ENIGMA-anxiety working group: Rationale for and organization of large-scale neuroimaging studies of anxiety disorders

Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.

Mega-analysis methods in ENIGMA: The experience of the generalized anxiety disorder working group

The ENIGMA group on Generalized Anxiety Disorder (ENIGMA-Anxiety/GAD) is part of a broader effort to investigate anxiety disorders using imaging and genetic data across multiple sites worldwide. The group is actively conducting a mega-analysis of a large number of brain structural scans. In this process, the group was confronted with many methodological challenges related to study planning and implementation, between-country transfer of subject-level data, quality control of a considerable amount of imaging data, and choices related to statistical methods and efficient use of resources. This report summarizes the background information and rationale for the various methodological decisions, as well as the approach taken to implement them. The goal is to document the approach and help guide other research groups working with large brain imaging data sets as they develop their own analytic pipelines for mega-analyses.

Cortical and subcortical brain structure in generalized anxiety disorder: findings from 28 research sites in the ENIGMA-Anxiety Working Group

The goal of this study was to compare brain structure between individuals with generalized anxiety disorder (GAD) and healthy controls. Previous studies have generated inconsistent findings, possibly due to small sample sizes, or clinical/analytic heterogeneity. To address these concerns, we combined data from 28 research sites worldwide through the ENIGMA-Anxiety Working Group, using a single, pre-registered mega-analysis. Structural magnetic resonance imaging data from children and adults (5-90 years) were processed using FreeSurfer. The main analysis included the regional and vertex-wise cortical thickness, cortical surface area, and subcortical volume as dependent variables, and GAD, age, age-squared, sex, and their interactions as independent variables. Nuisance variables included IQ, years of education, medication use, comorbidities, and global brain measures. The main analysis (1020 individuals with GAD and 2999 healthy controls) included random slopes per site and random intercepts per scanner. A secondary analysis (1112 individuals with GAD and 3282 healthy controls) included fixed slopes and random intercepts per scanner with the same variables. The main analysis showed no effect of GAD on brain structure, nor interactions involving GAD, age, or sex. The secondary analysis showed increased volume in the right ventral diencephalon in male individuals with GAD compared to male healthy controls, whereas female individuals with GAD did not differ from female healthy controls. This mega-analysis combining worldwide data showed that differences in brain structure related to GAD are small, possibly reflecting heterogeneity or those structural alterations are not a major component of its pathophysiology.

Major and trace elements in Boletus aereus and Clitopilus prunulus growing on volcanic and sedimentary soils of Sicily (Italy)

The aim of this study was to determine and compare the content of 28 elements (Ag, Al, As, Ba, Be, Bi, Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, Pb, Rb, Sb, Se, Sr, Tl, U, V and Zn) in fruiting bodies of Boletus aereus Bull. and Clitopilus prunulus P. Kumm collected from eleven unpolluted sites of Sicily (Italy) and, also to relate the abundance of chemical elements in soil with their concentration in mushrooms. Median concentrations of the most abundant elements in Boletus aereus ranged from 31,290 μg/g (K) to 107 μg/g (Zn) in caps and from 24,009 μg/g (K) to 57 μg/g (Zn) in stalks with the following abundance order: K > Na > Ca > Mg > Fe > Al > Rb > Zn. The same elements, in the whole fruiting body of Clitopilus prunulus samples, varied in the range 54,073-92 μg/g following the abundance order: K > Na > Mg > Ca > Fe > Al > Rb > Zn. Metal contents in Boletus aereus and in the whole fruiting body of Clitopilus prunulus, collected from the same sampling sites, showed statistically significant differences for most elements. In particular, Clitopilus prunulus contained around two to four times more Co, Cr, Fe, Mg, Mo, Pb, U and V than caps and stalks of Boletus aereus species which, in turn, was from two to four times more enriched in Cu, Se and Tl. Thus, the elemental content of Boletus aereus and Clitopilus prunulus appeared to be species-dependent. The distribution of chemical elements in Boletus aereus was not uniform throughout the whole fruiting body as most elements were significantly bioconcentrated in caps. Furthermore, the fruit bodies of Boletus aereus from the volcanic soil differed both in major and minor elements concentrations from those collected from sedimentary soils. Cadmium and lead concentrations were below the threshold limits for wild mushrooms proposed by EU Directives (2008 and 2015). The elemental content was not significantly influenced by soil pH.

