1
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Muhie S, Gautam A, Yang R, Misganaw B, Daigle BJ, Mellon SH, Flory JD, Abu-Amara D, Lee I, Wang K, Rampersaud R, Hood L, Yehuda R, Marmar CR, Wolkowitz OM, Ressler KJ, Doyle FJ, Hammamieh R, Jett M. Molecular signatures of post-traumatic stress disorder in war-zone-exposed veteran and active-duty soldiers. Cell Rep Med 2023; 4:101045. [PMID: 37196634 DOI: 10.1016/j.xcrm.2023.101045] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/23/2022] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a multisystem syndrome. Integration of systems-level multi-modal datasets can provide a molecular understanding of PTSD. Proteomic, metabolomic, and epigenomic assays are conducted on blood samples of two cohorts of well-characterized PTSD cases and controls: 340 veterans and 180 active-duty soldiers. All participants had been deployed to Iraq and/or Afghanistan and exposed to military-service-related criterion A trauma. Molecular signatures are identified from a discovery cohort of 218 veterans (109/109 PTSD+/-). Identified molecular signatures are tested in 122 separate veterans (62/60 PTSD+/-) and in 180 active-duty soldiers (PTSD+/-). Molecular profiles are computationally integrated with upstream regulators (genetic/methylation/microRNAs) and functional units (mRNAs/proteins/metabolites). Reproducible molecular features of PTSD are identified, including activated inflammation, oxidative stress, metabolic dysregulation, and impaired angiogenesis. These processes may play a role in psychiatric and physical comorbidities, including impaired repair/wound healing mechanisms and cardiovascular, metabolic, and psychiatric diseases.
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Affiliation(s)
- Seid Muhie
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; The Geneva Foundation, Silver Spring, MD 20910, USA.
| | - Aarti Gautam
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Ruoting Yang
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Burook Misganaw
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; Vysnova Inc., Landover, MD 20785, USA
| | - Bernie J Daigle
- Departments of Biological Sciences and Computer Science, The University of Memphis, Memphis, TN 38152, USA
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Janine D Flory
- Office of Mental Health, James J. Peters VA Medical Center, Bronx, NY 10468, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10468, USA
| | - Duna Abu-Amara
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Inyoul Lee
- Institute for Systems Biology, Seattle, WA 98109, USA
| | - Kai Wang
- Institute for Systems Biology, Seattle, WA 98109, USA
| | - Ryan Rampersaud
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Leroy Hood
- Institute for Systems Biology, Seattle, WA 98109, USA
| | - Rachel Yehuda
- Office of Mental Health, James J. Peters VA Medical Center, Bronx, NY 10468, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10468, USA
| | - Charles R Marmar
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Owen M Wolkowitz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kerry J Ressler
- McLean Hospital, Belmont, MA 02478, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02134, USA
| | - Rasha Hammamieh
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Marti Jett
- US Army Medical Research and Development Command, HQ, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
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2
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Ramos-Cejudo J, Genfi A, Abu-Amara D, Debure L, Qian M, Laska E, Siegel C, Milton N, Newman J, Blessing E, Li M, Etkin A, Marmar CR, Fossati S. CRF serum levels differentiate PTSD from healthy controls and TBI in military veterans. Psychiatr Res Clin Pract 2022; 3:153-162. [PMID: 35211666 PMCID: PMC8764614 DOI: 10.1176/appi.prcp.20210017] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Objective Posttraumatic stress disorder (PTSD) is a serious and frequently debilitating psychiatric condition that can occur in people who have experienced traumatic stressors, such as war, violence, sexual assault and other life‐threatening events. Treatment of PTSD and traumatic brain injury (TBI) in veterans is challenged by diagnostic complexity, partially due to PTSD and TBI symptoms overlap and to the fact that subjective self‐report assessments may be influenced by a patient's willingness to share their traumatic experiences and resulting symptoms. Corticotropin‐releasing factor (CRF) is one of the main mediators of hypothalamic pituitary adrenal (HPA)‐axis responses in stress and anxiety. Methods and Results We analyzed serum CRF levels in 230 participants including heathy controls (64), and individuals with PTSD (53), TBI (70) or PTSD + TBI (43) by enzyme immunoassay (EIA). Significantly lower CRF levels were found in both the PTSD and PTSD + TBI groups compared to healthy control (PTSD vs. Controls: P = 0.0014, PTSD + TBI vs. Controls: P = 0.0011) and chronic TBI participants (PTSD vs. TBI: P < 0.0001, PTSD + TBI vs. TBI: P < 0.0001), suggesting a PTSD‐related mechanism independent from TBI and associated with CRF reduction. CRF levels negatively correlated with PTSD severity on the Clinically Administered PTSD Scale (CAPS‐5) scale in the whole study group. Conclusions Hyperactivation of the HPA axis has been classically identified in acute stress. However, the recognized enhanced feedback inhibition of the HPA axis in chronic stress supports our findings of lower CRF in PTSD patients. This study suggests that reduced serum CRF in PTSD should be further investigated. Future validation studies will establish if CRF is a possible blood biomarker for PTSD and/or for differentiating PTSD and chronic TBI symptomatology. The HPA axis is activated under acute stress conditions, but an enhanced feedback inhibition may be prevalent in chronic stress conditions such as PTSD. We observed a reduction in serum CRF levels in veterans with PTSD and PTSD + TBI, but not in veterans with chronic TBI alone. A serum CRF reduction may be indicative of CNS mechanisms specific to PTSD and should be further evaluated as a possible peripheral biomarker.
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Affiliation(s)
- Jaime Ramos-Cejudo
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Afia Genfi
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Duna Abu-Amara
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Ludovic Debure
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,New York University, School of Medicine, Department of Neurology, New York, NY, USA
| | - Meng Qian
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Eugene Laska
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Carole Siegel
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Nicholas Milton
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Jennifer Newman
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Esther Blessing
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Meng Li
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Amit Etkin
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA USA.,Stanford University, Stanford Neurosciences Institute, Stanford, CA, USA.,VA Palo Alto Health Care System, Sierra-Pacific Mental Illness Research, Education and Clinical Center (MIRECC), Palo Alto, CA, USA
| | - Charles R Marmar
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Silvia Fossati
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,New York University, School of Medicine, Department of Neurology, New York, NY, USA.,Current Affiliation: Alzheimer's center at Temple, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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3
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Schultebraucks K, Qian M, Abu-Amara D, Dean K, Laska E, Siegel C, Gautam A, Guffanti G, Hammamieh R, Misganaw B, Mellon SH, Wolkowitz OM, Blessing EM, Etkin A, Ressler KJ, Doyle FJ, Jett M, Marmar CR. Pre-deployment risk factors for PTSD in active-duty personnel deployed to Afghanistan: a machine-learning approach for analyzing multivariate predictors. Mol Psychiatry 2021; 26:5011-5022. [PMID: 32488126 PMCID: PMC8589682 DOI: 10.1038/s41380-020-0789-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Abstract
Active-duty Army personnel can be exposed to traumatic warzone events and are at increased risk for developing post-traumatic stress disorder (PTSD) compared with the general population. PTSD is associated with high individual and societal costs, but identification of predictive markers to determine deployment readiness and risk mitigation strategies is not well understood. This prospective longitudinal naturalistic cohort study-the Fort Campbell Cohort study-examined the value of using a large multidimensional dataset collected from soldiers prior to deployment to Afghanistan for predicting post-deployment PTSD status. The dataset consisted of polygenic, epigenetic, metabolomic, endocrine, inflammatory and routine clinical lab markers, computerized neurocognitive testing, and symptom self-reports. The analysis was computed on active-duty Army personnel (N = 473) of the 101st Airborne at Fort Campbell, Kentucky. Machine-learning models predicted provisional PTSD diagnosis 90-180 days post deployment (random forest: AUC = 0.78, 95% CI = 0.67-0.89, sensitivity = 0.78, specificity = 0.71; SVM: AUC = 0.88, 95% CI = 0.78-0.98, sensitivity = 0.89, specificity = 0.79) and longitudinal PTSD symptom trajectories identified with latent growth mixture modeling (random forest: AUC = 0.85, 95% CI = 0.75-0.96, sensitivity = 0.88, specificity = 0.69; SVM: AUC = 0.87, 95% CI = 0.79-0.96, sensitivity = 0.80, specificity = 0.85). Among the highest-ranked predictive features were pre-deployment sleep quality, anxiety, depression, sustained attention, and cognitive flexibility. Blood-based biomarkers including metabolites, epigenomic, immune, inflammatory, and liver function markers complemented the most important predictors. The clinical prediction of post-deployment symptom trajectories and provisional PTSD diagnosis based on pre-deployment data achieved high discriminatory power. The predictive models may be used to determine deployment readiness and to determine novel pre-deployment interventions to mitigate the risk for deployment-related PTSD.
