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Mehta NH, Wang X, Keil SA, Xi K, Zhou L, Lee K, Tan W, Spector E, Goldan A, Kelly J, Karakatsanis NA, Mozley PD, Nehmeh S, Chazen JL, Morin S, Babich J, Ivanidze J, Pahlajani S, Tanzi EB, Saint-Louis L, Butler T, Chen K, Rusinek H, Carare RO, Li Y, Chiang GC, de Leon MJ. [1- 11C]-Butanol Positron Emission Tomography reveals an impaired brain to nasal turbinates pathway in aging amyloid positive subjects. Fluids Barriers CNS 2024; 21:30. [PMID: 38566110 PMCID: PMC10985958 DOI: 10.1186/s12987-024-00530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Reduced clearance of cerebrospinal fluid (CSF) has been suggested as a pathological feature of Alzheimer's disease (AD). With extensive documentation in non-human mammals and contradictory human neuroimaging data it remains unknown whether the nasal mucosa is a CSF drainage site in humans. Here, we used dynamic PET with [1-11C]-Butanol, a highly permeable radiotracer with no appreciable brain binding, to test the hypothesis that tracer drainage from the nasal pathway reflects CSF drainage from brain. As a test of the hypothesis, we examined whether brain and nasal fluid drainage times were correlated and affected by brain amyloid. METHODS 24 cognitively normal subjects (≥ 65 years) were dynamically PET imaged for 60 min. using [1-11C]-Butanol. Imaging with either [11C]-PiB or [18F]-FBB identified 8 amyloid PET positive (Aβ+) and 16 Aβ- subjects. MRI-determined regions of interest (ROI) included: the carotid artery, the lateral orbitofrontal (LOF) brain, the cribriform plate, and an All-turbinate region comprised of the superior, middle, and inferior turbinates. The bilateral temporalis muscle and jugular veins served as control regions. Regional time-activity were used to model tracer influx, egress, and AUC. RESULTS LOF and All-turbinate 60 min AUC were positively associated, thus suggesting a connection between the brain and the nose. Further, the Aβ+ subgroup demonstrated impaired tracer kinetics, marked by reduced tracer influx and slower egress. CONCLUSION The data show that tracer kinetics for brain and nasal turbinates are related to each other and both reflect the amyloid status of the brain. As such, these data add to evidence that the nasal pathway is a potential CSF drainage site in humans. These data warrant further investigation of brain and nasal contributions to protein clearance in neurodegenerative disease.
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Affiliation(s)
- Neel H Mehta
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
- Harvard Medical School, Boston, MA, USA
| | - Xiuyuan Wang
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
| | - Samantha A Keil
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
| | - Ke Xi
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
| | - Liangdong Zhou
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
| | - Kevin Lee
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
- Weill Cornell Medicine, School of Medicine New York, New York, NY, USA
| | - Wanbin Tan
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
| | - Edward Spector
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Amirhossein Goldan
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - James Kelly
- Department of Radiology, Molecule Imaging Innovations Institute, Weill Cornell Medicine, New York, NY, USA
| | | | - P David Mozley
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
- Radiopharm Theranostics, New York, NY, USA
| | - Sadek Nehmeh
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J Levi Chazen
- Department of Radiology, Hospital for Special Surgery, New York, NY, USA
| | - Simon Morin
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Jana Ivanidze
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Silky Pahlajani
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
| | - Emily B Tanzi
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
| | | | - Tracy Butler
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
| | - Kewei Chen
- College of Health Solutions, Arizona State University, Downtown Phoenix Campus, Arizona, USA
| | - Henry Rusinek
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Roxana O Carare
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Yi Li
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
| | - Gloria C Chiang
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Mony J de Leon
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, 407 East 61 Street, 10065, New York, NY, USA.
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Mosconi L, Williams S, Carlton C, Zarate C, Boneu C, Fauci F, Ajila T, Nerattini M, Jett S, Andy C, Battista M, Pahlajani S, Osborne J, Brinton RD, Dyke JP. Sex-specific associations of serum cortisol with brain biomarkers of Alzheimer's risk. Sci Rep 2024; 14:5519. [PMID: 38448497 PMCID: PMC10918173 DOI: 10.1038/s41598-024-56071-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024] Open
Abstract
Emerging evidence implicates chronic psychological stress as a risk factor for Alzheimer's disease (AD). Herein, we examined the relationships between serum cortisol and multimodality brain AD biomarkers in 277 cognitively normal midlife individuals at risk for AD. Overall, higher cortisol was associated with lower total brain volume, lower glucose metabolism (CMRglc) in frontal cortex, and higher β-amyloid (Aβ) load in AD-vulnerable regions; and marginally associated with phosphocreatine to ATP ratios (PCr/ATP) in precuneus and parietal regions. Sex-specific modification effects were noted: in women, cortisol exhibited stronger associations with Aβ load and frontal CMRglc, the latter being more pronounced postmenopause. In men, cortisol exhibited stronger associations with gray matter volume and PCr/ATP measures. Higher cortisol was associated with poorer delayed memory in men but not in women. Results were adjusted for age, Apolipoprotein E (APOE) epsilon 4 status, midlife health factors, and hormone therapy use. These results suggest sex-specific neurophysiological responses to stress, and support a role for stress reduction in AD prevention.
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Affiliation(s)
- Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA.