Lead isotopic fingerprint in human scalp hair: The case study of Iglesias mining district (Sardinia, Italy)

The Sulcis-Iglesiente district (SW Sardinia, Italy) has been, until recently, one of the most important Italian polymetallic mining areas for the extraction of lead. Epidemiological studies conducted over several decades have indicated this site at high risk of environmental crisis with possible adverse effects on the public health. In the present paper we discuss Pb isotope signatures in human scalp hair and road dust collected from the Sulcis-Iglesiente area in order to trace the exposure of populations to potential Pb sources. A total of 23 determinations (20 on hair samples and 3 on road dust samples) of lead isotope ratios (²⁰⁶Pb/²⁰⁷Pb and ²⁰⁸Pb/²⁰⁶Pb) were carried out. The obtained results were integrate with literature data regarding the total content of Pb in hair samples from the same study area. Hair from children living in Sant'Antioco exhibited lead isotope ratios in the ranges 1.152-1.165 for ²⁰⁶Pb/²⁰⁷Pb and 2.101-2.108 for ²⁰⁸Pb/²⁰⁶Pb, while hair samples from Iglesias resulted less radiogenic: ²⁰⁶Pb/²⁰⁷Pb~1.147-1.154 and ²⁰⁸Pb/²⁰⁶Pb~2.106-2.118. These values pointed to a multi-source mixing between the less radiogenic sources, corresponding to the Pb ore deposits, and the more radiogenic sources identified in local background.

Perturbation vectors to evaluate air quality using lichens and bromeliads: a Brazilian case study

Samples of one lichen species, Parmotrema crinitum, and one bromeliad species, Tillandsia usneoides, were collected in the state of Rio de Janeiro, Brazil, at four sites differently affected by anthropogenic pollution. The concentrations of aluminum, cadmium, copper, iron, lanthanum, lead, sulfur, titanium, zinc, and zirconium were determined by inductively coupled plasma-atomic emission spectroscopy. The environmental diagnosis was established by examining compositional changes via perturbation vectors, an underused family of methods designed to circumvent the problem of closure in any compositional dataset. The perturbation vectors between the reference site and the other three sites were similar for both species, although body concentration levels were different. At each site, perturbation vectors between lichens and bromeliads were approximately the same, whatever the local pollution level. It should thus be possible to combine these organisms, though physiologically different, for air quality surveys, after making all results comparable with appropriate correction. The use of perturbation vectors seems particularly suitable for assessing pollution level by biomonitoring, and for many frequently met situations in environmental geochemistry, where elemental ratios are more relevant than absolute concentrations.

Penalized linear discriminant analysis and Discrete AdaBoost to distinguish human hair metal profiles: The case of adolescents residing near Mt. Etna

The research focus of the present paper was twofold. First, we tried to document that human intake of trace elements is influenced by geological factors of the place of residence. Second, we showed that the elemental composition of human hair is a useful screening tool for assessing people's exposure to potentially toxic substances. For this purpose, we used samples of human hair from adolescents and applied two robust statistical approaches. Samples from two distinct geological and environmental sites were collected: the first one was characterized by the presence of the active volcano Mt. Etna (ETNA group) and the second one lithologically made up of sedimentary rocks (SIC group). Chemical data were statistically processed by Penalized Linear Discriminant Analysis (pLDA) and Discrete AdaBoost (DAB). The separation between the two groups turned out well, with few overlaps accounting for less than 5%. The chemical variables that better distinguished ETNA group from SIC group were As, Cd, Co, Li, Mo, Rb, Sr, U and V. Both pLDA and DAB allowed us to characterize the elements most closely related to the volcanic contribution (As, U and V) and those (Cd, Co, Li, Mo, Rb and Sr) prevalently influenced by the geology of the area where SIC samples were collected. We conclude that the geological characteristics of the area of residence constitute a key factor in influencing the potential exposure to trace elements. Hair analysis coupled with robust statistical methods can be effectively used as a screening procedure to identify areas at great environmental risk.

Reduced binding of Pittsburgh Compound-B in areas of white matter hyperintensities

The amyloid imaging agent, Pittsburgh Compound-B, binds with high affinity to β-amyloid (Aβ) in the brain, and it is well established that PiB also shows non-specific retention in white matter (WM). However, little is known about retention of PiB in areas of white matter hyperintensities (WMH), abnormalities commonly seen in older adults. Further, it is hypothesized that WMH are related to both cognitive dysfunction and Aβ deposition. The goal of the present study was to explore PiB retention in both normal-appearing WM (NAWM) and WMH in a group of elderly, cognitively normal individuals. In a group of cognitively normal elderly (n = 64; 86.5 ± 2.6 years) two analyses were applied: (1) ROIs were placed over periventricular areas in which WMH caps are commonly seen on all subjects, regardless of WMH burden or size. (2) Subject-specific maps of NAWM and WMH were co-registered with the PiB-PET images and mean SUVR values were calculated in these NAWM and WMH maps. PiB retention was significantly reduced in the ROIs of subjects with high WMH compared to subjects with low WMH. Additionally, in subjects with high WMH, there was significantly lower PiB retention in subject-specific maps of WMH compared to NAWM, which was not observed in subjects with low WMH, likely because of the small size of WMH maps in this group. These data suggest that WM in areas of WMH binds PiB less effectively than does normal WM. Further exploration of this phenomenon may lead to insights about the molecular basis of the non-specific retention of amyloid tracers in white matter.