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Affiliation(s)
- Katharina Schultebraucks
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Emergency Medicine, Vagelos School of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
- Data Science Institute, Columbia University, New York, NY, USA.
| | - Meng Qian
- Department of Psychiatry, Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY, USA
| | - Duna Abu-Amara
- Department of Psychiatry, Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY, USA
| | - Kelsey Dean
- Harvard Paulson School of Engineering & Applied Sciences, Boston, MA, USA
| | - Eugene Laska
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, Biostatistics Division, New York University Grossman School of Medicine, New York, NY, USA
| | - Carole Siegel
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, Biostatistics Division, New York University Grossman School of Medicine, New York, NY, USA
| | - Aarti Gautam
- Integrative Systems Biology, US Army Center for Environmental Health Research, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Guia Guffanti
- McLean Hospital, Harvard University, Boston, MA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Rasha Hammamieh
- Integrative Systems Biology, US Army Center for Environmental Health Research, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Burook Misganaw
- Harvard Paulson School of Engineering & Applied Sciences, Boston, MA, USA
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Department of Psychiatry/Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Esther M Blessing
- Department of Psychiatry, Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY, USA
| | - Amit Etkin
- Alto Neuroscience, Inc., Los Altos, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Kerry J Ressler
- McLean Hospital, Harvard University, Boston, MA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Francis J Doyle
- Harvard Paulson School of Engineering & Applied Sciences, Boston, MA, USA
| | - Marti Jett
- Integrative Systems Biology, US Army Center for Environmental Health Research, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Charles R Marmar
- Department of Psychiatry, Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY, USA
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4
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Yang R, Wu GWY, Verhoeven JE, Gautam A, Reus VI, Kang JI, Flory JD, Abu-Amara D, Hood L, Doyle FJ, Yehuda R, Marmar CR, Jett M, Hammamieh R, Mellon SH, Wolkowitz OM. A DNA methylation clock associated with age-related illnesses and mortality is accelerated in men with combat PTSD. Mol Psychiatry 2021; 26:4999-5009. [PMID: 32382136 DOI: 10.1038/s41380-020-0755-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 01/29/2020] [Revised: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023]
Abstract
DNA methylation patterns at specific cytosine-phosphate-guanine (CpG) sites predictably change with age and can be used to derive "epigenetic age", an indicator of biological age, as opposed to merely chronological age. A relatively new estimator, called "DNAm GrimAge", is notable for its superior predictive ability in older populations regarding numerous age-related metrics like time-to-death, time-to-coronary heart disease, and time-to-cancer. PTSD is associated with premature mortality and frequently has comorbid physical illnesses suggestive of accelerated biological aging. This is the first study to assess DNAm GrimAge in PTSD patients. We investigated the acceleration of GrimAge relative to chronological age, denoted "AgeAccelGrim" in combat trauma-exposed male veterans with and without PTSD using cross-sectional and longitudinal data from two independent well-characterized veteran cohorts. In both cohorts, AgeAccelGrim was significantly higher in the PTSD group compared to the control group (N = 162, 1.26 vs -0.57, p = 0.001 and N = 53, 0.93 vs -1.60 Years, p = 0.008), suggesting accelerated biological aging in both cohorts with PTSD. In 3-year follow-up study of individuals initially diagnosed with PTSD (N = 26), changes in PTSD symptom severity were correlated with AgeAccelGrim changes (r = 0.39, p = 0.049). In addition, the loss of CD28 cell surface markers on CD8 + T cells, an indicator of T-cell senescence/exhaustion that is associated with biological aging, was positively correlated with AgeAccelGrim, suggesting an immunological contribution to the accelerated biological aging. Overall, our findings delineate cellular correlates of biological aging in combat-related PTSD, which may help explain the increased medical morbidity and mortality seen in this disease.
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Affiliation(s)
- Ruoting Yang
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - Gwyneth W Y Wu
- Weill Institute for Neurosciences and Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Josine E Verhoeven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Aarti Gautam
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Victor I Reus
- Weill Institute for Neurosciences and Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Jee In Kang
- Institute of Behavioral Science in Medicine & Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea
| | - Janine D Flory
- James J Peters VA Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Duna Abu-Amara
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | | | - Leroy Hood
- Institute for Systems Biology, Seattle, WA, USA
| | - Francis J Doyle
- John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Rachel Yehuda
- James J Peters VA Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles R Marmar
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Marti Jett
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rasha Hammamieh
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Synthia H Mellon
- Department of OB-GYN and Reproductive Sciences, UCSF School of Medicine, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Weill Institute for Neurosciences and Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
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5
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Eshel N, Maron-Katz A, Wu W, Abu-Amara D, Marmar CR, Etkin A. Neural correlates of anger expression in patients with PTSD. Neuropsychopharmacology 2021; 46:1635-1642. [PMID: 33500557 PMCID: PMC8280145 DOI: 10.1038/s41386-020-00942-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/01/2020] [Revised: 11/10/2020] [Accepted: 12/09/2020] [Indexed: 01/30/2023]
Abstract
Anger is a common and debilitating symptom of post-traumatic stress disorder (PTSD). Although studies have identified brain circuits underlying anger experience and expression in healthy individuals, how these circuits interact with trauma remains unclear. Here, we performed the first study examining the neural correlates of anger in patients with PTSD. Using a data-driven approach with resting-state fMRI, we identified two prefrontal regions whose overall functional connectivity was inversely associated with anger: the left anterior middle frontal gyrus (aMFG) and the right orbitofrontal cortex (OFC). We then used concurrent TMS-EEG to target the left aMFG parcel previously identified through fMRI, measuring its cortical excitability and causal connectivity to downstream areas. We found that low-anger PTSD patients exhibited enhanced excitability in the left aMFG and enhanced causal connectivity between this region and visual areas. Together, our results suggest that left aMFG activity may confer protection against the development of anger, and therefore may be an intriguing target for circuit-based interventions for anger in PTSD.
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Affiliation(s)
- Neir Eshel
- Department of Psychiatry, Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA. .,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Adi Maron-Katz
- grid.168010.e0000000419368956Department of Psychiatry, Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA ,grid.280747.e0000 0004 0419 2556Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA USA
| | - Wei Wu
- grid.168010.e0000000419368956Department of Psychiatry, Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA ,grid.79703.3a0000 0004 1764 3838School of Automation Science and Engineering, South China University of Technology, Guangzhou, China
| | - Duna Abu-Amara
- grid.240324.30000 0001 2109 4251Department of Psychiatry and Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY USA
| | - Charles R. Marmar
- grid.240324.30000 0001 2109 4251Department of Psychiatry and Center for Alcohol Use Disorder and PTSD, New York University Grossman School of Medicine, New York, NY USA
| | - Amit Etkin
- grid.168010.e0000000419368956Department of Psychiatry, Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA USA ,grid.511021.6Alto Neuroscience, Los Altos, CA USA
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6
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Wu GWY, Wolkowitz OM, Reus VI, Kang JI, Elnar M, Sarwal R, Flory JD, Abu-Amara D, Hammamieh R, Gautam A, Doyle FJ, Yehuda R, Marmar CR, Jett M, Mellon SH. Serum brain-derived neurotrophic factor remains elevated after long term follow-up of combat veterans with chronic post-traumatic stress disorder. Psychoneuroendocrinology 2021; 134:105360. [PMID: 34757255 DOI: 10.1016/j.psyneuen.2021.105360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/12/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
Attempts to correlate blood levels of brain-derived neurotrophic factor (BDNF) with post-traumatic stress disorder (PTSD) have provided conflicting results. Some studies found a positive association between BDNF and PTSD diagnosis and symptom severity, while others found the association to be negative. The present study investigated whether serum levels of BDNF are different cross-sectionally between combat trauma-exposed veterans with and without PTSD, as well as whether longitudinal changes in serum BDNF differ as a function of PTSD diagnosis over time. We analyzed data of 270 combat trauma-exposed veterans (230 males, 40 females, average age: 33.29 ± 8.28 years) and found that, at the initial cross-sectional assessment (T0), which averaged 6 years after the initial exposure to combat trauma (SD=2.83 years), the PTSD positive group had significantly higher serum BDNF levels than the PTSD negative controls [31.03 vs. 26.95 ng/mL, t(268) = 3.921, p < 0.001]. This difference remained significant after excluding individuals with comorbid major depressive disorder, antidepressant users and controlling for age, gender, race, BMI, and time since trauma. Fifty-nine of the male veterans who participated at the first timepoint (T0) were re-assessed at follow-up evaluation (T1), approximately 3 years (SD=0.88 years) after T0. A one-way ANOVA comparing PTSD positive, "subthreshold PTSD" and control groups revealed that serum BDNF remained significantly higher in the PTSD positive group than the control group at T1 [30.05 vs 24.66 ng/mL, F(2, 56)= 3.420, p = 0.040]. Serum BDNF levels did not correlate with PTSD symptom severity at either time point within the PTSD group [r(128) = 0.062, p = 0.481 and r(28) = 0.157, p = 0.407]. Serum BDNF did not significantly change over time within subjects [t(56) = 1.269, p = 0.210] nor did the change of serum BDNF from T0 to T1 correlate with change in PTSD symptom severity within those who were diagnosed with PTSD at T0 [r(27) = -0.250, p = 0.192]. Our longitudinal data are the first to be reported in combat PTSD and suggest that higher serum BDNF levels may be a stable biological characteristic of chronic combat PTSD independent of symptom severity.
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Affiliation(s)
- Gwyneth W Y Wu
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA.
| | - Owen M Wolkowitz
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Victor I Reus
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Jee In Kang
- Institute of Behavioral Science in Medicine & Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea
| | - Mathea Elnar
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Reuben Sarwal
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Janine D Flory
- James J Peters VA Medical Center, Bronx NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Duna Abu-Amara
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Rasha Hammamieh
- Medical Readiness Systems Biology, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Aarti Gautam
- Medical Readiness Systems Biology, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Rachel Yehuda
- James J Peters VA Medical Center, Bronx NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles R Marmar
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Marti Jett
- Headquarter, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Synthia H Mellon
- Department of OB-GYN and Reproductive Sciences, UCSF School of Medicine, San Francisco, CA, USA
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7
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Siegel CE, Laska EM, Lin Z, Xu M, Abu-Amara D, Jeffers MK, Qian M, Milton N, Flory JD, Hammamieh R, Daigle BJ, Gautam A, Dean KR, Reus VI, Wolkowitz OM, Mellon SH, Ressler KJ, Yehuda R, Wang K, Hood L, Doyle FJ, Jett M, Marmar CR. Utilization of machine learning for identifying symptom severity military-related PTSD subtypes and their biological correlates. Transl Psychiatry 2021; 11:227. [PMID: 33879773 PMCID: PMC8058082 DOI: 10.1038/s41398-021-01324-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022] Open
Abstract
We sought to find clinical subtypes of posttraumatic stress disorder (PTSD) in veterans 6-10 years post-trauma exposure based on current symptom assessments and to examine whether blood biomarkers could differentiate them. Samples were males deployed to Iraq and Afghanistan studied by the PTSD Systems Biology Consortium: a discovery sample of 74 PTSD cases and 71 healthy controls (HC), and a validation sample of 26 PTSD cases and 36 HC. A machine learning method, random forests (RF), in conjunction with a clustering method, partitioning around medoids, were used to identify subtypes derived from 16 self-report and clinician assessment scales, including the clinician-administered PTSD scale for DSM-IV (CAPS). Two subtypes were identified, designated S1 and S2, differing on mean current CAPS total scores: S2 = 75.6 (sd 14.6) and S1 = 54.3 (sd 6.6). S2 had greater symptom severity scores than both S1 and HC on all scale items. The mean first principal component score derived from clinical summary scales was three times higher in S2 than in S1. Distinct RFs were grown to classify S1 and S2 vs. HCs and vs. each other on multi-omic blood markers feature classes of current medical comorbidities, neurocognitive functioning, demographics, pre-military trauma, and psychiatric history. Among these classes, in each RF intergroup comparison of S1, S2, and HC, multi-omic biomarkers yielded the highest AUC-ROCs (0.819-0.922); other classes added little to further discrimination of the subtypes. Among the top five biomarkers in each of these RFs were methylation, micro RNA, and lactate markers, suggesting their biological role in symptom severity.