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
| | - Schantel Williams
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Camila Zarate
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Camila Boneu
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Francesca Fauci
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Trisha Ajila
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Matilde Nerattini
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Clinical Pathophysiology, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Steven Jett
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Michael Battista
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Joseph Osborne
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Roberta Diaz Brinton
- Department of Neurology and Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Jonathan P Dyke
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
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3
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Andy C, Nerattini M, Jett S, Carlton C, Zarate C, Boneu C, Fauci F, Ajila T, Battista M, Pahlajani S, Christos P, Fink ME, Williams S, Brinton RD, Mosconi L. Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition. Front Endocrinol (Lausanne) 2024; 15:1350318. [PMID: 38501109 PMCID: PMC10944893 DOI: 10.3389/fendo.2024.1350318] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Despite evidence from preclinical studies suggesting estrogen's neuroprotective effects, the use of menopausal hormone therapy (MHT) to support cognitive function remains controversial. Methods We used random-effect meta-analysis and multi-level meta-regression to derive pooled standardized mean difference (SMD) and 95% confidence intervals (C.I.) from 34 randomized controlled trials, including 14,914 treated and 12,679 placebo participants. Results Associations between MHT and cognitive function in some domains and tests of interest varied by formulation and treatment timing. While MHT had no overall effects on cognitive domain scores, treatment for surgical menopause, mostly estrogen-only therapy, improved global cognition (SMD=1.575, 95% CI 0.228, 2.921; P=0.043) compared to placebo. When initiated specifically in midlife or close to menopause onset, estrogen therapy was associated with improved verbal memory (SMD=0.394, 95% CI 0.014, 0.774; P=0.046), while late-life initiation had no effects. Overall, estrogen-progestogen therapy for spontaneous menopause was associated with a decline in Mini Mental State Exam (MMSE) scores as compared to placebo, with most studies administering treatment in a late-life population (SMD=-1.853, 95% CI -2.974, -0.733; P = 0.030). In analysis of timing of initiation, estrogen-progestogen therapy had no significant effects in midlife but was associated with improved verbal memory in late-life (P = 0.049). Duration of treatment >1 year was associated with worsening in visual memory as compared to shorter duration. Analysis of individual cognitive tests yielded more variable results of positive and negative effects associated with MHT. Discussion These findings suggest time-dependent effects of MHT on certain aspects of cognition, with variations based on formulation and timing of initiation, underscoring the need for further research with larger samples and more homogeneous study designs.
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Affiliation(s)
- Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Matilde Nerattini
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Steven Jett
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Zarate
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Boneu
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Francesca Fauci
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Trisha Ajila
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Michael Battista
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Matthew E Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Schantel Williams
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Neurology and Pharmacology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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Nerattini M, Jett S, Andy C, Carlton C, Zarate C, Boneu C, Battista M, Pahlajani S, Loeb-Zeitlin S, Havryulik Y, Williams S, Christos P, Fink M, Brinton RD, Mosconi L. Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia. Front Aging Neurosci 2023; 15:1260427. [PMID: 37937120 PMCID: PMC10625913 DOI: 10.3389/fnagi.2023.1260427] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Despite a large preclinical literature demonstrating neuroprotective effects of estrogen, use of menopausal hormone therapy (HT) for Alzheimer's disease (AD) risk reduction has been controversial. Herein, we conducted a systematic review and meta-analysis of HT effects on AD and dementia risk. Methods Our systematic search yielded 6 RCT reports (21,065 treated and 20,997 placebo participants) and 45 observational reports (768,866 patient cases and 5.5 million controls). We used fixed and random effect meta-analysis to derive pooled relative risk (RR) and 95% confidence intervals (C.I.) from these studies. Results Randomized controlled trials conducted in postmenopausal women ages 65 and older show an increased risk of dementia with HT use compared with placebo [RR = 1.38, 95% C.I. 1.16-1.64, p < 0.001], driven by estrogen-plus-progestogen therapy (EPT) [RR = 1.64, 95% C.I. 1.20-2.25, p = 0.002] and no significant effects of estrogen-only therapy (ET) [RR = 1.19, 95% C.I. 0.92-1.54, p = 0.18]. Conversely, observational studies indicate a reduced risk of AD [RR = 0.78, 95% C.I. 0.64-0.95, p = 0.013] and all-cause dementia [RR = .81, 95% C.I. 0.70-0.94, p = 0.007] with HT use, with protective effects noted with ET [RR = 0.86, 95% C.I. 0.77-0.95, p = 0.002] but not with EPT [RR = 0.910, 95% C.I. 0.775-1.069, p = 0.251]. Stratified analysis of pooled estimates indicates a 32% reduced risk of dementia with midlife ET [RR = 0.685, 95% C.I. 0.513-0.915, p = 0.010] and non-significant reductions with midlife EPT [RR = 0.775, 95% C.I. 0.474-1.266, p = 0.309]. Late-life HT use was associated with increased risk, albeit not significant [EPT: RR = 1.323, 95% C.I. 0.979-1.789, p = 0.069; ET: RR = 1.066, 95% C.I. 0.996-1.140, p = 0.066]. Discussion These findings support renewed research interest in evaluating midlife estrogen therapy for AD risk reduction.
