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He H, He H, Mo L, You Z, Zhang J. Priming of microglia with dysfunctional gut microbiota impairs hippocampal neurogenesis and fosters stress vulnerability of mice. Brain Behav Immun 2024; 115:280-294. [PMID: 37914097 DOI: 10.1016/j.bbi.2023.10.031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Mental disorders may be involved in neuroinflammatory processes that are triggered by gut microbiota. How gut microbiota influence microglia-mediated sensitivity to stress remains unclear. Here we explored in an animal model of depression whether disruption of the gut microbiome primes hippocampal microglia, thereby impairing neurogenesis and sensitizing to stress. METHODS Male C57BL/6J mice were exposed to chronic unpredictable mild stress (CUMS) for 4 weeks, and effects on gut microbiota were assessed using 16S rRNA sequencing. Fecal microbiota was transplanted from control or CUMS mice into naïve animals. The depression-like behaviors of recipients were evaluated in a forced swimming test and sucrose preference test. The morphology and phenotype of microglia in the hippocampus of recipients were examined using immunohistochemistry, quantitative PCR, and enzyme-linked immunosorbent assays. The recipients were treated with lipopolysaccharide or chronic stress exposure, and effects were evaluated on behavior, microglial responses and hippocampal neurogenesis. Finally, we explored the ability of minocycline to reverse the effects of CUMS on hippocampal neurogenesis and stress sensitivity in recipients. RESULTS CUMS altered the gut microbiome, leading to higher relative abundance of some bacteria (Helicobacter, Bacteroides, and Desulfovibrio) and lower relative abundance of some bacteria (Lactobacillus, Bifidobacterium, and Akkermansia). Fecal microbiota transplantation from CUMS mice to naïve animals induced microglial priming in the dentate gyrus of recipients. This microglia showed hyper-ramified morphology, and became more sensitive to LPS challenge or chronic stress, which characterized by more significant morphological changes and inflammatory responses, as well as impaired hippocampal neurogenesis and increased depressive-like behaviors. Giving minocycline to recipients reversed these effects of fecal transplantation. CONCLUSIONS These findings suggest that gut microbiota from stressed animals can induce microglial priming in the dentate gyrus, which is associated with a hyper-immune response to stress and impaired hippocampal neurogenesis. Remodeling the gut microbiome or inhibiting microglial priming may be strategies to reduce sensitivity to stress.
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Affiliation(s)
- Hui He
- Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Haili He
- Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Li Mo
- Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Zili You
- Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China.
| | - Jinqiang Zhang
- Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China.
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Rauschenberg C, Schulte-Strathaus JCC, van Os J, Goedhart M, Schieveld JNM, Reininghaus U. Negative life events and stress sensitivity in youth's daily life: an ecological momentary assessment study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1641-1657. [PMID: 35467134 PMCID: PMC9288944 DOI: 10.1007/s00127-022-02276-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/31/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE Negative life events (LEs) are associated with mental health problems in youth. However, little is known about underlying mechanisms. The aim of the study was to investigate whether exposure to LEs modifies stress sensitivity in youth's daily life. METHODS Ecological Momentary Assessment (EMA) was used to assess stress sensitivity (i.e., association of momentary stress with (i) negative affect and (ii) psychotic experiences) in 99 adolescents and young adults (42 service users, 17 siblings, and 40 controls; Mage 15 years). Before EMA, exposure to LEs (e.g., intrusive threats, experience of loss, serious illness) was assessed. RESULTS Lifetime as well as previous-year exposure to LEs modified stress sensitivity in service users: they experienced more intense negative affect and psychotic experiences in response to stress when high vs. low exposure levels were compared. In contrast, controls showed no differences in stress sensitivity by exposure levels. Looking at specific types of LEs, controls showed less intense negative affect in response to stress when high vs. low exposure levels to threatening events during the last year, but not lifetime exposure, were compared. In siblings, no evidence was found that LEs modified stress sensitivity. CONCLUSION Stress sensitivity may constitute a putative risk mechanism linking LEs and mental health in help-seeking youth, while unfavourable effects of LEs on stress sensitivity may attenuate over time or do not occur in controls and siblings. Targeting individuals' sensitivity to stress in daily life using novel digital interventions may be a promising approach towards improving youth mental health.