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Affiliation(s)
- Carole E Siegel
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Eugene M Laska
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Ziqiang Lin
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Mu Xu
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Duna Abu-Amara
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Michelle K Jeffers
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Meng Qian
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Nicholas Milton
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Janine D Flory
- Department of Psychiatry, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rasha Hammamieh
- Military Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Bernie J Daigle
- Departments of Biological Sciences and Computer Science, The University of Memphis, Memphis, TN, USA
| | - Aarti Gautam
- Military Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kelsey R Dean
- Department of Systems Biology, Harvard University, Cambridge, MA, USA
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Victor I Reus
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Rachel Yehuda
- Department of Psychiatry, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kai Wang
- Institute for Systems Biology, Seattle, WA, USA
| | - Leroy Hood
- Institute for Systems Biology, Seattle, WA, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Marti Jett
- Military Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Charles R Marmar
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
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8
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Etkin A, Maron-Katz A, Wu W, Fonzo GA, Huemer J, Vértes PE, Patenaude B, Richiardi J, Goodkind MS, Keller CJ, Ramos-Cejudo J, Zaiko YV, Peng KK, Shpigel E, Longwell P, Toll RT, Thompson A, Zack S, Gonzalez B, Edelstein R, Chen J, Akingbade I, Weiss E, Hart R, Mann S, Durkin K, Baete SH, Boada FE, Genfi A, Autea J, Newman J, Oathes DJ, Lindley SE, Abu-Amara D, Arnow BA, Crossley N, Hallmayer J, Fossati S, Rothbaum BO, Marmar CR, Bullmore ET, O'Hara R. Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder. Sci Transl Med 2020; 11:11/486/eaal3236. [PMID: 30944165 DOI: 10.1126/scitranslmed.aal3236] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/01/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022]
Abstract
A mechanistic understanding of the pathology of psychiatric disorders has been hampered by extensive heterogeneity in biology, symptoms, and behavior within diagnostic categories that are defined subjectively. We investigated whether leveraging individual differences in information-processing impairments in patients with post-traumatic stress disorder (PTSD) could reveal phenotypes within the disorder. We found that a subgroup of patients with PTSD from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) as revealed by functional magnetic resonance imaging (fMRI) neuroimaging and impaired verbal memory on a word list learning task. This combined phenotype was not associated with differences in symptoms or comorbidities, but nonetheless could be used to predict a poor response to psychotherapy, the best-validated treatment for PTSD. Using concurrent focal noninvasive transcranial magnetic stimulation and electroencephalography, we then identified alterations in neural signal flow in the VAN that were evoked by direct stimulation of that network. These alterations were associated with individual differences in functional fMRI connectivity within the VAN. Our findings define specific neurobiological mechanisms in a subgroup of patients with PTSD that could contribute to the poor response to psychotherapy.
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Affiliation(s)
- Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA. .,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Adi Maron-Katz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Wei Wu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510640, China
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Julia Huemer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Petra E Vértes
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0SZ, UK.,School of Mathematical Sciences, Queen Mary University of London, London E1 4NS, UK.,The Alan Turing Institute, London NW1 2DB, UK
| | - Brian Patenaude
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jonas Richiardi
- Department of Medical Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Madeleine S Goodkind
- New Mexico Veterans Affairs Healthcare System, Albuquerque, NM 87108, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jaime Ramos-Cejudo
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Yevgeniya V Zaiko
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Kathy K Peng
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Emmanuel Shpigel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Parker Longwell
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Russ T Toll
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Allison Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Sanno Zack
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Bryan Gonzalez
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Raleigh Edelstein
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jingyun Chen
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Irene Akingbade
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Elizabeth Weiss
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Roland Hart
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Silas Mann
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Kathleen Durkin
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Steven H Baete
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,New Mexico Veterans Affairs Healthcare System, Albuquerque, NM 87108, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Fernando E Boada
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Center for Advanced Imaging Innovation and Research (CAI2R), NYU School of Medicine, New York, NY 10016, USA.,Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
| | - Afia Genfi
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jillian Autea
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jennifer Newman
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Steven E Lindley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Nicolas Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, 6513677 Santiago, Chile.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Silvia Fossati
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Barbara O Rothbaum
- Trauma and Anxiety Recovery Program, Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Edward T Bullmore
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0SZ, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK.,ImmunoPsychiatry, Alternative Discovery and Development, GlaxoSmithKline, Stevenage SG1 2NY, UK
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
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9
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Gautam A, Yang R, Chakraborty N, Abu-Amara D, Hammamieh R, Marmar C, Jett M. Longitudinal analyses of epigenetic pathways in deployed active duty Service Members. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.05184] [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] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury
| | | | - Charles Marmar
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury
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10
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Maron-Katz A, Zhang Y, Narayan M, Wu W, Toll RT, Naparstek S, De Los Angeles C, Longwell P, Shpigel E, Newman J, Abu-Amara D, Marmar C, Etkin A. Individual Patterns of Abnormality in Resting-State Functional Connectivity Reveal Two Data-Driven PTSD Subgroups. Am J Psychiatry 2020; 177:244-253. [PMID: 31838870 DOI: 10.1176/appi.ajp.2019.19010060] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A major challenge in understanding and treating posttraumatic stress disorder (PTSD) is its clinical heterogeneity, which is likely determined by various neurobiological perturbations. This heterogeneity likely also reduces the effectiveness of standard group comparison approaches. The authors tested whether a statistical approach aimed at identifying individual-level neuroimaging abnormalities that are more prevalent in case subjects than in control subjects could reveal new clinically meaningful insights into the heterogeneity of PTSD. METHODS Resting-state functional MRI data were recorded from 87 unmedicated PTSD case subjects and 105 war zone-exposed healthy control subjects. Abnormalities were modeled using tolerance intervals, which referenced the distribution of healthy control subjects as the "normative population." Out-of-norm functional connectivity values were examined for enrichment in cases and then used in a clustering analysis to identify biologically defined PTSD subgroups based on their abnormality profiles. RESULTS The authors identified two subgroups among PTSD cases, each with a distinct pattern of functional connectivity abnormalities with respect to healthy control subjects. Subgroups differed clinically on levels of reexperiencing symptoms and improved case-control discriminability and were detectable using independently recorded resting-state EEG data. CONCLUSIONS The results provide proof of concept for the utility of abnormality-based approaches for studying heterogeneity within clinical populations. Such approaches, applied not only to neuroimaging data, may allow detection of subpopulations with distinct biological signatures so that further clinical and mechanistic investigations can be focused on more biologically homogeneous subgroups.
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Affiliation(s)
- Adi Maron-Katz
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Yu Zhang
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Manjari Narayan
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Wei Wu
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Russell T Toll
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Sharon Naparstek
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Carlo De Los Angeles
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Parker Longwell
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Emmanuel Shpigel
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Jennifer Newman
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Duna Abu-Amara
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Charles Marmar
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
| | - Amit Etkin
- Department of Bioengineering (Toll) and Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin), Stanford University, Stanford, Calif.; VA Palo Alto Health Care System and Sierra Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, Calif. (Maron-Katz, Zhang, Narayan, Wu, Toll, Naparstek, De Los Angeles, Longwell, Shpigel, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China (Wu); Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury and Department of Psychiatry (Newman, Abu-Amara, Marmar), New York University Langone School of Medicine, New York
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Toll RT, Wu W, Naparstek S, Zhang Y, Narayan M, Patenaude B, De Los Angeles C, Sarhadi K, Anicetti N, Longwell P, Shpigel E, Wright R, Newman J, Gonzalez B, Hart R, Mann S, Abu-Amara D, Sarhadi K, Cornelssen C, Marmar C, Etkin A. An Electroencephalography Connectomic Profile of Posttraumatic Stress Disorder. Am J Psychiatry 2020; 177:233-243. [PMID: 31964161 DOI: 10.1176/appi.ajp.2019.18080911] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to identify brain regions whose frequency-specific, orthogonalized resting-state EEG power envelope connectivity differs between combat veterans with posttraumatic stress disorder (PTSD) and healthy combat-exposed veterans, and to determine the behavioral correlates of connectomic differences. METHODS The authors first conducted a connectivity method validation study in healthy control subjects (N=36). They then conducted a two-site case-control study of veterans with and without PTSD who were deployed to Iraq and/or Afghanistan. Healthy individuals (N=95) and those meeting full or subthreshold criteria for PTSD (N=106) underwent 64-channel resting EEG (eyes open and closed), which was then source-localized and orthogonalized to mitigate effects of volume conduction. Correlation coefficients between band-limited source-space power envelopes of different regions of interest were then calculated and corrected for multiple comparisons. Post hoc correlations of connectomic abnormalities with clinical features and performance on cognitive tasks were conducted to investigate the relevance of the dysconnectivity findings. RESULTS Seventy-four brain region connections were significantly reduced in PTSD (all in the eyes-open condition and predominantly using the theta carrier frequency). Underconnectivity of the orbital and anterior middle frontal gyri were most prominent. Performance differences in the digit span task mapped onto connectivity between 25 of the 74 brain region pairs, including within-network connections in the dorsal attention, frontoparietal control, and ventral attention networks. CONCLUSIONS Robust PTSD-related abnormalities were evident in theta-band source-space orthogonalized power envelope connectivity, which furthermore related to cognitive deficits in these patients. These findings establish a clinically relevant connectomic profile of PTSD using a tool that facilitates the lower-cost clinical translation of network connectivity research.