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Affiliation(s)
- Matilde Nerattini
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Steven Jett
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Zarate
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Boneu
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Michael Battista
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Susan Loeb-Zeitlin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States
| | - Yelena Havryulik
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States
| | - Schantel Williams
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Matthew Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Neurology and Pharmacology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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5
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Jett S, Boneu C, Zarate C, Carlton C, Kodancha V, Nerattini M, Battista M, Pahlajani S, Williams S, Dyke JP, Mosconi L. Systematic review of 31P-magnetic resonance spectroscopy studies of brain high energy phosphates and membrane phospholipids in aging and Alzheimer's disease. Front Aging Neurosci 2023; 15:1183228. [PMID: 37273652 PMCID: PMC10232902 DOI: 10.3389/fnagi.2023.1183228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Many lines of evidence suggest that mitochondria have a central role in aging-related neurodegenerative diseases, such as Alzheimer's disease (AD). Mitochondrial dysfunction, cerebral energy dysmetabolism and oxidative damage increase with age, and are early event in AD pathophysiology and may precede amyloid beta (Aβ) plaques. In vivo probes of mitochondrial function and energy metabolism are therefore crucial to characterize the bioenergetic abnormalities underlying AD risk, and their relationship to pathophysiology and cognition. A majority of the research conducted in humans have used 18F-fluoro-deoxygluose (FDG) PET to image cerebral glucose metabolism (CMRglc), but key information regarding oxidative phosphorylation (OXPHOS), the process which generates 90% of the energy for the brain, cannot be assessed with this method. Thus, there is a crucial need for imaging tools to measure mitochondrial processes and OXPHOS in vivo in the human brain. 31Phosphorus-magnetic resonance spectroscopy (31P-MRS) is a non-invasive method which allows for the measurement of OXPHOS-related high-energy phosphates (HEP), including phosphocreatine (PCr), adenosine triphosphate (ATP), and inorganic phosphate (Pi), in addition to potential of hydrogen (pH), as well as components of phospholipid metabolism, such as phosphomonoesters (PMEs) and phosphodiesters (PDEs). Herein, we provide a systematic review of the existing literature utilizing the 31P-MRS methodology during the normal aging process and in patients with mild cognitive impairment (MCI) and AD, with an additional focus on individuals at risk for AD. We discuss the strengths and limitations of the technique, in addition to considering future directions toward validating the use of 31P-MRS measures as biomarkers for the early detection of AD.
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Affiliation(s)
- Steven Jett
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Camila Boneu
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Camila Zarate
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Vibha Kodancha
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Matilde Nerattini
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Michael Battista
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Schantel Williams
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Jonathan P. Dyke
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
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6
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Mosconi L, Jett S, Nerattini M, Andy C, Yepez CB, Zarate C, Carlton C, Kodancha V, Schelbaum E, Williams S, Pahlajani S, Loeb-Zeitlin S, Havryliuk Y, Andrews R, Pupi A, Ballon D, Kelly J, Osborne J, Nehmeh S, Fink M, Berti V, Matthews D, Dyke J, Brinton RD. In vivo Brain Estrogen Receptor Expression By Neuroendocrine Aging And Relationships With Gray Matter Volume, Bio-Energetics, and Clinical Symptomatology. RESEARCH SQUARE 2023:rs.3.rs-2573335. [PMID: 36909660 PMCID: PMC10002830 DOI: 10.21203/rs.3.rs-2573335/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
17β-estradiol,the most biologically active estrogen, exerts wide-ranging effects in brain through its action on estrogen receptors (ERs), influencing higher-order cognitive function and neurobiological aging. However, our knowledge of ER expression and regulation by neuroendocrine aging in the living human brain is limited. This in vivo multi-modality neuroimaging study of healthy midlife women reveals progressively higher ER density over the menopause transition in estrogen-regulated networks. Effects were independent of age and plasma estradiol levels, and were highly consistent, correctly classifying all women as being post-menopausal or not. Higher ER density was generally associated with lower gray matter volume and blood flow, and with higher mitochondria ATP production, possibly reflecting compensatory mechanisms. Additionally, ER density predicted changes in thermoregulation, mood, cognition, and libido. Our data provide evidence that ER density impacts brainstructure, perfusion and energy production during female endocrine aging, with clinical implications for women's health.
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Jett S, Dyke JP, Boneu Yepez C, Zarate C, Carlton C, Schelbaum E, Jang G, Pahlajani S, Williams S, Diaz Brinton R, Mosconi L. Effects of sex and APOE ε4 genotype on brain mitochondrial high-energy phosphates in midlife individuals at risk for Alzheimer's disease: A 31Phosphorus MR spectroscopy study. PLoS One 2023; 18:e0281302. [PMID: 36787293 PMCID: PMC9928085 DOI: 10.1371/journal.pone.0281302] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023] Open
Abstract
Age, female sex, and APOE epsilon 4 (APOE4) genotype are the three greatest risk factors for late-onset Alzheimer's disease (AD). The convergence of these risks creates a hypometabolic AD-risk profile unique to women, which may help explain their higher lifetime risk of AD. Less is known about APOE4 effects in men, although APOE4 positive men also experience an increased AD risk. This study uses 31Phosphorus Magnetic Resonance Spectroscopy (31P-MRS) to examine effects of sex and APOE4 status on brain high-energy phosphates [adenosine triphosphate (ATP), phosphocreatine (PCr), inorganic phosphate (Pi)] and membrane phospholipids [phosphomonoesters (PME), phosphodiesters (PDE)] in 209 cognitively normal individuals at risk for AD, ages 40-65, 80% female, 46% APOE4 carriers (APOE4+). Women exhibited lower PCr/ATP and PCr/Pi levels than men in AD-vulnerable regions, including frontal, posterior cingulate, lateral and medial temporal cortex (multi-variable adjusted p≤0.037). The APOE4+ group exhibited lower PCr/ATP and PCr/Pi in frontal regions as compared to non-carriers (APOE4-) (multi-variable adjusted p≤0.005). Sex by APOE4 status interactions were observed in frontal regions (multi-variable adjusted p≤0.046), where both female groups and APOE4+ men exhibited lower PCr/ATP and PCr/Pi than APOE4- men. Among men, APOE4 homozygotes exhibited lower frontal PCr/ATP than heterozygotes and non-carriers. There were no significant effects of sex or APOE4 status on Pi/ATP and PME/PDE measures. Among midlife individuals at risk for AD, women exhibit lower PCr/ATP (e.g. higher ATP utilization) and lower PCr/Pi (e.g. higher energy demand) than age-controlled men, independent of APOE4 status. However, a double dose of APOE4 allele shifted men's brains to a similar metabolic range as women's brains. Examination of brain metabolic heterogeneity can support identification of AD-specific pathways within at-risk subgroups, further advancing both preventive and precision medicine for AD.