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Affiliation(s)
- Christian Rauschenberg
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany.
| | - Julia C C Schulte-Strathaus
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthieu Goedhart
- Tilburg School of Humanities, Tilburg University, Tilburg, The Netherlands
- Mutsaers Foundation and Educational Institute Wijnberg, Venlo, The Netherlands
| | - Jan N M Schieveld
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Murlanova K, Begmatova D, Weber-Stadlbauer U, Meyer U, Pletnikov M, Pinhasov A. Double trouble: Prenatal immune activation in stress sensitive offspring. Brain Behav Immun 2022; 99:3-8. [PMID: 34547401 DOI: 10.1016/j.bbi.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/09/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
Viral infections during pregnancy are associated with increased incidence of psychiatric disorders in offspring. The pathological outcomes of viral infection appear to be caused by the deleterious effects of innate immune response-associated factors on development of the fetus, which predispose the offspring to pathological conditions in adulthood. The negative impact of viral infections varies substantially between pregnancies. Here, we explored whether differential stress sensitivity underlies the high heterogeneity of immune reactivity and whether this may influence the pathological consequences of maternal immune activation. Using mouse models of social dominance (Dom) and submissiveness (Sub), which possess innate features of stress resilience and vulnerability, respectively, we identified differential immune reactivity to the synthetic analogue of viral double-stranded RNA, Poly(I:C), in Sub and Dom nulliparous and pregnant females. More specifically, we found that Sub females showed an exacerbated pro- and anti-inflammatory cytokine response to Poly(I:C) as compared with Dom females. Sub offspring born to Sub mothers (stress sensitive offspring) showed enhanced locomotory response to the non-competitive NMDA antagonist, MK-801, which was potentiated by prenatal Poly(I:C) exposure. Our findings suggest that inherited stress sensitivity may lead to functional changes in glutamatergic signaling, which in turn is further exacerbated by prenatal exposure to viral-like infection. The maternal immunome seems to play a crucial role in these observed phenomena.
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Affiliation(s)
- Kateryna Murlanova
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel; Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Dilorom Begmatova
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Ulrike Weber-Stadlbauer
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH, Zurich, Zurich, Switzerland
| | - Urs Meyer
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH, Zurich, Zurich, Switzerland
| | - Mikhail Pletnikov
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Albert Pinhasov
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel.
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4
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Meijer M, Keo A, van Leeuwen JMC, Dzyubachyk O, Meijer OC, Vinkers CH, Mahfouz A. Molecular characterization of the stress network in individuals at risk for schizophrenia. Neurobiol Stress 2021; 14:100307. [PMID: 33644266 DOI: 10.1016/j.ynstr.2021.100307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/14/2021] [Accepted: 02/03/2021] [Indexed: 01/24/2023] Open
Abstract
The biological mechanisms underlying inter-individual differences in human stress reactivity remain poorly understood. We aimed to identify the molecular underpinning of aberrant neural stress sensitivity in individuals at risk for schizophrenia. Linking mRNA expression data from the Allen Human Brain Atlas to task-based fMRI revealed 201 differentially expressed genes in cortex-specific brain regions differentially activated by stress in individuals with low (healthy siblings of schizophrenia patients) or high (healthy controls) stress sensitivity. These genes are associated with stress-related psychiatric disorders (e.g. schizophrenia and anxiety) and include markers for specific neuronal populations (e.g. ADCYAP1, GABRB1, SSTR1, and TNFRSF12A), neurotransmitter receptors (e.g. GRIN3A, SSTR1, GABRB1, and HTR1E), and signaling factors that interact with the corticosteroid receptor and hypothalamic-pituitary-adrenal axis (e.g. ADCYAP1, IGSF11, and PKIA). Overall, the identified genes potentially underlie altered stress reactivity in individuals at risk for schizophrenia and other psychiatric disorders and play a role in mounting an adaptive stress response in at-risk individuals, making them potentially druggable targets for stress-related diseases.
