitude of baseline impairment that warrants follow-up testing. The aim of the current paper was to review existing evidence for longitudinal validity of HAND screening tools. Only those HAND screening tools previously found to have high cross-sectional criterion validity were included. Preliminary recommendations for clinical use and future research are proposed including in international settings.
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Affiliation(s)
- Jody Kamminga
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,Ongoing and Extended Care Services, Hunter New England Local Health District, Armidale Community Health, Armidale, NSW, 2350, Australia
| | - Luxshimi Lal
- The Burnet Institute, Melbourne, VIC, 3004, Australia.,The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Edwina J Wright
- The Burnet Institute, Melbourne, VIC, 3004, Australia.,The Alfred Hospital, Melbourne, VIC, 3004, Australia.,Monash University, Clayton, VIC, 3800, Australia
| | - Mark Bloch
- Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia.,Holdsworth House Medical Practice, Sydney, NSW, 2000, Australia
| | - Bruce J Brew
- Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia.,St. Vincent's Hospital Applied Medical Research Center, The Peter Duncan Neuroscience Unit, Darlinghurst, NSW, 2010, Australia.,Neurology and HIV Departments, St. Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Lucette A Cysique
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia. .,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia. .,St. Vincent's Hospital Applied Medical Research Center, The Peter Duncan Neuroscience Unit, Darlinghurst, NSW, 2010, Australia. .,Neurology and HIV Departments, St. Vincent's Hospital, Darlinghurst, NSW, 2010, Australia.
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Bukhari W, Prain KM, Waters P, Woodhall M, O'Gorman CM, Clarke L, Silvestrini RA, Bundell CS, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brown M, Brownlee WJ, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Dear K, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Jimenez-Sanchez S, Killpatrick T, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell R, Mason DF, McCombe PA, Pender MP, Pereira JA, Pollard JD, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Wilson RJ, Vincent A, Broadley SA. Incidence and prevalence of NMOSD in Australia and New Zealand. J Neurol Neurosurg Psychiatry 2017; 88:632-638. [PMID: 28550069 DOI: 10.1136/jnnp-2016-314839] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We have undertaken a clinic-based survey of neuromyelitis optica spectrum disorders (NMOSDs) in Australia and New Zealand to establish incidence and prevalence across the region and in populations of differing ancestry. BACKGROUND NMOSD is a recently defined demyelinating disease of the central nervous system (CNS). The incidence and prevalence of NMOSD in Australia and New Zealand has not been established. METHODS Centres managing patients with demyelinating disease of the CNS across Australia and New Zealand reported patients with clinical and laboratory features that were suspicious for NMOSD. Testing for aquaporin 4 antibodies was undertaken in all suspected cases. From this group, cases were identified who fulfilled the 2015 Wingerchuk diagnostic criteria for NMOSD. A capture-recapture methodology was used to estimate incidence and prevalence, based on additional laboratory identified cases. RESULTS NMOSD was confirmed in 81/170 (48%) cases referred. Capture-recapture analysis gave an adjusted incidence estimate of 0.37 (95% CI 0.35 to 0.39) per million per year and a prevalence estimate for NMOSD of 0.70 (95% CI 0.61 to 0.78) per 100 000. NMOSD was three times more common in the Asian population (1.57 (95% CI 1.15 to 1.98) per 100 000) compared with the remainder of the population (0.57 (95% CI 0.50 to 0.65) per 100 000). The latitudinal gradient evident in multiple sclerosis was not seen in NMOSD. CONCLUSIONS NMOSD incidence and prevalence in Australia and New Zealand are comparable with figures from other populations of largely European ancestry. We found NMOSD to be more common in the population with Asian ancestry.
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Affiliation(s)
- Wajih Bukhari
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Brisbane, Australia
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Laura Clarke
- School of Medicine, Griffith University, Gold Coast, Australia
| | | | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
| | - Sandeep Bhuta
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Townsville, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Bruce J Brew
- Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Matthew Brown
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Wallace J Brownlee
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, London, UK
| | - Helmut Butzkueven
- Melbourne Brain Centre, University of Melbourne, Melbourne, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Alan Coulthard
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Russell C Dale
- Childrens Hospital at Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Canberra, Australia
| | - Keith Dear
- Global Health Research Centre, Duke Kunshan University, Kunshan, Jiangsu, China
| | | | - David Fulcher
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Gillis
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Simon Hawke
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Robert Heard
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | - Saman Heshmat
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, Australia.,South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | | | - Trevor Killpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - John King
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Ming-Wei Lin
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Christpher Lynch
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, University of Queensland, Herston, QLD, Australia
| | - Michael P Pender
- School of Medicine, The University of Queensland, Brisbane, Australia
| | | | - John D Pollard
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Cameron Shaw
- Department of Neurology, Geelong Hospital, Geelong, VIC, Australia
| | - Judith Spies
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, Australia
| | - Michael Walsh
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Richard C Wong
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Eppie M Yiu
- Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Allan G Kermode
- Western Australian Neuroscience Research Institute, Nedlands, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, University of Melbourne, Melbourne, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, Adelaide, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | | | - Robert J Wilson
- Department of Immunology, Pathology Queensland, Brisbane, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Simon A Broadley
- School of Medicine, Griffith University, Gold Coast, Australia.,Department of Neurology, Gold Coast University Hospital, Gold Coast, QLD, Australia
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