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Affiliation(s)
- Steven Jett
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
| | - Jonathan P. Dyke
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Camila Boneu Yepez
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
| | - Camila Zarate
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
| | - Grace Jang
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Schantel Williams
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
| | - Roberta Diaz Brinton
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
- Department of Neurology, University of Arizona, Tucson, Arizona, United States of America
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
- Department of Radiology, Weill Cornell Medicine, New York, New York, United States of America
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Jett S, Dyke JP, Andy C, Schelbaum E, Jang G, Boneu Yepez C, Pahlajani S, Diaz I, Diaz Brinton R, Mosconi L. Sex and menopause impact 31P-Magnetic Resonance Spectroscopy brain mitochondrial function in association with 11C-PiB PET amyloid-beta load. Sci Rep 2022; 12:22087. [PMID: 36543814 PMCID: PMC9772209 DOI: 10.1038/s41598-022-26573-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Increasing evidence implicates sex and endocrine aging effects on brain bioenergetic aging in the greater lifetime risk of Alzheimer's disease (AD) in women. We conducted 31Phosphorus Magnetic Resonance Spectroscopy (31P-MRS) to assess the impact of sex and menopause on brain high-energy phosphates [adenosine triphosphate (ATP), phosphocreatine (PCr), inorganic phosphate (Pi)] and membrane phospholipids [phosphomonoesters/phosphodiesters (PME/PDE)] in 216 midlife cognitively normal individuals at risk for AD, 80% female. Ninety-seven participants completed amyloid-beta (Aβ) 11C-PiB PET. Women exhibited higher ATP utilization than men in AD-vulnerable frontal, posterior cingulate, fusiform, medial and lateral temporal regions (p < 0.001). This profile was evident in frontal cortex at the pre-menopausal and peri-menopausal stage and extended to the other regions at the post-menopausal stage (p = 0.001). Results were significant after multi-variable adjustment for age, APOE-4 status, midlife health indicators, history of hysterectomy/oophorectomy, use of menopause hormonal therapy, and total intracranial volume. While associations between ATP/PCr and Aβ load were not significant, individuals with the highest Aβ load were post-menopausal and peri-menopausal women with ATP/PCr ratios in the higher end of the distribution. No differences in Pi/PCr, Pi/ATP or PME/PDE were detected. Outcomes are consistent with dynamic bioenergetic brain adaptations that are associated with female sex and endocrine aging.
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Affiliation(s)
- Steven Jett
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Jonathan P Dyke
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Grace Jang
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Camila Boneu Yepez
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Ivan Diaz
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Roberta Diaz Brinton
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA
- Department of Neurology, University of Arizona, Tucson, AZ, USA
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10021, USA.
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
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9
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Mehta NH, Suss RA, Dyke JP, Theise ND, Chiang GC, Strauss S, Saint-Louis L, Li Y, Pahlajani S, Babaria V, Glodzik L, Carare RO, de Leon MJ. Quantifying cerebrospinal fluid dynamics: A review of human neuroimaging contributions to CSF physiology and neurodegenerative disease. Neurobiol Dis 2022; 170:105776. [PMID: 35643187 PMCID: PMC9987579 DOI: 10.1016/j.nbd.2022.105776] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/21/2022] [Indexed: 01/13/2023] Open
Abstract
Cerebrospinal fluid (CSF), predominantly produced in the ventricles and circulating throughout the brain and spinal cord, is a key protective mechanism of the central nervous system (CNS). Physical cushioning, nutrient delivery, metabolic waste, including protein clearance, are key functions of the CSF in humans. CSF volume and flow dynamics regulate intracranial pressure and are fundamental to diagnosing disorders including normal pressure hydrocephalus, intracranial hypotension, CSF leaks, and possibly Alzheimer's disease (AD). The ability of CSF to clear normal and pathological proteins, such as amyloid-beta (Aβ), tau, alpha synuclein and others, implicates it production, circulation, and composition, in many neuropathologies. Several neuroimaging modalities have been developed to probe CSF fluid dynamics and better relate CSF volume and flow to anatomy and clinical conditions. Approaches include 2-photon microscopic techniques, MRI (tracer-based, gadolinium contrast, endogenous phase-contrast), and dynamic positron emission tomography (PET) using existing approved radiotracers. Here, we discuss CSF flow neuroimaging, from animal models to recent clinical-research advances, summarizing current endeavors to quantify and map CSF flow with implications towards pathophysiology, new biomarkers, and treatments of neurological diseases.
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Affiliation(s)
- Neel H Mehta
- Department of Biology, Cornell University, Ithaca, NY, USA
| | - Richard A Suss
- Division of Neuroradiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan P Dyke
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY, USA
| | - Neil D Theise
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Gloria C Chiang
- Division of Neuroradiology, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Sara Strauss
- Division of Neuroradiology, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Yi Li
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Silky Pahlajani
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Vivek Babaria
- Orange County Spine and Sports, Interventional Physiatry, Newport Beach, CA, USA
| | - Lidia Glodzik
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Roxana O Carare
- Department of Medicine, University of Southampton, Southampton, UK
| | - Mony J de Leon
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
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10
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Jett S, Schelbaum E, Jang G, Boneu Yepez C, Dyke JP, Pahlajani S, Diaz Brinton R, Mosconi L. Ovarian steroid hormones: A long overlooked but critical contributor to brain aging and Alzheimer’s disease. Front Aging Neurosci 2022; 14:948219. [PMID: 35928995 PMCID: PMC9344010 DOI: 10.3389/fnagi.2022.948219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/28/2022] [Indexed: 01/19/2023] Open
Abstract
Ovarian hormones, particularly 17β-estradiol, are involved in numerous neurophysiological and neurochemical processes, including those subserving cognitive function. Estradiol plays a key role in the neurobiology of aging, in part due to extensive interconnectivity of the neural and endocrine system. This aspect of aging is fundamental for women’s brains as all women experience a drop in circulating estradiol levels in midlife, after menopause. Given the importance of estradiol for brain function, it is not surprising that up to 80% of peri-menopausal and post-menopausal women report neurological symptoms including changes in thermoregulation (vasomotor symptoms), mood, sleep, and cognitive performance. Preclinical evidence for neuroprotective effects of 17β-estradiol also indicate associations between menopause, cognitive aging, and Alzheimer’s disease (AD), the most common cause of dementia affecting nearly twice more women than men. Brain imaging studies demonstrated that middle-aged women exhibit increased indicators of AD endophenotype as compared to men of the same age, with onset in perimenopause. Herein, we take a translational approach to illustrate the contribution of ovarian hormones in maintaining cognition in women, with evidence implicating menopause-related declines in 17β-estradiol in cognitive aging and AD risk. We will review research focused on the role of endogenous and exogenous estrogen exposure as a key underlying mechanism to neuropathological aging in women, with a focus on whether brain structure, function and neurochemistry respond to hormone treatment. While still in development, this research area offers a new sex-based perspective on brain aging and risk of AD, while also highlighting an urgent need for better integration between neurology, psychiatry, and women’s health practices.