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Grattan RE, Linscott RJ. Components of schizophrenia liability affect the growth of psychological stress sensitivity following major life events. Schizophr Res 2019; 212:134-139. [PMID: 31387827 DOI: 10.1016/j.schres.2019.07.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/27/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Some argue that physiological and psychological stress sensitivities contribute causally to schizophrenia. Indeed, evidence shows that those with or at risk for schizophrenia have highly sensitive stress responses. However, it is unclear how psychological stress sensitivity develops. Our aim was to test whether psychological stress sensitization develops longitudinally in association with major life events and components of schizophrenia liability. We expected schizophrenia liability to predict higher psychological stress sensitivity; life events to predict subsequent increases in psychological stress sensitivity; and schizophrenia liability to moderate this relationship. METHODS In a prospective study, undergraduates (n = 184) completed a measure of schizophrenia liability at baseline. Then at 2-month intervals over 6 months, they reported on the occurrence of major life events and completed measures of psychological stress sensitivity. RESULTS Latent variable growth modelling showed that stress sensitivity increased following incident life events when controlling for baseline life events. Higher cognitive-perceptual and interpersonal scores predicted higher baseline sensitivity. Higher cognitive-perceptual features predicted larger increases in psychological stress sensitivity following life events whereas greater disorganization reduced growth. CONCLUSIONS This evidence is consistent with the idea that psychological sensitization is involved in the development of schizophrenia and suggests an important link between positive features of schizophrenia liability and the magnification of psychological stress sensitivity.
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Affiliation(s)
- Rebecca E Grattan
- Department of Psychology, University of Otago, Dunedin, New Zealand; Department of Psychiatry and Behavioral Sciences, Davis School of Medicine, University of California, Sacramento, CA, USA
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Gibson LE, Reeves LE, Cooper S, Olino TM, Ellman LM. Traumatic life event exposure and psychotic-like experiences: A multiple mediation model of cognitive-based mechanisms. Schizophr Res 2019; 205:15-22. [PMID: 29463456 DOI: 10.1016/j.schres.2018.02.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 12/15/2022]
Abstract
Several cognitive mechanisms have been proposed to account for the relationship between exposure to traumatic life events (TLEs) and the entire psychosis spectrum. However, only few of these mechanisms have been empirically tested and those that have been tested have not considered multiple mechanisms simultaneously. The purpose of this study was to examine whether perceived stress, dissociation, negative self-schemas, negative other-schemas, and/or external locus of control mediated the association between TLEs and psychotic-like experiences (PLEs). An undergraduate sample of 945 individuals completed a battery of self-report questionnaires. We found significant indirect effects from TLE exposure to PLEs through perceived stress, dissociation, external locus of control, negative self-schemas, and negative other-schemas. When controlling for comorbid psychological symptoms, only the indirect effect from TLE exposure to PLEs through dissociation continued to be significant. Targeting stress sensitivity, maladaptive schemas, dissociative tendencies, and externalizing attributional styles may prove useful in the amelioration of risk for various psychopathologies (e.g., mood, psychosis) in the aftermath of TLE exposure. Findings underscore the importance of targeting trauma-related cognitions in the prevention or reduction of psychotic-like experiences or disorders.
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An X, Zhang F, Liu Y, Yang P, Yu D. Remote fear memory is sensitive to reconditioning. Behav Brain Res 2019; 359:723-730. [PMID: 30240637 DOI: 10.1016/j.bbr.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 11/24/2022]
Abstract
Exposure of some individuals to recurring traumatic events from the same perpetrator or situation, such as during child abuse or domestic violence, is quite prevalent. Studies have shown that the number of traumatic events experienced is positively related to the severity of post-traumatic stress disorder and other mental disorders. Using a contextual fear conditioning (Cond1) and reconditioning (Cond2) paradigm, which were separated by either 1 or 35 days, we examined fear responses to immediate extinction and retrieval-extinction procedures after repeated fear conditioning stress. Based on the time interval between Cond1 and Cond2, the animals were divided into recent and remote fear memory groups. We observed that when Cond2 was performed in the original conditioning context in which Cond1 was performed, the reconditioned remote fear memory was resistant to the disruptive effect of immediate extinction and retrieval-extinction paradigms. Furthermore, the resistance to disruptive effects could be induced by very low shock intensities, which cannot even induce any fear response in naive animals. When Cond2 was performed in a novel context, animals with remote fear memory acquired a significantly higher fear response to the novel context. Our findings suggest that remote fear memory may be more sensitive to reconditioning and resistant to post-reconditioning disruption.