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Affiliation(s)
- Russell T Toll
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Wei Wu
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Sharon Naparstek
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Yu Zhang
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Manjari Narayan
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Brian Patenaude
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Carlo De Los Angeles
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Kasra Sarhadi
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Nicole Anicetti
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Parker Longwell
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Emmanuel Shpigel
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Rachael Wright
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Jennifer Newman
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Bryan Gonzalez
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Roland Hart
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Silas Mann
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Duna Abu-Amara
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Kamron Sarhadi
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Carena Cornelssen
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Charles Marmar
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Amit Etkin
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
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12
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Somvanshi PR, Mellon SH, Flory JD, Abu-Amara D, Wolkowitz OM, Yehuda R, Jett M, Hood L, Marmar C, Doyle FJ. Mechanistic inferences on metabolic dysfunction in posttraumatic stress disorder from an integrated model and multiomic analysis: role of glucocorticoid receptor sensitivity. Am J Physiol Endocrinol Metab 2019; 317:E879-E898. [PMID: 31322414 PMCID: PMC6879860 DOI: 10.1152/ajpendo.00065.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/28/2019] [Accepted: 07/17/2019] [Indexed: 02/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with neuroendocrine alterations and metabolic abnormalities; however, how metabolism is affected by neuroendocrine disturbances is unclear. The data from combat-exposed veterans with PTSD show increased glycolysis to lactate flux, reduced TCA cycle flux, impaired amino acid and lipid metabolism, insulin resistance, inflammation, and hypersensitive hypothalamic-pituitary-adrenal (HPA) axis. To analyze whether the co-occurrence of multiple metabolic abnormalities is independent or arises from an underlying regulatory defect, we employed a systems biological approach using an integrated mathematical model and multiomic analysis. The models for hepatic metabolism, HPA axis, inflammation, and regulatory signaling were integrated to perform metabolic control analysis (MCA) with respect to the observations from our clinical data. We combined the metabolomics, neuroendocrine, clinical laboratory, and cytokine data from combat-exposed veterans with and without PTSD to characterize the differences in regulatory effects. MCA revealed mechanistic association of the HPA axis and inflammation with metabolic dysfunction consistent with PTSD. This was supported by the data using correlational and causal analysis that revealed significant associations between cortisol suppression, high-sensitivity C-reactive protein, homeostatic model assessment of insulin resistance, γ-glutamyltransferase, hypoxanthine, and several metabolites. Causal mediation analysis indicates that the effects of enhanced glucocorticoid receptor sensitivity (GRS) on glycolytic pathway, gluconeogenic and branched-chain amino acids, triglycerides, and hepatic function are jointly mediated by inflammation, insulin resistance, oxidative stress, and energy deficit. Our analysis suggests that the interventions to normalize GRS and inflammation may help to manage features of metabolic dysfunction in PTSD.
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Affiliation(s)
- Pramod R Somvanshi
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California
| | - Janine D Flory
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Duna Abu-Amara
- Department of Psychiatry, New York Langone Medical School, New York, New York
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California, San Francisco, California
| | - Rachel Yehuda
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marti Jett
- Integrative Systems Biology, US Army Medical Research and Materiel Command, US Army Center for Environmental Health Research, Fort Detrick, Frederick, Maryland
| | - Leroy Hood
- Institute for Systems Biology, Seattle, Washington
| | - Charles Marmar
- Department of Psychiatry, New York Langone Medical School, New York, New York
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
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Donohue DE, Gautam A, Miller SA, Srinivasan S, Abu-Amara D, Campbell R, Marmar CR, Hammamieh R, Jett M. Gene expression profiling of whole blood: A comparative assessment of RNA-stabilizing collection methods. PLoS One 2019; 14:e0223065. [PMID: 31600258 PMCID: PMC6786555 DOI: 10.1371/journal.pone.0223065] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/12/2019] [Indexed: 11/18/2022] Open
Abstract
Peripheral Blood gene expression is widely used in the discovery of biomarkers and development of therapeutics. Recently, a spate of commercial blood collection and preservation systems have been introduced with proprietary variations that may differentially impact the transcriptomic profiles. Comparative analysis of these collection platforms will help optimize protocols to detect, identify, and reproducibly validate true biological variance among subjects. In the current study, we tested two recently introduced whole blood collection methods, RNAgard® and PAXgene® RNA, in addition to the traditional method of peripheral blood mononuclear cells (PBMCs) separated from whole blood and preserved in Trizol reagent. Study results revealed striking differences in the transcriptomic profiles from the three different methods that imply ex vivo changes in gene expression occurred during the blood collection, preservation, and mRNA extraction processes. When comparing the ability of the three preservation methods to accurately capture individuals’ expression differences, RNAgard® outperformed PAXgene® RNA, and both showed better individual separation of transcriptomic profiles than PBMCs. Hence, our study recommends using a single blood collection platform, and strongly cautions against combining methods during the course of a defined study.
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Affiliation(s)
- Duncan E. Donohue
- Integrative Systems Biology Program, U.S. Army Center for Environmental Health Research, Fort Detrick, MD, United States of America
- The Geneva Foundation, Fort Detrick, MD, United States of America
| | - Aarti Gautam
- Integrative Systems Biology Program, U.S. Army Center for Environmental Health Research, Fort Detrick, MD, United States of America
| | - Stacy-Ann Miller
- Integrative Systems Biology Program, U.S. Army Center for Environmental Health Research, Fort Detrick, MD, United States of America
- The Geneva Foundation, Fort Detrick, MD, United States of America
| | - Seshamalini Srinivasan
- Integrative Systems Biology Program, U.S. Army Center for Environmental Health Research, Fort Detrick, MD, United States of America
- The Geneva Foundation, Fort Detrick, MD, United States of America
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, United States of America
| | - Ross Campbell
- Integrative Systems Biology Program, U.S. Army Center for Environmental Health Research, Fort Detrick, MD, United States of America
- Advanced Biomedical Computing Center, Frederick, MD, United States of America
| | - Charles R. Marmar
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, United States of America
| | - Rasha Hammamieh
- Integrative Systems Biology Program, U.S. Army Center for Environmental Health Research, Fort Detrick, MD, United States of America
| | - Marti Jett
- Integrative Systems Biology Program, U.S. Army Center for Environmental Health Research, Fort Detrick, MD, United States of America
- * E-mail:
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14
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Marmar CR, Brown AD, Qian M, Laska E, Siegel C, Li M, Abu-Amara D, Tsiartas A, Richey C, Smith J, Knoth B, Vergyri D. Speech-based markers for posttraumatic stress disorder in US veterans. Depress Anxiety 2019; 36:607-616. [PMID: 31006959 PMCID: PMC6602854 DOI: 10.1002/da.22890] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 12/04/2018] [Revised: 02/14/2019] [Accepted: 03/08/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The diagnosis of posttraumatic stress disorder (PTSD) is usually based on clinical interviews or self-report measures. Both approaches are subject to under- and over-reporting of symptoms. An objective test is lacking. We have developed a classifier of PTSD based on objective speech-marker features that discriminate PTSD cases from controls. METHODS Speech samples were obtained from warzone-exposed veterans, 52 cases with PTSD and 77 controls, assessed with the Clinician-Administered PTSD Scale. Individuals with major depressive disorder (MDD) were excluded. Audio recordings of clinical interviews were used to obtain 40,526 speech features which were input to a random forest (RF) algorithm. RESULTS The selected RF used 18 speech features and the receiver operating characteristic curve had an area under the curve (AUC) of 0.954. At a probability of PTSD cut point of 0.423, Youden's index was 0.787, and overall correct classification rate was 89.1%. The probability of PTSD was higher for markers that indicated slower, more monotonous speech, less change in tonality, and less activation. Depression symptoms, alcohol use disorder, and TBI did not meet statistical tests to be considered confounders. CONCLUSIONS This study demonstrates that a speech-based algorithm can objectively differentiate PTSD cases from controls. The RF classifier had a high AUC. Further validation in an independent sample and appraisal of the classifier to identify those with MDD only compared with those with PTSD comorbid with MDD is required.