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Affiliation(s)
- Steven Jett
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Grace Jang
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Camila Boneu Yepez
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Jonathan P. Dyke
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
- Department of Neurology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
- *Correspondence: Lisa Mosconi,
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11
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Li Y, Rusinek H, Butler T, Glodzik L, Pirraglia E, Babich J, Mozley PD, Nehmeh S, Pahlajani S, Wang X, Tanzi EB, Zhou L, Strauss S, Carare RO, Theise N, Okamura N, de Leon MJ. Decreased CSF clearance and increased brain amyloid in Alzheimer's disease. Fluids Barriers CNS 2022; 19:21. [PMID: 35287702 PMCID: PMC8919541 DOI: 10.1186/s12987-022-00318-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In sporadic Alzheimer's disease (AD), brain amyloid-beta (Aβ) deposition is believed to be a consequence of impaired Aβ clearance, but this relationship is not well established in living humans. CSF clearance, a major feature of brain glymphatic clearance (BGC), has been shown to be abnormal in AD murine models. MRI phase contrast and intrathecally delivered contrast studies have reported reduced CSF flow in AD. Using PET and tau tracer 18F-THK5117, we previously reported that the ventricular CSF clearance of the PET tracer was reduced in AD and associated with elevated brain Aβ levels. METHODS In the present study, we use two PET tracers, 18F-THK5351 and 11C-PiB to estimate CSF clearance calculated from early dynamic PET frames in 9 normal controls and 15 AD participants. RESULTS we observed that the ventricular CSF clearance measures were correlated (r = 0.66, p < 0.01), with reductions in AD of 18 and 27%, respectively. We also replicated a significant relationship between ventricular CSF clearance (18F-THK5351) and brain Aβ load (r = - 0.64, n = 24, p < 0.01). With a larger sample size, we extended our observations to show that reduced CSF clearance is associated with reductions in cortical thickness and cognitive performance. CONCLUSIONS Overall, the findings support the hypothesis that failed CSF clearance is a feature of AD that is related to Aβ deposition and to the pathology of AD. Longitudinal studies are needed to determine whether failed CSF clearance is a predictor of progressive amyloidosis or its consequence.
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Affiliation(s)
- Yi Li
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA.
| | - Henry Rusinek
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Tracy Butler
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Lidia Glodzik
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Elizabeth Pirraglia
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - John Babich
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - P David Mozley
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Sadek Nehmeh
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Silky Pahlajani
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Xiuyuan Wang
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Emily B Tanzi
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Liangdong Zhou
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Sara Strauss
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Roxana O Carare
- Department of Clinical Neuroanatomy, University of Southampton, Southampton, UK
| | - Neil Theise
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Nobuyuki Okamura
- Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mony J de Leon
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA.
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12
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Jett S, Malviya N, Schelbaum E, Jang G, Jahan E, Clancy K, Hristov H, Pahlajani S, Niotis K, Loeb-Zeitlin S, Havryliuk Y, Isaacson R, Brinton RD, Mosconi L. Endogenous and Exogenous Estrogen Exposures: How Women’s Reproductive Health Can Drive Brain Aging and Inform Alzheimer’s Prevention. Front Aging Neurosci 2022; 14:831807. [PMID: 35356299 PMCID: PMC8959926 DOI: 10.3389/fnagi.2022.831807] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 01/14/2023] Open
Abstract
After advanced age, female sex is the major risk factor for late-onset Alzheimer’s disease (AD), the most common cause of dementia affecting over 24 million people worldwide. The prevalence of AD is higher in women than in men, with postmenopausal women accounting for over 60% of all those affected. While most research has focused on gender-combined risk, emerging data indicate sex and gender differences in AD pathophysiology, onset, and progression, which may help account for the higher prevalence in women. Notably, AD-related brain changes develop during a 10–20 year prodromal phase originating in midlife, thus proximate with the hormonal transitions of endocrine aging characteristic of the menopause transition in women. Preclinical evidence for neuroprotective effects of gonadal sex steroid hormones, especially 17β-estradiol, strongly argue for associations between female fertility, reproductive history, and AD risk. The level of gonadal hormones to which the female brain is exposed changes considerably across the lifespan, with relevance to AD risk. However, the neurobiological consequences of hormonal fluctuations, as well as that of hormone therapies, are yet to be fully understood. Epidemiological studies have yielded contrasting results of protective, deleterious and null effects of estrogen exposure on dementia risk. In contrast, brain imaging studies provide encouraging evidence for positive associations between greater cumulative lifetime estrogen exposure and lower AD risk in women, whereas estrogen deprivation is associated with negative consequences on brain structure, function, and biochemistry. Herein, we review the existing literature and evaluate the strength of observed associations between female-specific reproductive health factors and AD risk in women, with a focus on the role of endogenous and exogenous estrogen exposures as a key underlying mechanism. Chief among these variables are reproductive lifespan, menopause status, type of menopause (spontaneous vs. induced), number of pregnancies, and exposure to hormonal therapy, including hormonal contraceptives, hormonal therapy for menopause, and anti-estrogen treatment. As aging is the greatest risk factor for AD followed by female sex, understanding sex-specific biological pathways through which reproductive history modulates brain aging is crucial to inform preventative and therapeutic strategies for AD.