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Affiliation(s)
- Xianli An
- School of Educational Science, Yangzhou University, Yangzhou, China; Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research, School of Medicine, Yangzhou University, Yangzhou, China
| | - Fenfen Zhang
- School of Educational Science, Yangzhou University, Yangzhou, China
| | - Yuan Liu
- School of Educational Science, Yangzhou University, Yangzhou, China
| | - Ping Yang
- School of Educational Science, Yangzhou University, Yangzhou, China
| | - Duonan Yu
- Jiangsu Key Laboratory of Experimental & Translational Non-Coding RNA Research, School of Medicine, Yangzhou University, Yangzhou, China; Institute of Comparative Medicine, Yangzhou University, Yangzhou, China; Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Disease and Zoonosis, Yangzhou, China.
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8
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Grygier B, Kubera M, Wrona D, Roman A, Basta-Kaim A, Gruca P, Papp M, Rogoz Z, Leskiewicz M, Budziszewska B, Regulska M, Korzeniak B, Curzytek K, Glombik K, Slusarczyk J, Maes M, Lason W. Stimulatory effect of desipramine on lung metastases of adenocarcinoma MADB 106 in stress highly-sensitive and stress non-reactive rats. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:279-290. [PMID: 28433460 DOI: 10.1016/j.pnpbp.2017.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/01/2017] [Indexed: 12/31/2022]
Abstract
The effect of antidepressant drugs on tumor progress is very poorly recognized. The aim of the present study was to examine the effect of individual reactivity to stress and 24-day desipramine (DES) administration on the metastatic colonization of adenocarcinoma MADB 106 cells in the lungs of Wistar rats. Wistar rats were subjected to stress procedure according to the chronic mild stress (CMS) model of depression for two weeks and stress highly-sensitive (SHS) and stress non-reactive (SNR) rats were selected. SHS rats were more prone to cancer metastasis than SNR ones and chronic DES treatment further increased the number of lung metastases by 59% and 50% in comparison to vehicle-treated appropriate control rats. The increase in lung metastases was connected with DES-induced skew macrophage activity towards M2 functional phenotype in SHS and SNR rats. Moreover, during 24h after DES injection in healthy rats, the decreased number of TCD8+ and B cells in SHS and SNR rats as well as NK cell cytotoxic activity in SNR rats could be attributed to the lowered capacity to defend against cancer metastasis observed in chronic DES treated and tumor injected rats.
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Affiliation(s)
- Beata Grygier
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland; Department of Immunology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, 7 Gronostajowa St., 30-387 Krakow, Poland
| | - Marta Kubera
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland.
| | - Danuta Wrona
- Department of Animal and Human Physiology, University of Gdansk, 59 Wita Stwosza Street, 80-308 Gdansk, Poland
| | - Adam Roman
- Department of Brain Biochemistry, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Agnieszka Basta-Kaim
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Piotr Gruca
- Behavioural Pharmacology Laboratory, Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Mariusz Papp
- Behavioural Pharmacology Laboratory, Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Zofia Rogoz
- Department of Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, 31-343 Krakow, Poland
| | - Monika Leskiewicz
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Boguslawa Budziszewska
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Magdalena Regulska
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Barbara Korzeniak
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Katarzyna Curzytek
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Katarzyna Glombik
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Joanna Slusarczyk
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 10330 Bangkok, Thailand
| | - Wladyslaw Lason
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, PL 31-343 Krakow, Poland
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Iwase T, Okai C, Kamata Y, Tajima A, Mizunoe Y. A straightforward assay for measuring glycogen levels and RpoS. J Microbiol Methods 2018; 145:93-7. [PMID: 29288674 DOI: 10.1016/j.mimet.2017.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/26/2017] [Accepted: 12/26/2017] [Indexed: 11/21/2022]
Abstract
Cellular glycogen levels reflect the activity of RpoS, an important stress-inducible bacterial sigma factor known to regulate several stress-resistance related genes, such as katE, encoding hydroperoxidase II (HPII), and the glg genes, encoding glycogen synthesis enzymes, in Escherichia coli. In this study, a straightforward assay for measuring glycogen levels and RpoS activity was developed combining the ease and simplicity of qualitative approaches. The assay reagent was a 2% iodine solution (2% iodine/1M NaOH), and the basic principle of this assay is the iodine-glycogen reaction, which produces a reddish brown color that can be measured using a spectrophotometer. A calibration plot using a known amount of glycogen yielded the best linear fit over a range of 10-300μg/assay (R2=0.994). The applicability of the assay for measuring the glycogen level of various samples was assessed using a wild type (WT) E. coli K-12 strain, glycogen- and RpoS-deficient isogenic mutants, and clinical bacterial isolates with or without RpoS activity; the assay generated reproducible results. Additionally, the assay was successfully applied for measuring glycogen levels in human cells. In conclusion, we developed a straightforward and cost-effective assay for measuring glycogen levels, which can be applied for measuring RpoS activity.