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Affiliation(s)
- Charles R. Marmar
- Department of Psychiatry, New York University School of Medicine, New York, New York; Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, New York,Corresponding Author: Charles R. Marmar, MD - Department of Psychiatry, New York University School of Medicine, 1 Park Avenue, New York, NY 10016,
| | - Adam D. Brown
- Department of Psychiatry, New York University School of Medicine, New York, New York; Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, New York,Department of Psychology, New School for Social Research, New York, New York
| | - Meng Qian
- Department of Psychiatry, New York University School of Medicine, New York, New York; Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, New York
| | - Eugene Laska
- Department of Psychiatry, New York University School of Medicine, New York, New York; Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, New York
| | - Carole Siegel
- Department of Psychiatry, New York University School of Medicine, New York, New York; Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, New York
| | - Meng Li
- Department of Psychiatry, New York University School of Medicine, New York, New York; Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, New York
| | - Duna Abu-Amara
- Department of Psychiatry, New York University School of Medicine, New York, New York; Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, New York
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Misganaw B, Guffanti G, Lori A, Abu-Amara D, Flory JD, Mueller S, Yehuda R, Jett M, Marmar CR, Ressler KJ, Doyle FJ. Polygenic risk associated with post-traumatic stress disorder onset and severity. Transl Psychiatry 2019; 9:165. [PMID: 31175274 PMCID: PMC6555815 DOI: 10.1038/s41398-019-0497-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/07/2019] [Indexed: 01/14/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric illness with a highly polygenic architecture without large effect-size common single-nucleotide polymorphisms (SNPs). Thus, to capture a substantial portion of the genetic contribution, effects from many variants need to be aggregated. We investigated various aspects of one such approach that has been successfully applied to many traits, polygenic risk score (PRS) for PTSD. Theoretical analyses indicate the potential prediction ability of PRS. We used the latest summary statistics from the largest published genome-wide association study (GWAS) conducted by Psychiatric Genomics Consortium for PTSD (PGC-PTSD). We found that the PRS constructed for a cohort comprising veterans of recent wars (n = 244) explains a considerable proportion of PTSD onset (Nagelkerke R2 = 4.68%, P = 0.003) and severity (R2 = 4.35%, P = 0.0008) variances. However, the performance on an African ancestry sub-cohort was minimal. A PRS constructed with schizophrenia GWAS also explained a significant fraction of PTSD diagnosis variance (Nagelkerke R2 = 2.96%, P = 0.0175), confirming previously reported genetic correlation between the two psychiatric ailments. Overall, these findings demonstrate the important role polygenic analyses of PTSD will play in risk prediction models as well as in elucidating the biology of the disorder.
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Affiliation(s)
- Burook Misganaw
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Guia Guffanti
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury; and Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Janine D Flory
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susanne Mueller
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Rachel Yehuda
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marti Jett
- Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Frederick, MD, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury; and Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
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16
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Aschbacher K, Mellon SH, Wolkowitz OM, Henn-Haase C, Yehuda R, Flory JD, Bierer LM, Abu-Amara D, Marmar CR, Mueller SG. Posttraumatic stress disorder, symptoms, and white matter abnormalities among combat-exposed veterans. Brain Imaging Behav 2019; 12:989-999. [PMID: 28823023 DOI: 10.1007/s11682-017-9759-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with abnormalities in functional connectivity of a specific cortico-limbic network; however, less is known about white matter abnormalities providing structural connections for this network. This study investigated whether the diagnosis and symptoms of PTSD are associated with alterations in fractional anisotropy (FA), an index reflecting white matter organization, across six, a priori-defined tracts. White matter FA was quantified by diffusion tensor imaging using 3 T-MRI among 57 male, combat-exposed veterans with no history of moderate to severe head injuries or current alcohol dependence: 31 met criteria for PTSD and 26 were demographically comparable, combat-exposed controls without PTSD. Clinician-administered and self-report questionnaires assessed PTSD severity, dissociation, and mood. PTSD + veterans had significantly higher FA than exposed controls in the superior fronto-occipital fasciculus (SFOF) and borderline higher FA in the anterior corona radiata (ACR) and cingulum (CGC), controlling for age and neurovascular comorbidities. When lifetime alcohol use disorders was included, only the association of PTSD with SFOF-FA remained significant. Among PTSD + veterans, higher SFOF-FA was associated with greater mood disturbance, dissociative symptoms, and re-experiencing, while lower FA of the uncinate fasciculus (UF) was associated with greater mood disturbance symptoms. Compared to combat-exposed controls without PTSD, veterans with PTSD exhibited higher white matter FA in the SFOF, and a similar tendency in the ACR and CGC, tracts involved in conflict-processing and spatial attention. Prior alcohol use might explain the associations of PTSD with ACR-FA and CGC-FA but not the association with SFOF-FA.
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Affiliation(s)
- Kirstin Aschbacher
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, San Francisco, CA, 94158, USA. .,Department of Psychiatry, University of California, San Francisco, 3333 California Street, San Francisco, CA, 94118, USA. .,The Institute for Integrative Health, 1407 Fleet Street, Baltimore, MD, 21231, USA.
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Owen M Wolkowitz
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, San Francisco, CA, 94158, USA
| | - Clare Henn-Haase
- Stephen and Alexandra Cohen Veterans Center, Department of Psychiatry, New York University Langone Medical Center, 550 1st Avenue, New York, NY, 10016, USA
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai/James J. Peters Veterans Administration Medical Center, 130 W Kingsbridge Rd, Bronx, NY, 10468, USA
| | - Janine D Flory
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai/James J. Peters Veterans Administration Medical Center, 130 W Kingsbridge Rd, Bronx, NY, 10468, USA
| | - Linda M Bierer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai/James J. Peters Veterans Administration Medical Center, 130 W Kingsbridge Rd, Bronx, NY, 10468, USA
| | - Duna Abu-Amara
- Stephen and Alexandra Cohen Veterans Center, Department of Psychiatry, New York University Langone Medical Center, 550 1st Avenue, New York, NY, 10016, USA
| | - Charles R Marmar
- Stephen and Alexandra Cohen Veterans Center, Department of Psychiatry, New York University Langone Medical Center, 550 1st Avenue, New York, NY, 10016, USA
| | - Susanne G Mueller
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 4150 Clement Street, San Francisco, CA, 94121, USA
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17
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Verhoeven JE, Yang R, Wolkowitz OM, Bersani FS, Lindqvist D, Mellon SH, Yehuda R, Flory JD, Lin J, Abu-Amara D, Makotkine I, Marmar C, Jett M, Hammamieh R. Epigenetic Age in Male Combat-Exposed War Veterans: Associations with Posttraumatic Stress Disorder Status. Mol Neuropsychiatry 2018; 4:90-99. [PMID: 30397597 PMCID: PMC6206951 DOI: 10.1159/000491431] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/30/2018] [Indexed: 12/27/2022]
Abstract
DNA methylation patterns change with age and can be used to derive an estimate of "epigenetic age," an indicator of biological age. Several studies have shown associations of posttraumatic stress disorder (PTSD) with worse somatic health and early mortality, raising the possibility of accelerated biological aging. This study examined associations between estimated epigenetic age and various variables in 160 male combat-exposed war veterans with (n = 79) and without PTSD (n = 81). DNA methylation was assessed in leukocyte genomic DNA using the Illumina 450K DNA methylation arrays. Epigenetic age was estimated using Horvath's epigenetic clock algorithm and Δage (epigenetic age-chronological age) was calculated. In veterans with PTSD (Δage = 3.2), Δage was on average lower compared to those without PTSD (Δage = 5.0; p = 0.02; Cohen's d = 0.42). This between-group difference was not explained by race/ethnicity, lifestyle factors or childhood trauma. Antidepressant use, however, explained part of the association. In the PTSD positive group, telomerase activity was negatively related to Δage (β = -0.35; p = 0.007). In conclusion, veterans with PTSD had significantly lower epigenetic age profiles than those without PTSD. Further, current antidepressant use and higher telomerase activity were related to relatively less epigenetic aging in veterans with PTSD, speculative of a mechanistic pathway that might attenuate biological aging-related processes in the context of PTSD.
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Affiliation(s)
- Josine E. Verhoeven
- Department of Psychiatry, UCSF Weill Institute for Neuroscience, University of California San Francisco, School of Medicine, San Francisco, California, USA
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruoting Yang
- D, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
- Integrative Systems Biology, U.S. Army Center for Environmental Health Research, Fort Detrick, Maryland, USA
| | - Owen M. Wolkowitz
- Department of Psychiatry, UCSF Weill Institute for Neuroscience, University of California San Francisco, School of Medicine, San Francisco, California, USA
| | - Francesco S. Bersani
- Department of Psychiatry, UCSF Weill Institute for Neuroscience, University of California San Francisco, School of Medicine, San Francisco, California, USA
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Daniel Lindqvist
- Department of Psychiatry, UCSF Weill Institute for Neuroscience, University of California San Francisco, School of Medicine, San Francisco, California, USA
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Synthia H. Mellon
- Department of OB/GYN and Reproductive Sciences, University of California San Francisco, School of Medicine, San Francisco, California, USA
| | - Rachel Yehuda
- James J. Peters Veterans Administration Medical Center Bronx, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Janine D. Flory
- James J. Peters Veterans Administration Medical Center Bronx, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, School of Medicine, San Francisco, California, USA
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, New York, USA
- Department of Psychiatry, New York University, New York, New York, USA
| | - Iouri Makotkine
- James J. Peters Veterans Administration Medical Center Bronx, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Charles Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, New York, USA
- Department of Psychiatry, New York University, New York, New York, USA
| | - Marti Jett
- Integrative Systems Biology, U.S. Army Center for Environmental Health Research, Fort Detrick, Maryland, USA
| | - Rasha Hammamieh
- Integrative Systems Biology, U.S. Army Center for Environmental Health Research, Fort Detrick, Maryland, USA
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Lotan E, Morley C, Newman J, Qian M, Abu-Amara D, Marmar C, Lui YW. Prevalence of Cerebral Microhemorrhage following Chronic Blast-Related Mild Traumatic Brain Injury in Military Service Members Using Susceptibility-Weighted MRI. AJNR Am J Neuroradiol 2018; 39:1222-1225. [PMID: 29794235 PMCID: PMC7655437 DOI: 10.3174/ajnr.a5688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/04/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral microhemorrhages are a known marker of mild traumatic brain injury. Blast-related mild traumatic brain injury relates to a propagating pressure wave, and there is evidence that the mechanism of injury in blast-related mild traumatic brain injury may be different from that in blunt head trauma. Two recent reports in mixed cohorts of blunt and blast-related traumatic brain injury in military personnel suggest that the prevalence of cerebral microhemorrhages is lower than in civilian head injury. In this study, we aimed to characterize the prevalence of cerebral microhemorrhages in military service members specifically with chronic blast-related mild traumatic brain injury. MATERIALS AND METHODS Participants were prospectively recruited and underwent 3T MR imaging. Susceptibility-weighted images were assessed by 2 neuroradiologists independently for the presence of cerebral microhemorrhages. RESULTS Our cohort included 146 veterans (132 men) who experienced remote blast-related mild traumatic brain injury (mean, 9.4 years; median, 9 years after injury). Twenty-one (14.4%) reported loss of consciousness for <30 minutes. Seventy-seven subjects (52.7%) had 1 episode of blast-related mild traumatic brain injury; 41 (28.1%) had 2 episodes; and 28 (19.2%) had >2 episodes. No cerebral microhemorrhages were identified in any subject, as opposed to the frequency of SWI-detectable cerebral microhemorrhages following blunt-related mild traumatic brain injury in the civilian population, which has been reported to be as high as 28% in the acute and subacute stages. CONCLUSIONS Our results may reflect differences in pathophysiology and the mechanism of injury between blast- and blunt-related mild traumatic brain injury. Additionally, the chronicity of injury may play a role in the detection of cerebral microhemorrhages.