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PiB retention was significantly reduced in the “typical-WMH” ROIs of subjects with high WMH compared to subjects with low WMH.

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In subjects with high WMH, there was significantly lower PiB retention in subject-specific maps of WMH compared to NAWM.

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These data suggest that WM in areas of WMH binds PiB less effectively than does normal WM.

Coverage intervals for trace elements in human scalp hair are site specific

Coverage intervals for trace elements in human scalp hair commonly provide the basis for interpreting laboratory results and also in comparative decision-making processes regarding exposure risk assessment. This short communication documents, by some examples, that those computed for human hair are to be considered site specific, as they reflect local environmental conditions; also each geographic area has a typical profile of hair elemental composition of its inhabitants. Therefore, the levels of trace elements in hair are not strictly comparable between different areas of the world. This issue is particularly relevant when identification of anomalous environmental exposures are requested or even in detecting physiological disorders.

Metals and metalloids in hair samples of children living near the abandoned mine sites of Sulcis-Inglesiente (Sardinia, Italy)

The Sulcis-Iglesiente district (SW Sardinia, Italy) is one of the oldest and most important polymetallic mining areas in Italy. Large outcrops of sulfide and oxide ores, as well as the products of the long-lasting mining activity, are present throughout the district releasing significant quantities of metals and metalloids into the surrounding environment. Here are reported concentrations of 21 elements determined in scalp hair samples from children (aged 11-13 years) living in different geochemical environments of southwestern Sardinia: Iglesias, hosting several abandoned mines, and the island of Sant׳Antioco, not affected by significant base metal mineralization events. Trace element determinations were performed by ICP-MS. Statistically significant differences (p<0.01) in elemental concentration levels between the two study sites were found. Hair of children from Iglesias exhibited higher concentration values for Ag, Ba, Cd, Cr, Ni, Pb, Rb, Sb, U, V, and Zn. Rubidium, V and U resulted more abundant at Sant׳Antioco. Hair samples from Iglesias showed gender-related differences for a larger number of elements (Ag, Ba, Cd, Co, Cu, Ni, Sr, U and Zn) than at Sant׳Antioco, where only U was significantly different. The above elemental concentrations in females were always higher than in male donors. Robust Principal Component Analysis operated on log-transformed elemental concentrations showed components indicative of a) sulfides ore minerals (PC1) reflecting the influence of the diffuse mineralization covering the entire study area, b) the presence of some bioavailable As sources (PC2) as As-rich pyrite and Fe-containing sphalerite and c) other sources of metals overlapping the diffuse mineralizations, as carbonate rocks and coal deposits (PC3). The results provided evidence of a potential risk of adverse effects on the health of the exposed population, with children living at Iglesias being greatly exposed to several metals and metalloids originated in mining tailings, enriched soils, waters and food.

Trace elements in scalp hair of children chronically exposed to volcanic activity (Mt. Etna, Italy)

The aim of this survey was to use scalp hair as a biomonitor to evaluate the environmental exposure to metals and metalloids of schoolchildren living around the Mt. Etna area, and to verify whether the degree of human exposure to trace elements is subject to changes in local environmental factors. Twenty trace elements were determined in 376 samples of scalp hair from schoolboys (11-13 years old) of both genders, living in ten towns located around the volcanic area of Mt. Etna (Sicily). The results were compared with those (215 samples) from children living in areas of Sicily characterized by a different geological setting (reference site). As, U and V showed much higher concentrations at the volcanic site whereas Sr was particularly more abundant at the reference site. Linear Discriminant Analysis (LDA) indicated an Etna factor, made up of V, U and Mn, and a second factor, concerning the reference site, characterized by Ni and Sr, and to a lesser extent by Mo and Cd. Significant differences in element concentrations were also observed among three different sectors of Mt. Etna area. Young people living in the Mt. Etna area are naturally exposed to enhanced intakes of some metals (V, U, Mn) and non-metals (e.g., As) than individuals of the same age residing in other areas of Sicily, characterized by different lithologies and not influenced by volcanic activity. The petrographic nature of local rocks and the dispersion of the volcanic plume explain the differences, with ingestion of water and local food as the most probable exposure pathways.