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Barry TJ, Murray L, Fearon P, Moutsiana C, Johnstone T, Halligan SL. Amygdala volume and hypothalamic-pituitary-adrenal axis reactivity to social stress. Psychoneuroendocrinology 2017; 85:96-99. [PMID: 28843903 PMCID: PMC5632999 DOI: 10.1016/j.psyneuen.2017.07.487] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 01/16/2023]
Abstract
The amygdala plays a central role in emotional processing and has an activating influence on the hypothalamic-pituitary-adrenal (HPA) axis. Structural changes in the amygdala have been associated with early adversity and, in principle, may contribute to the later emergence of emotional pathologies by influencing the way that the brain responds to stress provocation. The present study examined the relationship between amygdala volumes and cortisol secretion in response to a social stressor among young adults who were or were not exposed to maternal postnatal depression (PND) early in development (referred to as PND offspring and controls, respectively). Hierarchical Linear Modelling (HLM) revealed that, on a sample-wide level, there was no evidence of a relationship between total amygdala volume, or the volume of the right or left hemisphere amygdala taken separately, and cortisol reactivity. Unexpectedly, for PND offspring, larger right hemisphere amygdala volume was associated with lower cortisol reactivity in response to stress, an effect that was not apparent in control offspring. We conclude that the relationship between amygdala volumes and stress reactivity may not be as clear as previous models suggested.
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Affiliation(s)
- Tom J. Barry
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong,Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Lynne Murray
- School of Psychology and CLS, University of Reading, Reading RG6 6AL, UK,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Christina Moutsiana
- Department of Psychology, University of Westminster, 115 New Cavendish Street, London W1W 6UW, UK
| | - Tom Johnstone
- School of Psychology and CLS, University of Reading, Reading RG6 6AL, UK
| | - Sarah L. Halligan
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa,Department of Psychology, University of Bath, Bath BA2 7AY, UK,Corresponding author at: Department of Psychology, University of Bath, Bath BA2 7AY, UK.Department of PsychologyUniversity of BathBathBA2 7AYUK
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11
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Stubbs B, Koyanagi A, Thompson T, Veronese N, Carvalho AF, Solomi M, Mugisha J, Schofield P, Cosco T, Wilson N, Vancampfort D. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen Hosp Psychiatry 2016; 43:63-70. [PMID: 27796261 DOI: 10.1016/j.genhosppsych.2016.09.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Back pain (BP) is a leading cause of global disability. However, population-based studies investigating its impact on mental health outcomes are lacking, particularly among low- and middle-income countries (LMICs). Thus, the primary aims of this study were to: (1) determine the epidemiology of BP in 43 LMICs; (2) explore the relationship between BP and mental health (depression spectrum, psychosis spectrum, anxiety, sleep disturbances and stress). METHODS Data on 190,593 community-dwelling adults aged ≥18 years from the World Health Survey (WHS) 2002-2004 were analyzed. The presence of past-12 month psychotic symptoms and depression was established using questions from the Composite International Diagnostic Interview. Anxiety, sleep problems, stress sensitivity, and any BP or chronic BP (CBP) during the previous 30 days were also self-reported. Multivariable logistic regression analyses were undertaken. RESULTS The overall prevalence of any BP and CBP were 35.1% and 6.9% respectively. Significant associations with any BP were observed for subsyndromal depression [OR (odds ratio)=2.21], brief depressive episode (OR=2.64), depressive episode (OR=2.88), psychosis diagnosis with symptoms (OR=2.05), anxiety (OR=2.12), sleep disturbance (OR=2.37) and the continuous variable of stress sensitivity. Associations were generally more pronounced for chronic BP. CONCLUSION Our data establish that BP is associated with elevated mental health comorbidity in LMICs. Integrated interventions that address back pain and metal health comorbidities might be an important next step to tackle this considerable burden.