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Affiliation(s)
- E Lotan
- From the Departments of Radiology (E.L., C.M., Y.W.L.)
- Sackler Faculty of Medicine (E.L.), Tel Aviv University, Tel Aviv, Israel
| | - C Morley
- From the Departments of Radiology (E.L., C.M., Y.W.L.)
- Psychiatry (J.N., M.Q., D.A.-A., C.M.), Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone Medical Center, New York, New York
| | - J Newman
- Psychiatry (J.N., M.Q., D.A.-A., C.M.), Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone Medical Center, New York, New York
| | - M Qian
- Psychiatry (J.N., M.Q., D.A.-A., C.M.), Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone Medical Center, New York, New York
| | - D Abu-Amara
- Psychiatry (J.N., M.Q., D.A.-A., C.M.), Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone Medical Center, New York, New York
| | - C Marmar
- From the Departments of Radiology (E.L., C.M., Y.W.L.)
| | - Y W Lui
- From the Departments of Radiology (E.L., C.M., Y.W.L.)
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Lindqvist D, Mellon SH, Dhabhar FS, Yehuda R, Grenon SM, Flory JD, Bierer LM, Abu-Amara D, Coy M, Makotkine I, Reus VI, Aschbacher K, Bersani FS, Marmar CR, Wolkowitz OM. Increased circulating blood cell counts in combat-related PTSD: Associations with inflammation and PTSD severity. Psychiatry Res 2017; 258:330-336. [PMID: 28942957 DOI: 10.1016/j.psychres.2017.08.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 05/27/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 12/18/2022]
Abstract
Inflammation is reported in post-traumatic stress disorder (PTSD). Few studies have investigated circulating blood cells that may contribute to inflammation. We assessed circulating platelets, white blood cells (WBC) and red blood cells (RBC) in PTSD and assessed their relationship to inflammation and symptom severity. One-hundred and sixty-three male combat-exposed veterans (82 PTSD, 81 non-PTSD) had blood assessed for platelets, WBC, and RBC. Data were correlated with symptom severity and inflammation. All cell counts were significantly elevated in PTSD. There were small mediation effects of BMI and smoking on these relationships. After adjusting for these, the differences in WBC and RBC remained significant, while platelet count was at trend level. In all subjects, all of the cell counts correlated significantly with inflammation. Platelet count correlated with inflammation only in the PTSD subjects. Platelet count, but none of the other cell counts, was directly correlated with PTSD severity ratings in the PTSD group. Combat PTSD is associated with elevations in RBC, WBC, and platelets. Dysregulation of all three major lineages of hematopoietic cells in PTSD, as well as their significant correlation with inflammation, suggest clinical significance of these changes.
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Affiliation(s)
- Daniel Lindqvist
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Sciences, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States
| | - Rachel Yehuda
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States; Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Janine D Flory
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Linda M Bierer
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, New York, United States
| | - Michelle Coy
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Iouri Makotkine
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Kirstin Aschbacher
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - F Saverio Bersani
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, New York, United States.
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States.
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Blessing EM, Reus V, Mellon SH, Wolkowitz OM, Flory JD, Bierer L, Lindqvist D, Dhabhar F, Li M, Qian M, Abu-Amara D, Galatzer-Levy I, Yehuda R, Marmar CR. Biological predictors of insulin resistance associated with posttraumatic stress disorder in young military veterans. Psychoneuroendocrinology 2017; 82:91-97. [PMID: 28521179 DOI: 10.1016/j.psyneuen.2017.04.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 12/13/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with increased risk for Type 2 diabetes and cardiovascular disease (cardiometabolic disease), warranting research into targeted prevention strategies. In the present case-control study of 160 young (mean age 32.7 years) male military veterans, we aimed to assess whether PTSD status predicted increased markers of cardiometabolic risk in otherwise healthy individuals, and further, to explore biological pathways between PTSD and these increased markers of cardiometabolic risk. Toward these aims, we compared measures of cardiometabolic risk, namely insulin resistance (IR) (HOMA-IR), metabolic syndrome (MetS) and prediabetes, between 80 PTSD cases and 80 controls without PTSD. We then determined whether PTSD-associated increases in HOMA-IR were correlated with select biological variables from pathways previously hypothesized to link PTSD with cardiometabolic risk, including systemic inflammation (increased C-reactive protein, interleukin-6, and tumor necrosis factor α), sympathetic over-activity (increased resting heart rate), and neuroendocrine dysregulation (increased plasma cortisol or serum brain-derived neurotrophic factor (BDNF)). We found PTSD diagnosis was associated with substantially higher HOMA-IR (cases 4.3±4.3 vs controls 2.4±2.0; p<0.001), and a higher frequency of MetS (cases 21.3% vs controls 2.5%; p<0.001), but not prediabetes (cases 20.0% vs controls 18.8%; p>0.05). Cases also had increased pro-inflammatory cytokines (p<0.01), heart rate (p<0.001), and BDNF (p<0.001), which together predicted increased HOMA-IR (adjusted R2=0.68, p<0.001). Results show PTSD diagnosis in young male military veterans without cardiometabolic disease is associated with increased IR, predicted by biological alterations previously hypothesized to link PTSD to increased cardiometabolic risk. Findings support further research into early, targeted prevention of cardiometabolic disease in individuals with PTSD.
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Affiliation(s)
- Esther M Blessing
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, United States.
| | - Victor Reus
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Synthia H Mellon
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States; Department of OB/GYN and Reproductive Sciences, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Janine D Flory
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (ISMMS)/James J. Peters Veterans Affairs Medical Center, NY, United States
| | - Linda Bierer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (ISMMS)/James J. Peters Veterans Affairs Medical Center, NY, United States
| | - Daniel Lindqvist
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States; Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Psychiatry, Sweden
| | - Firdaus Dhabhar
- Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States
| | - Meng Li
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, United States
| | - Meng Qian
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, United States
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, United States
| | - Isaac Galatzer-Levy
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, United States
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (ISMMS)/James J. Peters Veterans Affairs Medical Center, NY, United States
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, United States
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Lindqvist D, Dhabhar FS, Mellon SH, Yehuda R, Grenon SM, Flory JD, Bierer LM, Abu-Amara D, Coy M, Makotkine I, Reus VI, Bersani FS, Marmar CR, Wolkowitz OM. Increased pro-inflammatory milieu in combat related PTSD - A new cohort replication study. Brain Behav Immun 2017; 59:260-264. [PMID: 27638184 DOI: 10.1016/j.bbi.2016.09.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Several lines of evidence indicate that increased inflammation is associated with Post-Traumatic Stress Disorder (PTSD). We have previously reported that peripheral inflammatory markers are significantly higher in combat-exposed veterans with than without PTSD. This study was designed to replicate these findings in a new study cohort using the same population and recruitment strategies. METHODS Sixty-one male war veterans (31 PTSD and 30 control subjects) were included in this replication study. Levels of Interleukin-6, Tumor Necrosis Factor-alpha, Gamma interferon, and high-sensitivity C-reactive protein were quantified in blood samples. A standardized "total pro-inflammatory score" was calculated to limit the number of statistical comparisons. The Clinician Administered PTSD Scale (CAPS) rating scale was used to assess PTSD symptom severity. RESULTS PTSD subjects had significantly higher total pro-inflammatory scores compared to non-PTSD subjects in unadjusted analysis (Cohen's d=0.75, p=0.005) as well as after adjusting for potentially confounding effects of age, BMI, smoking, and potentially interfering medications and somatic co-morbidities (p=0.023). There were no significant correlations between inflammatory markers and severity of symptoms within the PTSD group. CONCLUSIONS We replicated, in a new sample, our previous finding of increased inflammatory markers in combat-exposed PTSD subjects compared to combat-exposed non-PTSD controls. These findings strongly add to the growing literature suggesting that immune activation may be an important aspect of PTSD pathophysiology, although not directly correlated with current PTSD symptom levels in the PTSD group.
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Affiliation(s)
- Daniel Lindqvist
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
| | - Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States
| | - Rachel Yehuda
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States; Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Janine D Flory
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Linda M Bierer
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, New York, United States
| | - Michelle Coy
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States
| | - Iouri Makotkine
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States
| | - F Saverio Bersani
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, New York, United States.
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States.