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Affiliation(s)
- Steven Jett
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Niharika Malviya
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Grace Jang
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Jahan
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Katherine Clancy
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Kellyann Niotis
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Susan Loeb-Zeitlin
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Yelena Havryliuk
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Richard Isaacson
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
- Department of Neurology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
- *Correspondence: Lisa Mosconi,
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13
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Butler T, Chiang GC, Niogi SN, Wang XH, Skudin C, Tanzi E, Wickramasuriya N, Spiegel J, Maloney T, Pahlajani S, Zhou L, Morim S, Rusinek H, Normandin M, Dyke JP, Fung EK, Li Y, Glodzik L, Razlighi QR, Shah SA, de Leon M. Tau PET following acute TBI: Off-target binding to blood products, tauopathy, or both? Front Neuroimaging 2022; 1:958558. [PMID: 36876118 PMCID: PMC9979975 DOI: 10.3389/fnimg.2022.958558] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Repeated mild Traumatic Brain Injury (TBI) is a risk factor for Chronic Traumatic Encephalopathy (CTE), characterized pathologically by neurofibrillary tau deposition in the depths of brain sulci and surrounding blood vessels. The mechanism by which TBI leads to CTE remains unknown but has been posited to relate to axonal shear injury leading to release and possibly deposition of tau at the time of injury. As part of an IRB-approved study designed to learn how processes occurring acutely after TBI may predict later proteinopathy and neurodegeneration, we performed tau PET using 18F-MK6240 and MRI within 14 days of complicated mild TBI in three subjects. PET radiotracer accumulation was apparent in regions of traumatic hemorrhage in all subjects, with prominent intraparenchymal PET signal in one young subject with a history of repeated sports-related concussions. These results are consistent with off-target tracer binding to blood products as well as possible on-target binding to chronically and/or acutely-deposited neurofibrillary tau. Both explanations are highly relevant to applying tau PET to understanding TBI and CTE. Additional study is needed to assess the potential utility of tau PET in understanding how processes occurring acutely after TBI, such as release and deposition of tau and blood from damaged axons and blood vessels, may relate to development CTE years later.
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Affiliation(s)
- Tracy Butler
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Gloria C Chiang
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Sumit Narayan Niogi
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Xiuyuan Hugh Wang
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Carly Skudin
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Emily Tanzi
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | | | - Jonathan Spiegel
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Thomas Maloney
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Silky Pahlajani
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Liangdong Zhou
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Simon Morim
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Henry Rusinek
- New York University Grossman School of Medicine, New York, NY, United States
| | - Marc Normandin
- Department of Radiology Harvard Medical School, Boston, MA, United States
| | - Jonathan P Dyke
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Edward K Fung
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Yi Li
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Lidia Glodzik
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | | | - Sudhin A Shah
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Mony de Leon
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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14
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Schelbaum E, Loughlin L, Jett S, Zhang C, Jang G, Malviya N, Hristov H, Pahlajani S, Isaacson R, Dyke JP, Kamel H, Brinton RD, Mosconi L. Association of Reproductive History With Brain MRI Biomarkers of Dementia Risk in Midlife. Neurology 2021; 97:e2328-e2339. [PMID: 34732544 PMCID: PMC8665431 DOI: 10.1212/wnl.0000000000012941] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/22/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To examine associations between indicators of estrogen exposure from women's reproductive history and brain MRI biomarkers of Alzheimer disease (AD) in midlife. METHODS We evaluated 99 cognitively normal women 52 ± 6 years of age and 29 men 52 ± 7 years of age with reproductive history data, neuropsychological testing, and volumetric MRI scans. We used multiple regressions to examine associations among reproductive history indicators, voxel-wise gray matter volume (GMV), and memory and global cognition scores, adjusting for demographics and midlife health indicators. Exposure variables were menopause status, age at menarche, age at menopause, reproductive span, hysterectomy status, number of children and pregnancies, and use of menopause hormonal therapy (HT) and hormonal contraceptives (HC). RESULTS All menopausal groups exhibited lower GMV in AD-vulnerable regions compared to men, with perimenopausal and postmenopausal groups also exhibiting lower GMV in temporal cortex compared to the premenopausal group. Reproductive span, number of children and pregnancies, and use of HT and HC were positively associated with GMV, chiefly in temporal cortex, frontal cortex, and precuneus, independent of age, APOE ε4 status, and midlife health indicators. Although reproductive history indicators were not directly associated with cognitive measures, GMV in temporal regions was positively associated with memory and global cognition scores. DISCUSSION Reproductive history events signaling more estrogen exposure such as premenopausal status, longer reproductive span, higher number of children, and use of HT and HC were associated with larger GMV in women in midlife. Further studies are needed to elucidate sex-specific biological pathways through which reproductive history influences cognitive aging and AD risk.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lisa Mosconi
- From the Departments of Neurology (E.S., L.L., S.J., C.Z., G.J., N.M., H.H., S.P., R.I., H.K., L.M.) and Radiology (J.P.D., L.M.), Weill Cornell Medicine, New York, NY; Department of Pharmacology (R.D.B.), University of Arizona, Tucson.