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Affiliation(s)
- Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom.
| | - Ai Koyanagi
- Research and Development Unit, ParcSanitariSant Joan de Déu, Universitat de Barcelona, FundacióSant Joan de Déu, Dr. Antoni Pujadas, 42, SantBoi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de InvestigaciónBiomédicaen Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Nicola Veronese
- Geriatrics Division, Department of Medicine-DIMED, University of Padova, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Andre F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Marco Solomi
- Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Neurosciences, University of Padova, Padova, Italy
| | - James Mugisha
- Kyambogo University, Kampala, Uganda; Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Theodore Cosco
- MRC Unit for Lifelong Health & Ageing, University College London, 33 Bedford Place, London WC1B 5JU, United Kingdom
| | - Nicky Wilson
- Physiotherapy Service, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
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12
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Rössler W, Ajdacic-Gross V, Rodgers S, Haker H, Müller M. Childhood trauma as a risk factor for the onset of subclinical psychotic experiences: Exploring the mediating effect of stress sensitivity in a cross-sectional epidemiological community study. Schizophr Res 2016; 172:46-53. [PMID: 26874870 DOI: 10.1016/j.schres.2016.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 02/06/2023]
Abstract
Childhood trauma is a risk factor for the onset of schizophrenic psychosis. Because the psychosis phenotype can be described as a continuum with varying levels of severity and persistence, childhood trauma might likewise increase the risk for psychotic experiences below the diagnostic threshold. But the impact of stressful experiences depends upon its subjective appraisal. Therefore, varying degrees of stress sensitivity possibly mediate how childhood trauma impacts in the end upon the occurrence of subclinical psychotic experiences. We investigated this research question in a representative community cohort of 1500 participants. A questionnaire, comprising five domains of physical and emotional neglect, as well as physical, emotional, and sexual abuse, was used to assess childhood trauma. Based on different symptoms of subclinical psychotic experiences, we conducted a latent profile analysis (LPA) to derive distinct profiles for such experiences. Path modeling was performed to identify the direct and indirect (via stress sensitivity) pathways from childhood trauma to subclinical psychotic experiences. The LPA revealed four classes - unaffected, anomalous perceptions, odd beliefs and behavior, and combined anomalous perceptions/odd beliefs and behavior, that - except for sexual abuse - were all linked to childhood trauma. Moreover, except for physical abuse, childhood trauma was significantly associated with stress sensitivity. Thus, our results revealed that the pathways from emotional neglect/abuse and physical neglect to subclinical psychotic experiences were mediated by stress sensitivity. In conclusion, we can state that subclinical psychotic experiences are affected by childhood traumatic experiences in particular through the pathway of a heightened subjective stress appraisal.
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland.
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Helene Haker
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
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13
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Grattan RE, Morton SE, Warhurst ES, Parker TR, Nicolson MP, Maha JLK, Linscott RJ. Paternal and maternal ages have contrasting associations with self-reported schizophrenia liability. Schizophr Res 2015; 169:308-312. [PMID: 26421690 DOI: 10.1016/j.schres.2015.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/15/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Older paternal age predicts schizophrenia diagnosis in offspring. If this relationship reflects a pathogenic process, paternal age should predict the expression of subclinical schizophrenia liability (schizotypy). We hypothesized that paternal and maternal ages predict positive, negative, and disorganized features of schizotypy, that family history of psychosis moderates the relationship of paternal age with schizotypy, and that stress sensitivity mediates the relationship of maternal age with schizotypy. METHOD Two studies are reported, each of undergraduates (n=500 and n=211) who completed the Schizotypal Personality Questionnaire. The second was designed to replicate and extend the first and included assessment of stress sensitivity. RESULTS In Study 1, older paternal age and younger maternal age predicted greater positive schizotypy (β=.13 and β=-.19, respectively). Parental ages did not predict negative or disorganized features and family history did not moderate the paternal age association. In Study 2, the same pattern of associations between parental ages and schizotypy components was observed. Additionally, stress sensitivity partially mediated the association of maternal age with positive schizotypy whereas it did not contribute to the paternal age association. CONCLUSION The association between older paternal age and schizophrenia extends to self-reported positive features of schizophrenia liability, consistent with the notion that this relationship arises from a pathogenic process, such as de novo mutations. Importantly, younger maternal age was an equally potent predictor of positive schizotypy, with its association partially mediated by stress sensitivity.