Resting state functional connectivity and treatment response in late-life depression

Indices of functional connectivity in the default mode network (DMN) are promising neural markers of treatment response in late-life depression. We examined the differences in DMN functional connectivity between treatment-responsive and treatment-resistant depressed older adults. Forty-seven depressed older adults underwent MRI scanning pre- and post-pharmacotherapy. Forty-six never depressed older adults underwent MR scanning as comparison subjects. Treatment response was defined as achieving a Hamilton Depression Rating Scale of 10 or less post-treatment. We analyzed resting state functional connectivity using the posterior cingulate cortex as the seed region-of-interest. The resulting correlation maps were employed to investigate between-group differences. Additionally we examined the association between white matter hyperintensity burden and functional connectivity results. Comparison of pre- and post-treatment scans of depressed participants revealed greater post-treatment functional connectivity in the frontal precentral gyrus. Relative to treatment-responsive participants, treatment-resistant participants had increased functional connectivity in the left striatum. When adjusting for white matter hyperintensity burden, the observed differences lost significance for the PCC-prefrontal functional connectivity, but not for the PCC-striatum functional connectivity. The post-treatment "frontalization" of the DMN connectivity suggests a normalizing effect of antidepressant treatment. Moreover, our study confirms the central role of white matter lesions in disrupting brain functional connectivity.

Trace elements in scalp hair of children living in differing environmental contexts in Sicily (Italy)

We present here data about trace elements in human scalp hair samples to test whether they are valuable to reflect environmental exposure and contamination by trace elements. The study compares contents of trace elements in scalp hair from a total of 336 children, aged 11-13 years old, living in various geographical areas of Sicily (southern Italy) characterized by differing environmental conditions. Nineteen elements (Al, As, Ba, Cd, Co, Cr, Cu, Li, Mn, Mo, Ni, Pb, Rb, Sb, Se, Sr, U, V and Zn) were determined by inductively coupled plasma mass spectrometry (ICP-MS). Coverage intervals (CI) formulated by the elemental composition of hair samples from the Palermo subjects were compared with the median content of hair from children living in the other study areas. Statistical analysis showed that Al, Ba, Sr and Zn concentrations differed significantly between gender, higher concentrations being observed in girls' hair. Children living close to the volcanic area had higher concentrations of As, Cr, Mn, Ni, Rb, Sb, U, V and Zn. Those living in an area with several old quarries had higher levels of Al, As, Pb, Rb and U. The hair of children living near the Pace del Mela industrial area contained higher levels of As, Ba, Mn, Pb, Rb, Sr and U. Linear discriminant analysis (LDA) between Palermo and the other sites allowed to better assess which variables contribute towards differentiating the groups. Our observations suggest that human hair can be used to monitor exposure to several metals, provided that sampling and analytical procedures, together with statistical treatment of data, are carried out according to standardized protocols.

Concentration and reference interval of trace elements in human hair from students living in Palermo, Sicily (Italy)

Trace element contents in specimens of hair collected from 137 children aged 11-13 years old, living in Palermo (Sicily, Italy) were determined by ICP-MS. This work reports analytical data for the following 19 elements: Al, As, Ba, Cd, Co, Cr, Cu, Li, Mn, Mo, Ni, Pb, Rb, Sb, Se, Sr, U, V and Zn. The most abundant chemical elements were zinc and copper (Zn > Cu), with concentrations exceeding 10 μg/g (Zn = 189.2 μg/g; Cu = 22.9 μg/g). Other elements with concentrations greater than 1 μg/g were, in order of abundance, Al>Sr>Ba>Pb. The remaining elements were all below 1 μg/g. The average elemental concentrations in hair were statistically compared by Kolmogorov-Smirnov's test taking children's gender into account. Al, Ba, Cr, Li, Rb, Sb, Sr, V and Zn were statistically different according to gender, with significance p < 0.001. This study thus confirms the need for hair analysis to differentiate female data from those of males. IUPAC coverage intervals and coverage uncertainties for trace elements in the analysed hair samples are also reported.

Yttrium and lanthanides in human lung fluids, probing the exposure to atmospheric fallout

Inhalation of airborne particles can produce crystallization of phosphatic microcrysts in intraaveolar areas of lungs, sometimes degenerating into pulmonary fibrosis. Results of this study indicate that these pathologies are induced by interactions between lung fluids and inhaled atmospheric dust in people exposed to volcanic dust ejected from Mount Etna in 2001. Here, the lung solid-liquid interaction is evaluated by the distribution of yttrium and lanthanides (YLn) in fluid bronchoalveolar lavages on selected individuals according the classical geochemical approaches. We found that shale-normalised patterns of yttrium and lanthanides have a 'V shaped' feature corresponding to the depletion of elements from Nd to Tb when compared to the variable enrichments of heavy lanthanides, Y, La and Ce. These features and concurrent thermodynamic simulations suggest that phosphate precipitation can occur in lungs due to interactions between volcanic particles and fluids. We propose that patterns of yttrium and lanthanides can represent a viable explanation of some pathology observed in patients after prolonged exposure to atmospheric fallout and are suitable to become a diagnostic parameter of chemical environmental stresses.