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Ironside M, Duda JM, Moser AD, Holsen LM, Zuo CS, Du F, Perlo S, Richards CE, Chen X, Nickerson LD, Null KE, Esfand SM, Alexander MM, Crowley DJ, Lauze M, Misra M, Goldstein JM, Pizzagalli DA. Association of Lower Rostral Anterior Cingulate GABA+ and Dysregulated Cortisol Stress Response With Altered Functional Connectivity in Young Adults With Lifetime Depression: A Multimodal Imaging Investigation of Trait and State Effects. Am J Psychiatry 2024:appiajp20230382. [PMID: 38685857 DOI: 10.1176/appi.ajp.20230382] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Preclinical work suggests that excess glucocorticoids and reduced cortical γ-aminobutyric acid (GABA) may affect sex-dependent differences in brain regions implicated in stress regulation and depressive phenotypes. The authors sought to address a critical gap in knowledge, namely, how stress circuitry is functionally affected by glucocorticoids and GABA in current or remitted major depressive disorder (MDD). METHODS Multimodal imaging data were collected from 130 young adults (ages 18-25), of whom 44 had current MDD, 42 had remitted MDD, and 44 were healthy comparison subjects. GABA+ (γ-aminobutyric acid and macromolecules) was assessed using magnetic resonance spectroscopy, and task-related functional MRI data were collected under acute stress and analyzed using data-driven network modeling. RESULTS Across modalities, trait-related abnormalities emerged. Relative to healthy comparison subjects, both clinical groups were characterized by lower rostral anterior cingulate cortex (rACC) GABA+ and frontoparietal network amplitude but higher amplitude in salience and stress-related networks. For the remitted MDD group, differences from the healthy comparison group emerged in the context of elevated cortisol levels, whereas the MDD group had lower cortisol levels than the healthy comparison group. In the comparison group, frontoparietal and stress-related network connectivity was positively associated with cortisol level (highlighting putative top-down regulation of stress), but the opposite relationship emerged in the MDD and remitted MDD groups. Finally, rACC GABA+ was associated with stress-induced changes in connectivity between overlapping default mode and salience networks. CONCLUSIONS Lifetime MDD was characterized by reduced rACC GABA+ as well as dysregulated cortisol-related interactions between top-down control (frontoparietal) and threat (task-related) networks. These findings warrant further investigation of the role of GABA in the vulnerability to and treatment of MDD.
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Affiliation(s)
- Maria Ironside
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Jessica M Duda
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Amelia D Moser
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Laura M Holsen
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Chun S Zuo
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Fei Du
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Sarah Perlo
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Christine E Richards
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Xi Chen
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Lisa D Nickerson
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Kaylee E Null
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Shiba M Esfand
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Madeline M Alexander
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - David J Crowley
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Meghan Lauze
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Madhusmita Misra
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Jill M Goldstein
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
| | - Diego A Pizzagalli
- Center for Depression, Anxiety, and Stress Research (Ironside, Duda, Moser, Perlo, Richards, Null, Esfand, Alexander, Crowley, Pizzagalli) and McLean Imaging Center (Zuo, Du, Chen, Nickerson, Pizzagalli), McLean Hospital, Belmont, Mass.; Laureate Institute for Brain Research, Tulsa, Okla. (Ironside); Harvard Medical School, Boston (Holsen, Zuo, Du, Chen, Nickerson, Misra, Goldstein, Pizzagalli); Division of Women's Health, Department of Medicine (Holsen), and Department of Psychiatry, Brigham and Women's Hospital, Boston (Holsen); Division of Pediatric Endocrinology (Lauze, Misra), Department of Psychiatry (Goldstein), and Innovation Center on Sex Differences in Medicine (Holsen, Misra, Goldstein), Massachusetts General Hospital, Boston
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Kaur S, Nimmala S, Singhal V, Mitchell DM, Pedreira CC, Lauze M, Lee H, Stanford FC, Bouxsein ML, Bredella MA, Misra M. Bone changes post-sleeve gastrectomy in relation to body mass and hormonal changes. Eur J Endocrinol 2023; 189:346-354. [PMID: 37633255 DOI: 10.1093/ejendo/lvad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE To determine mechanisms contributing to impaired bone health in youth 24 months following sleeve gastrectomy (SG). DESIGN Twenty-four-month longitudinal observational study. METHODS Participants included 23 youth undergoing SG and 30 non-surgical controls (NS) 13-25 years old with moderate-to-severe obesity. Subjects underwent fasting labs for bone turnover markers (N-terminal propeptide of type 1 procollagen, C-telopeptide (CTX)), sex hormones, sex hormone binding globulin (SHBG), and enteric peptides, DXA for areal bone mineral density (aBMD) and body composition, high-resolution peripheral quantitative CT for volumetric BMD (vBMD) at the distal radius and tibia, and microfinite element analysis for strength estimates. RESULTS Groups did not differ for mean age or BMI z-scores. Over 24 months, compared to NS, SG had greater reductions in BMI z-scores, and spine, hip, and femoral neck aBMD Z-scores (P ≤ .012), greater increases in serum CTX and SHBG (P ≤ .039), and greater decreases in estrone and ghrelin (P ≤ .021). Among females, estrone and free androgen index (FAI) decreased (P ≤ .022) in SG vs NS groups. After controlling for age and sex, decreases in BMI and lean mass were associated with decreases in total hip and femoral neck aBMD Z-scores, and decreases in radial total and trabecular vBMD and failure load, and tibial total and trabecular vBMD. Among females, after controlling for age, decreases in estrone were associated with decreases in spine aBMD Z-scores and radial total and trabecular vBMD, and decrease in FAI with decreases in radial failure load. CONCLUSION Reductions in BMI, lean mass, and sex steroids over 24 months post-SG are associated with bone loss and could be targeted for preventative or therapeutic interventions. Clinical trial registration number: The study is registered in ClinicalTrials.gov (NCT02557438).
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Affiliation(s)
- Snimarjot Kaur
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Supritha Nimmala
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- MGH Weight Center, Boston, MA, United States
| | - Deborah M Mitchell
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Clarissa C Pedreira
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Meghan Lauze
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Hang Lee
- MGH Biostatistics Center and Harvard Medical School, Boston, MA, United States
| | - Fatima Cody Stanford
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- MGH Weight Center, Boston, MA, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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