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Bersani FS, Wolkowitz OM, Milush JM, Sinclair E, Eppling L, Aschbacher K, Lindqvist D, Yehuda R, Flory J, Bierer LM, Matokine I, Abu-Amara D, Reus VI, Coy M, Hough CM, Marmar CR, Mellon SH. A population of atypical CD56(-)CD16(+) natural killer cells is expanded in PTSD and is associated with symptom severity. Brain Behav Immun 2016; 56:264-70. [PMID: 27025668 DOI: 10.1016/j.bbi.2016.03.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 11/05/2015] [Revised: 03/22/2016] [Accepted: 03/25/2016] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) has been associated with immune disturbances, including a higher incidence of infections and autoimmune diseases as well as a net pro-inflammatory state. Natural killer (NK) cells, a key component of the innate immune system, have been less well-studied in PTSD despite their importance in immunity. METHODS We studied two independent samples of combat-exposed male war veterans with or without PTSD, the first ("Discovery Sample") to generate hypotheses, and the second ("Validation Sample") to replicate the findings. The Discovery Sample was comprised of 42 PTSD subjects and 42 controls. The Validation Sample was comprised of 25 PTSD subjects and 30 controls. Participants had fasting, morning blood samples collected for examination of the frequency of NK cell subsets, determined by flow cytometry. The current and lifetime Clinician Administered PTSD Scale (CAPS) was used to assess symptom severity. Statistical analyses were adjusted for age and BMI. RESULTS PTSD subjects compared to controls had (i) a significantly higher relative frequency of atypical CD56(-)CD16(+) NK cells in the Discovery Sample (p=0.027), which was replicated in the Validation Sample (p=0.004) and the combined sample (p<0.001), and (ii) a non-significantly lower relative frequency of CD56(bright)CD16(-) NK cells in the two samples (p=0.082; p=0.118), which became statistically significant in the combined sample (p=0.020). Further, within subjects with PTSD of both samples, the relative frequency of atypical CD56(-)CD16(+) NK cells was near significantly positively correlated with lifetime PTSD severity (p=0.074). DISCUSSION This study is the first to characterize NK cell subsets in individuals with PTSD. The results suggest that combat-exposed men with PTSD exhibit an aberrant profile of NK cells with significantly higher frequencies of an atypical population of CD56(-)CD16(+) cells and possibly lower frequencies of the functional CD56(bright)CD16(-) NK cell subsets. Higher proportions of dysfunctional CD56(-)CD16(+) cells have been reported in certain chronic viral infections and in senescent individuals. It is possible that this could contribute to immune dysfunctions and prematurely senescent phenotypes seen in PTSD.
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Affiliation(s)
- Francesco S Bersani
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
| | - Jeffrey M Milush
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Elizabeth Sinclair
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Lorrie Eppling
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Kirstin Aschbacher
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Lindqvist
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - Janine Flory
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - Linda M Bierer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - Iouri Matokine
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, New York, NY, USA
| | - Duna Abu-Amara
- Department of Psychiatry, New York University, New York, NY, USA; Steven and Alexandra Cohen Center for Posttraumatic Stress and TBI, New York, NY, USA
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Michelle Coy
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Christina M Hough
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Charles R Marmar
- Department of Psychiatry, New York University, New York, NY, USA; Steven and Alexandra Cohen Center for Posttraumatic Stress and TBI, New York, NY, USA
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Science, University of California San Francisco, San Francisco, CA, USA
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Bersani FS, Wolkowitz OM, Lindqvist D, Yehuda R, Flory J, Bierer LM, Makotine I, Abu-Amara D, Coy M, Reus VI, Epel ES, Marmar C, Mellon SH. Global arginine bioavailability, a marker of nitric oxide synthetic capacity, is decreased in PTSD and correlated with symptom severity and markers of inflammation. Brain Behav Immun 2016; 52:153-160. [PMID: 26515034 DOI: 10.1016/j.bbi.2015.10.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [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: 05/16/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Psychiatric, physical and biological aspects of posttraumatic stress disorder (PTSD) may be associated with dysfunctions in several cellular processes including nitric oxide (NO) production. NO is synthesized from arginine in a reaction carried out by NO synthase (NOS) enzymes. The recently introduced "global arginine bioavailability ratio" (GABR; ratio of arginine to [ornithine+citrulline]) has been proposed as a reliable approximation of NO synthetic capacity in vivo. The objectives of the present study were to test the hypotheses that (i) subjects with combat-related PTSD have lower GABR scores than combat controls, (ii) GABR score is inversely associated with the severity of psychopathological measures, (iii) GABR score is inversely associated with markers of inflammation. METHODS Metabolic profiling for plasma samples (i.e. arginine, citrulline and ornithine) and inflammation markers (interleukin [IL]-6, IL-1β, tumor necrosis factor [TNF]-α, interferon [IFN]-γ and C-reactive protein [CRP]) were assessed in 56 combat-exposed males with PTSD and 65 combat-exposed males without PTSD. We assessed severity of PTSD (Clinician Administered PTSD Scale [CAPS]) and depression (Beck Depression Inventory-II [BDI-II]) as well as history of early life trauma (Early Trauma Inventory [ETI]) and affectivity (Positive and Negative Affect Schedule [PANAS]). RESULTS The GABR value was (i) significantly lower in PTSD subjects compared to controls (p=0.001), (ii) significantly inversely correlated with markers of inflammation including IL6 (p=0.04) and TNFα (p=0.02), and (iii) significantly inversely correlated with CAPS current (p=0.001) and lifetime (p<0.001) subscales, ETI (p=0.045) and PANAS negative (p=0.006). Adding antidepressant use or MDD diagnosis as covariates led to similar results. Adding age and BMI as covariates also led to similar results, with the exception of IL6 and ETI losing their significant association with GABR. DISCUSSION This study provides the first evidence that global arginine bioavailability, a marker of NO synthetic capacity in vivo, is lower in veterans with PTSD and is negatively associated with some markers of inflammation as well as with measures of PTSD symptom severity, negative affectivity and childhood adverse experiences. These findings add to the accumulating evidence that specific cellular dysfunction may be associated with the symptomatology of PTSD and may help to explain the higher burden of cardio-metabolic disturbances seen in this disorder.
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Affiliation(s)
- Francesco Saverio Bersani
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States.
| | - Daniel Lindqvist
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States; Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; James J. Peters Veterans Affairs Medical Center, New York, NY, United States
| | - Janine Flory
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; James J. Peters Veterans Affairs Medical Center, New York, NY, United States
| | - Linda M Bierer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; James J. Peters Veterans Affairs Medical Center, New York, NY, United States
| | - Iouri Makotine
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; James J. Peters Veterans Affairs Medical Center, New York, NY, United States
| | - Duna Abu-Amara
- Department of Psychiatry, New York University, United States; Department of Psychiatry, Steven and Alexandra Cohen Center for Posttraumatic Stress and TBI, New York, NY, United States
| | - Michelle Coy
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Elissa S Epel
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States; Center for Health and Community, University of California San Francisco, San Francisco, CA, United States
| | - Charles Marmar
- Department of Psychiatry, New York University, United States; Department of Psychiatry, Steven and Alexandra Cohen Center for Posttraumatic Stress and TBI, New York, NY, United States
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Science, University of California San Francisco, San Francisco, CA, United States
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Bersani FS, Lindqvist D, Mellon SH, Epel ES, Yehuda R, Flory J, Henn-Hasse C, Bierer LM, Makotkine I, Abu-Amara D, Coy M, Reus VI, Lin J, Blackburn EH, Marmar C, Wolkowitz OM. Association of dimensional psychological health measures with telomere length in male war veterans. J Affect Disord 2016; 190:537-542. [PMID: 26571103 DOI: 10.1016/j.jad.2015.10.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 05/18/2015] [Revised: 10/12/2015] [Accepted: 10/16/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several psychiatric disorders may be characterized by peripheral telomere shortening. However, it is unclear whether telomere shortening is associated with these psychiatric disorders per se or, rather, with underlying dimensional parameters that are often, but not necessarily, associated with them. We explored the association between dimensional psychopathological measures and telomere length (TL) in granulocytes among veterans independent of psychiatric diagnosis. METHODS Seventy-six combat-exposed male veterans (41 psychiatrically healthy, 18 with Posttraumatic Stress Disorder [PTSD] and 17 with concomitant PTSD and Major Depressive Disorder [MDD]) had TL assayed. Assessments included Clinician-Administered PTSD Scale (CAPS), Beck Depression Inventory-II (BDI-II), Early Trauma Inventory (ETI), Symptom Checklist-90-R Global Severity Index (SCL-90-GSI), Perceived Stress Scale (PSS) and Positive and Negative Affect Schedule (PANAS). Correlations were corrected for age, BMI, antidepressants and ethnicity. RESULTS Across subjects, TL was negatively correlated with early trauma (p<0.001), global psychopathological severity (p=0.044) and perceived stress (p=0.019), positively correlated with positive affect (p=0.026), not significantly correlated with symptom severity of PTSD, depression or negative affect. Across these dimensions, early trauma and positive affect were associated with TL after excluding subjects with somatic illnesses. LIMITATIONS The study was cross-sectional with a moderate sample size and only male combat-exposed subjects. CONCLUSIONS These preliminary findings suggest that early trauma, severity of perceived stress and general psychopathological symptoms are more closely associated with shorter TL than is the severity of core diagnostic symptoms of PTSD or MDD, whereas positive affect is associated with longer TL. Larger-scale studies should assess TL associated with specific psychiatric dimensions, apart from only categorical psychiatric diagnoses, to develop more specific biologically-relevant endophenotypes.