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15
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Ford JN, Sweeney EM, Skafida M, Glynn S, Amoashiy M, Lange DJ, Lin E, Chiang GC, Osborne JR, Pahlajani S, de Leon MJ, Ivanidze J. Heuristic scoring method utilizing FDG-PET statistical parametric mapping in the evaluation of suspected Alzheimer disease and frontotemporal lobar degeneration. Am J Nucl Med Mol Imaging 2021; 11:313-326. [PMID: 34513285 PMCID: PMC8414399] [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] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
Distinguishing frontotemporal lobar degeneration (FTLD) and Alzheimer Disease (AD) on FDG-PET based on qualitative review alone can pose a diagnostic challenge. SPM has been shown to improve diagnostic performance in research settings, but translation to clinical practice has been lacking. Our purpose was to create a heuristic scoring method based on statistical parametric mapping z-scores. We aimed to compare the performance of the scoring method to the initial qualitative read and a machine learning (ML)-based method as benchmarks. FDG-PET/CT or PET/MRI of 65 patients with suspected dementia were processed using SPM software, yielding z-scores from either whole brain (W) or cerebellar (C) normalization relative to a healthy cohort. A non-ML, heuristic scoring system was applied using region counts below a preset z-score cutoff. W z-scores, C z-scores, or WC z-scores (z-scores from both W and C normalization) served as features to build random forest models. The neurological diagnosis was used as the gold standard. The sensitivity of the non-ML scoring system and the random forest models to detect AD was higher than the initial qualitative read of the standard FDG-PET [0.89-1.00 vs. 0.22 (95% CI, 0-0.33)]. A categorical random forest model to distinguish AD, FTLD, and normal cases had similar accuracy than the non-ML scoring model (0.63 vs. 0.61). Our non-ML-based scoring system of SPM z-scores approximated the diagnostic performance of a ML-based method and demonstrated higher sensitivity in the detection of AD compared to qualitative reads. This approach may improve the diagnostic performance.
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Affiliation(s)
- Jeremy N Ford
- Department of Radiology, Massachusetts General HospitalBoston, MA, United States
| | - Elizabeth M Sweeney
- Department of Population Health Sciences, Division of Biostatistics and Epidemiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Myrto Skafida
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Shannon Glynn
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Michael Amoashiy
- Department of Neurology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Dale J Lange
- Department of Neurology, Hospital for Special SurgeryNew York, NY, United States
| | - Eaton Lin
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Gloria C Chiang
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Joseph R Osborne
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Mony J de Leon
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
| | - Jana Ivanidze
- Department of Radiology, Weill Cornell Medical CollegeNew York, NY, United States
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Mosconi L, Berti V, Dyke J, Schelbaum E, Jett S, Loughlin L, Jang G, Rahman A, Hristov H, Pahlajani S, Andrews R, Matthews D, Etingin O, Ganzer C, de Leon M, Isaacson R, Brinton RD. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep 2021; 11:10867. [PMID: 34108509 PMCID: PMC8190071 DOI: 10.1038/s41598-021-90084-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/06/2021] [Indexed: 01/25/2023] Open
Abstract
All women undergo the menopause transition (MT), a neuro-endocrinological process that impacts aging trajectories of multiple organ systems including brain. The MT occurs over time and is characterized by clinically defined stages with specific neurological symptoms. Yet, little is known of how this process impacts the human brain. This multi-modality neuroimaging study indicates substantial differences in brain structure, connectivity, and energy metabolism across MT stages (pre-menopause, peri-menopause, and post-menopause). These effects involved brain regions subserving higher-order cognitive processes and were specific to menopausal endocrine aging rather than chronological aging, as determined by comparison to age-matched males. Brain biomarkers largely stabilized post-menopause, and gray matter volume (GMV) recovered in key brain regions for cognitive aging. Notably, GMV recovery and in vivo brain mitochondria ATP production correlated with preservation of cognitive performance post-menopause, suggesting adaptive compensatory processes. In parallel to the adaptive process, amyloid-β deposition was more pronounced in peri-menopausal and post-menopausal women carrying apolipoprotein E-4 (APOE-4) genotype, the major genetic risk factor for late-onset Alzheimer’s disease, relative to genotype-matched males. These data show that human menopause is a dynamic neurological transition that significantly impacts brain structure, connectivity, and metabolic profile during midlife endocrine aging of the female brain.
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Affiliation(s)
- Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA. .,Department of Radiology, Weill Cornell Medical College, New York, NY, USA. .,Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
| | - Valentina Berti
- Department of Nuclear Medicine, University of Florence, Florence, Italy
| | - Jonathan Dyke
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Steven Jett
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Lacey Loughlin
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Grace Jang
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Aneela Rahman
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | | | | | - Orli Etingin
- Department of Internal Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Christine Ganzer
- Hunter-Bellevue School of Nursing, Hunter College, CUNY, New York, NY, USA
| | - Mony de Leon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Richard Isaacson
- Department of Neurology, Weill Cornell Medicine, 420 East 70th, LH-404, New York, NY, 10021, USA
| | - Roberta Diaz Brinton
- Departments of Pharmacology and Neurology, College of Medicine, University of Arizona, Tucson, AZ, USA
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Rahman A, Schelbaum E, Hoffman K, Diaz I, Hristov H, Andrews R, Jett S, Jackson H, Lee A, Sarva H, Pahlajani S, Matthews D, Dyke J, de Leon MJ, Isaacson RS, Brinton RD, Mosconi L. Sex-driven modifiers of Alzheimer risk: A multimodality brain imaging study. Neurology 2020; 95:e166-e178. [PMID: 32580974 DOI: 10.1212/wnl.0000000000009781] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate sex differences in late-onset Alzheimer disease (AD) risks by means of multimodality brain biomarkers (β-amyloid load via 11C-Pittsburgh compound B [PiB] PET, neurodegeneration via 18F-fluorodeoxyglucose [FDG] PET and structural MRI). METHODS We examined 121 cognitively normal participants (85 women and 36 men) 40 to 65 years of age with clinical, laboratory, neuropsychological, lifestyle, MRI, FDG- and PiB-PET examinations. Several clinical (e.g., age, education, APOE status, family history), medical (e.g., depression, diabetes mellitus, hyperlipidemia), hormonal (e.g., thyroid disease, menopause), and lifestyle AD risk factors (e.g., smoking, diet, exercise, intellectual activity) were assessed. Statistical parametric mapping and least absolute shrinkage and selection operator regressions were used to compare AD biomarkers between men and women and to identify the risk factors associated with sex-related differences. RESULTS Groups were comparable on clinical and cognitive measures. After adjustment for each modality-specific confounders, the female group showed higher PiB β-amyloid deposition, lower FDG glucose metabolism, and lower MRI gray and white matter volumes compared to the male group (p < 0.05, family-wise error corrected for multiple comparisons). The male group did not show biomarker abnormalities compared to the female group. Results were independent of age and remained significant with the use of age-matched groups. Second to female sex, menopausal status was the predictor most consistently and strongly associated with the observed brain biomarker differences, followed by hormone therapy, hysterectomy status, and thyroid disease. CONCLUSION Hormonal risk factors, in particular menopause, predict AD endophenotype in middle-aged women. These findings suggest that the window of opportunity for AD preventive interventions in women is early in the endocrine aging process.