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Affiliation(s)
| | - Sarah E Morton
- Department of Psychology, University of Otago, New Zealand
| | | | | | - Max P Nicolson
- Department of Psychology, University of Otago, New Zealand
| | | | - Richard J Linscott
- Department of Psychology, University of Otago, New Zealand; Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands.
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14
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Montaquila JM, Trachik BJ, Bedwell JS. Heart rate variability and vagal tone in schizophrenia: A review. J Psychiatr Res 2015; 69:57-66. [PMID: 26343595 DOI: 10.1016/j.jpsychires.2015.07.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 01/08/2023]
Abstract
Recent heart rate variability (HRV) research has identified diminished levels of parasympathetic activity among schizophrenia patients. Over two dozen empirically-based studies have been published on this topic; primarily over the last decade. However, no theoretical review appears to have been published on this work. Further, only one empirical study has evaluated HRV research findings in the context of documented hypothalamic-pituitary-adrenal axis hyperactivity in schizophrenia. HRV research indicates that no abnormalities exist in the initial sympathetic stress response of schizophrenia patients. However, evidence has consistently demonstrated that patients exhibit a diminished capacity to recover from a stress response as a result of deficits in parasympathetic activity. Moreover, this diminished parasympathetic nervous system (PNS) response, also known as decreased vagal tone, has been found to relate to increased symptom severity. Although these findings may cause speculation that the observed vagal tone disruption merely results from anxiety produced by the presence of positive symptomology, additional studies have identified similar parasympathetic dysfunction among nonpsychotic relatives of individuals with schizophrenia. We posit that the resulting sympathovagal imbalance leads to an overall sympathetic dominance despite the fact that sympathetic nervous system activity is not abnormally elevated among patients. Implications are discussed within the context of the diathesis-stress/vulnerability-stress model, including the potential for identifying a mechanism of action by which environmental stressors may contribute to triggering first-episode psychosis.
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Affiliation(s)
- Julian M Montaquila
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States
| | - Benjamin J Trachik
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States
| | - Jeffrey S Bedwell
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States.
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15
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Barry TJ, Murray L, Fearon RP, Moutsiana C, Cooper P, Goodyer IM, Herbert J, Halligan SL. Maternal postnatal depression predicts altered offspring biological stress reactivity in adulthood. Psychoneuroendocrinology 2015; 52:251-60. [PMID: 25544737 PMCID: PMC4309884 DOI: 10.1016/j.psyneuen.2014.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
Abstract
The offspring of depressed parents have been found to show elevated basal levels of the stress hormone cortisol. Whether heightened cortisol stress reactivity is also present in this group has yet to be clearly demonstrated. We tested whether postnatal maternal depression predicts subsequent increases in offspring biological sensitivity to social stress, as indexed by elevated cortisol reactivity. Participants (mean age 22.4-years) derived from a 22-year prospective longitudinal study of the offspring of mothers who had postnatal depression (PND group; n=38) and a control group (n=38). Salivary cortisol response to a social-evaluative threat (Trier Social Stress Test) was measured. Hierarchical linear modelling indicated that PND group offspring showed greater cortisol reactivity to the stress test than control group participants. Group differences were not explained by offspring depressive or anxiety symptoms, experiences of negative life events, elevated basal cortisol at age 13-years, subsequent exposure to maternal depression, or other key covariates. The findings indicate that the presence of early maternal depression can predict offspring biological sensitivity to social stress in adulthood, with potential implications for broader functioning.