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Affiliation(s)
- Francesco S Bersani
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Daniel Lindqvist
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Science, University of California San Francisco, San Francisco, CA, USA
| | - Elissa S Epel
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Center for Health and Community, University of California San Francisco, San Francisco, CA, USA
| | - Rachel Yehuda
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, New York, NY, USA
| | - Janine Flory
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, New York, NY, USA
| | - Clare Henn-Hasse
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, NY, USA
| | - Linda M Bierer
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, New York, NY, USA
| | - Iouri Makotkine
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, New York, NY, USA
| | - Duna Abu-Amara
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, NY, USA
| | - Michelle Coy
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth H Blackburn
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, USA
| | - Charles Marmar
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, NY, USA
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
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Bersani FS, Morley C, Lindqvist D, Epel ES, Picard M, Yehuda R, Flory J, Bierer LM, Makotkine I, Abu-Amara D, Coy M, Reus VI, Lin J, Blackburn EH, Marmar C, Wolkowitz OM, Mellon SH. Mitochondrial DNA copy number is reduced in male combat veterans with PTSD. Prog Neuropsychopharmacol Biol Psychiatry 2016; 64:10-7. [PMID: 26120081 DOI: 10.1016/j.pnpbp.2015.06.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 05/14/2015] [Revised: 06/21/2015] [Accepted: 06/23/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Mitochondrial abnormalities may be involved in PTSD, although few studies have examined this. Mitochondrial DNA copy number (mtDNAcn) in blood cells is an emerging systemic index of mitochondrial biogenesis and function. The present study assessed mtDNAcn in male combat-exposed veterans with PTSD compared to those without PTSD as well as its correlation with clinical scales. METHODS mtDNAcn was assessed with a TaqMan multiplex assay in granulocytes of 43 male combat veterans with (n=43) or without (n=44) PTSD. Twenty of the PTSD subjects had co-morbid major depressive disorder (MDD). The Clinician Administered PTSD Scale (CAPS), the Positive and Negative Affect Schedule (PANAS), the Early Trauma Inventory (ETI) and the Beck Depression Inventory II (BDI-II) were used for the clinical assessments. All analyses were corrected for age and BMI. RESULTS mtDNAcn was significantly lower in subjects with PTSD (p<0.05). Within the PTSD group, those with moderate PTSD symptom severity had relatively higher mtDNAcn than those with mild or severe symptoms (p<0.01). Within the PTSD group, mtDNAcn was positively correlated with PANAS positive subscale ratings (p<0.01) but was not significantly correlated with PANAS negative subscale, ETI or BDI-II ratings. DISCUSSION This study provides the first evidence of: (i) a significant decrease of mtDNAcn in combat PTSD, (ii) a possible "inverted-U" shaped relationship between PTSD symptom severity and mtDNAcn within PTSD subjects, and (iii) a direct correlation of mtDNAcn with positive affectivity within PTSD subjects. Altered mtDNAcn in PTSD may reflect impaired energy metabolism, which might represent a novel aspect of its pathophysiology.
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Affiliation(s)
- Francesco Saverio Bersani
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Claire Morley
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Lindqvist
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden
| | - Elissa S Epel
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Center for Health and Community, University of California San Francisco, San Francisco, CA, USA
| | - Martin Picard
- Center for Mitochondrial and Epigenomic Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Yehuda
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, New York, NY, USA
| | - Janine Flory
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, New York, NY, USA
| | - Linda M Bierer
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, New York, NY, USA
| | - Iouri Makotkine
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, New York, NY, USA
| | - Duna Abu-Amara
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, NY, USA
| | - Michelle Coy
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth H Blackburn
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, USA
| | - Charles Marmar
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, NY, USA
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Science, University of California San Francisco, San Francisco, CA, USA
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Almli LM, Stevens JS, Smith AK, Kilaru V, Meng Q, Flory J, Abu-Amara D, Hammamieh R, Yang R, Mercer KB, Binder EB, Bradley B, Hamilton S, Jett M, Yehuda R, Marmar CR, Ressler KJ. A genome-wide identified risk variant for PTSD is a methylation quantitative trait locus and confers decreased cortical activation to fearful faces. Am J Med Genet B Neuropsychiatr Genet 2015; 168B:327-36. [PMID: 25988933 PMCID: PMC4844461 DOI: 10.1002/ajmg.b.32315] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 02/08/2015] [Accepted: 04/06/2015] [Indexed: 12/13/2022]
Abstract
Genetic factors appear to be highly relevant to predicting differential risk for the development of post-traumatic stress disorder (PTSD). In a discovery sample, we conducted a genome-wide association study (GWAS) for PTSD using a small military cohort (Systems Biology PTSD Biomarkers Consortium; SBPBC, N = 147) that was designed as a case-controlled sample of highly exposed, recently returning veterans with and without combat-related PTSD. A genome-wide significant single nucleotide polymorphism (SNP), rs717947, at chromosome 4p15 (N = 147, β = 31.34, P = 1.28 × 10(-8) ) was found to associate with the gold-standard diagnostic measure for PTSD (the Clinician Administered PTSD Scale). We conducted replication and follow-up studies in an external sample, a larger urban community cohort (Grady Trauma Project, GTP, N = 2006), to determine the robustness and putative functionality of this risk variant. In the GTP replication sample, SNP rs717947 associated with PTSD diagnosis in females (N = 2006, P = 0.005), but not males. SNP rs717947 was also found to be a methylation quantitative trait locus (meQTL) in the GTP replication sample (N = 157, P = 0.002). Further, the risk allele of rs717947 was associated with decreased medial and dorsolateral cortical activation to fearful faces (N = 53, P < 0.05) in the GTP replication sample. These data identify a genome-wide significant polymorphism conferring risk for PTSD, which was associated with differential epigenetic regulation and with differential cortical responses to fear in a replication sample. These results may provide new insight into understanding genetic and epigenetic regulation of PTSD and intermediate phenotypes that contribute to this disorder.
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Affiliation(s)
- Lynn M. Almli
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Alicia K. Smith
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Varun Kilaru
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Qian Meng
- Department of Psychiatry, University Medical Center, New York, New York
| | - Janine Flory
- Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York/Traumatic Stress Studies Division, New York, New York
| | - Duna Abu-Amara
- Department of Psychiatry, New York University, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, New York
| | - Rasha Hammamieh
- Integrative Systems Biology, US Army Center for Environmental Health Research, Fort Detrick, Maryland
| | - Ruoting Yang
- Advanced Biomedical Computing Center, Frederick National Laboratory for Cancer Research/SAIC-Frederick Inc., Frederick, Maryland
| | - Kristina B. Mercer
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Elizabeth B. Binder
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia,Department of Veterans Affairs Medical Center, Clinical Psychologist, Mental Health Service Line, Atlanta, Georgia
| | - Steven Hamilton
- Department of Psychiatry, University of California, San Francisco, California
| | - Marti Jett
- Integrative Systems Biology, US Army Center for Environmental Health Research, Fort Detrick, Maryland
| | - Rachel Yehuda
- Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York/Traumatic Stress Studies Division, New York, New York
| | - Charles R. Marmar
- Department of Psychiatry, New York University, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York, New York
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia,Howard Hughes Medical Institute, Chevy Chase, Maryland,Correspondence to: Kerry J. Ressler, M.D., Ph.D., Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia.
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Yan X, Lazar M, Shalev AY, Neylan TC, Wolkowitz OM, Brown AD, Henn-Haase C, Yehuda R, Flory JD, Abu-Amara D, Sodickson DK, Marmar CR. WITHDRAWN: Precuneal and amygdala spontaneous activity and functional connectivity in war-zone-related PTSD. Psychiatry Res 2014:S0925-4927(14)00328-X. [PMID: 25561375 DOI: 10.1016/j.pscychresns.2014.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/11/2014] [Revised: 11/13/2014] [Accepted: 12/04/2014] [Indexed: 11/23/2022]
Abstract
This article has been withdrawn at the request of the author. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Xiaodan Yan
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA.
| | - Mariana Lazar
- Bernard and Irene Schwartz Center for Biomedical Imaging, NYU School of Medicine, New York, NY, USA
| | - Arieh Y Shalev
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Adam D Brown
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA; Department of Psychology, Sarah Lawrence College, Bronxville, NY, USA
| | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Rachel Yehuda
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Janine D Flory
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Daniel K Sodickson
- Bernard and Irene Schwartz Center for Biomedical Imaging, NYU School of Medicine, New York, NY, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU School of Medicine, New York, NY, USA
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Lindqvist D, Wolkowitz OM, Mellon S, Yehuda R, Flory JD, Henn-Haase C, Bierer LM, Abu-Amara D, Coy M, Neylan TC, Makotkine I, Reus VI, Yan X, Taylor NM, Marmar CR, Dhabhar FS. Proinflammatory milieu in combat-related PTSD is independent of depression and early life stress. Brain Behav Immun 2014; 42:81-8. [PMID: 24929195 DOI: 10.1016/j.bbi.2014.06.003] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [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: 02/09/2014] [Revised: 05/20/2014] [Accepted: 06/02/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic inflammation may be involved in combat-related post-traumatic stress disorder (PTSD) and may help explain comorbid physical diseases. However, the extent to which combat exposure per se, depression, or early life trauma, all of which are associated with combat PTSD, may confound the relationship between PTSD and inflammation is unclear. METHODS We quantified interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and C-reactive protein (CRP) in 51 combat-exposed males with PTSD and 51 combat-exposed males without PTSD, and assessed PTSD and depression severity as well as history of early life trauma. To decrease the possibility of Type I errors, we summed standardized scores of IL-1β, IL-6, TNFα, IFNγ and CRP into a total "pro-inflammatory score". PTSD symptom severity was assessed with the Clinician Administered PTSD Scale (CAPS) rating scale. RESULTS Subjects with PTSD had significantly higher pro-inflammatory scores compared to combat-exposed subjects without PTSD (p=0.006), and even after controlling for early life trauma, depression diagnosis and severity, body mass index, ethnicity, education, asthma/allergies, time since combat and the use of possibly confounding medications (p=0.002). Within the PTSD group, the pro-inflammatory score was not significantly correlated with depressive symptom severity, CAPS total score, or with the number of early life traumas. CONCLUSIONS Combat-related PTSD in males is associated with higher levels of pro-inflammatory cytokines, even after accounting for depression and early life trauma. These results, from one of the largest studies of inflammatory cytokines in PTSD to date, suggest that immune activation may be a core element of PTSD pathophysiology more so than a signature of combat exposure alone.
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Affiliation(s)
- Daniel Lindqvist
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States; Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States.
| | - Synthia Mellon
- Department of OB/GYN and Reproductive Sciences, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Rachel Yehuda
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Janine D Flory
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States
| | - Linda M Bierer
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States
| | - Michelle Coy
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Iouri Makotkine
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Victor I Reus
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Xiaodan Yan
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States
| | - Nicole M Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States.
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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