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Affiliation(s)
- Aneela Rahman
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Eva Schelbaum
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Katherine Hoffman
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Ivan Diaz
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Hollie Hristov
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Randolph Andrews
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Steven Jett
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Hande Jackson
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Andrea Lee
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Harini Sarva
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Silky Pahlajani
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Dawn Matthews
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Jonathan Dyke
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Mony J de Leon
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Richard S Isaacson
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Roberta D Brinton
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson
| | - Lisa Mosconi
- From the Departments of Neurology (A.R., E.S., I.D., H.H., S.J., H.J., A.L., H.S., S.P., R.S.I., L.M.) and Radiology (J.D., M.J.d.L., L.M.), Weill Cornell Medical College; Division of Biostatistics and Epidemiology (K.H., I.D.), Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY; ADM Diagnostics (R.A., D.M.), Chicago, IL; and Departments of Pharmacology and Neurology (R.D.B.), College of Medicine, University of Arizona, Tucson.
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Najjar S, Pahlajani S, De Sanctis V, Stern JNH, Najjar A, Chong D. Neurovascular Unit Dysfunction and Blood-Brain Barrier Hyperpermeability Contribute to Schizophrenia Neurobiology: A Theoretical Integration of Clinical and Experimental Evidence. Front Psychiatry 2017; 8:83. [PMID: 28588507 PMCID: PMC5440518 DOI: 10.3389/fpsyt.2017.00083] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 04/28/2017] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia is a psychotic disorder characterized by delusions, hallucinations, negative symptoms, as well as behavioral and cognitive dysfunction. It is a pathoetiologically heterogeneous disorder involving complex interrelated mechanisms that include oxidative stress and neuroinflammation. Neurovascular endothelial dysfunction and blood-brain barrier (BBB) hyperpermeability are established mechanisms in neurological disorders with comorbid psychiatric symptoms such as epilepsy, traumatic brain injury, and Alzheimer's disease. Schizophrenia is frequently comorbid with medical conditions associated with peripheral vascular endothelial dysfunction, such as metabolic syndrome, cardiovascular disease, and diabetes mellitus. However, the existence and etiological relevance of neurovascular endothelial dysfunction and BBB hyperpermeability in schizophrenia are still not well recognized. Here, we review the growing clinical and experimental evidence, indicating that neurovascular endotheliopathy and BBB hyperpermeability occur in schizophrenia patients. We present a theoretical integration of human and animal data linking oxidative stress and neuroinflammation to neurovascular endotheliopathy and BBB breakdown in schizophrenia. These abnormalities may contribute to the cognitive and behavioral symptoms of schizophrenia via several mechanisms involving reduced cerebral perfusion and impaired homeostatic processes of cerebral microenvironment. Furthermore, BBB disruption can facilitate interactions between brain innate and peripheral adaptive immunity, thereby perpetuating harmful neuroimmune signals and toxic neuroinflammatory responses, which can also contribute to the symptoms of schizophrenia. Taken together, these findings support the "mild encephalitis" hypothesis of schizophrenia. If neurovascular abnormalities prove to be etiologically relevant to the neurobiology of schizophrenia, then targeting these abnormalities may represent a promising therapeutic strategy.
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Affiliation(s)
- Souhel Najjar
- Department of Neurology, Hofstra Northwell School of Medicine, New York, NY, USA.,Neuroinflammation Division, Department of Neurology, Lenox Hill Hospital, New York, NY, USA
| | - Silky Pahlajani
- Neuroinflammation Division, Department of Neurology, Lenox Hill Hospital, New York, NY, USA
| | - Virginia De Sanctis
- Neuroinflammation Division, Department of Neurology, Lenox Hill Hospital, New York, NY, USA
| | - Joel N H Stern
- Department of Neurology, Hofstra Northwell School of Medicine, New York, NY, USA.,Neuroinflammation Division, Department of Neurology, Lenox Hill Hospital, New York, NY, USA
| | - Amanda Najjar
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, TN, USA
| | - Derek Chong
- Department of Neurology, Hofstra Northwell School of Medicine, New York, NY, USA
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Munjal S, Pahlajani S, Baxi A, Ferrando S. Delayed Diagnosis of Glioblastoma Multiforme Presenting With Atypical Psychiatric Symptoms. Prim Care Companion CNS Disord 2016; 18. [DOI: 10.4088/pcc.16l01972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Affiliation(s)
- S Pahlajani
- New York Medical College, Valhalla, NY, USA.
| | - L Citrome
- New York Medical College, Valhalla, NY, USA
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