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Affiliation(s)
- Tom J. Barry
- Centre for the Psychology of Learning and Experimental Psychopathology, University of Leuven, Tiensestraat 102, Leuven 3000, Belgium
| | - Lynne Murray
- School of Psychology and CLS, University of Reading, Reading RG6 6AL, UK,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - R.M. Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Christina Moutsiana
- Experimental Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Peter Cooper
- School of Psychology and CLS, University of Reading, Reading RG6 6AL, UK,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Ian M. Goodyer
- Department of Psychiatry, Cambridge University, Cambridge CB2 2AH, UK
| | - Joe Herbert
- John van Geest Centre for Brain Repair, Department of Clinical Neuroscience, Cambridge University, Cambridge CB2 3BY, UK
| | - Sarah L. Halligan
- Department of Psychology, University of Bath, Bath BA2 7AY, UK,Corresponding author. Tel.: +44 1225 386636.
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16
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van Winkel M, Peeters F, van Winkel R, Kenis G, Collip D, Geschwind N, Jacobs N, Derom C, Thiery E, van Os J, Myin-Germeys I, Wichers M. Impact of variation in the BDNF gene on social stress sensitivity and the buffering impact of positive emotions: replication and extension of a gene-environment interaction. Eur Neuropsychopharmacol 2014; 24:930-8. [PMID: 24613654 DOI: 10.1016/j.euroneuro.2014.02.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 01/15/2014] [Accepted: 02/12/2014] [Indexed: 12/26/2022]
Abstract
A previous study reported that social stress sensitivity is moderated by the brain-derived-neurotrophic-factor(Val66Met) (BDNF rs6265) genotype. Additionally, positive emotions partially neutralize this moderating effect. The current study aimed to: (i) replicate in a new independent sample of subjects with residual depressive symptoms the moderating effect of BDNF(Val66Met) genotype on social stress sensitivity, (ii) replicate the neutralizing impact of positive emotions, (iii) extend these analyses to other variations in the BDNF gene in the new independent sample and the original sample of non-depressed individuals. Previous findings were replicated in an experience sampling method (ESM) study. Negative Affect (NA) responses to social stress were stronger in "Val/Met" carriers of BDNF(Val66Met) compared to "Val/Val" carriers. Positive emotions neutralized the moderating effect of BDNF(Val66Met) genotype on social stress sensitivity in a dose-response fashion. Finally, two of four additional BDNF SNPs (rs11030101, rs2049046) showed similar moderating effects on social stress-sensitivity across both samples. The neutralizing effect of positive emotions on the moderating effects of these two additional SNPs was found in one sample. In conclusion, ESM has important advantages in gene-environment (GxE) research and may attribute to more consistent findings in future GxE research. This study shows how the impact of BDNF genetic variation on depressive symptoms may be explained by its impact on subtle daily life responses to social stress. Further, it shows that the generation of positive affect (PA) can buffer social stress sensitivity and partially undo the genetic susceptibility.
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Affiliation(s)
- Mark van Winkel
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (DRT 10), Maastricht 6200 MD, The Netherlands; Riagg Maastricht, Parallelweg 45-47, 6221 BD, Maastricht, the Netherlands.
| | - Frenk Peeters
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (DRT 10), Maastricht 6200 MD, The Netherlands
| | - Ruud van Winkel
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (DRT 10), Maastricht 6200 MD, The Netherlands; University Psychiatric Centre, Catholic University Leuven, Kortenberg, Belgium
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (DRT 10), Maastricht 6200 MD, The Netherlands
| | - Dina Collip
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (DRT 10), Maastricht 6200 MD, The Netherlands
| | - Nicole Geschwind
- Clinical Psychological Science, Maastricht University, The Netherlands
| | - Nele Jacobs
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (DRT 10), Maastricht 6200 MD, The Netherlands; Faculty of Psychology, Open University of the Netherlands, Heerlen, the Netherlands
| | - Catherine Derom
- Centre of Human Genetics, University Hospitals Leuven, Department of Human Genetics, KU Leuven, Belgium
| | - Evert Thiery
- Dept of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (DRT 10), Maastricht 6200 MD, The Netherlands; King׳s College London, King׳s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Inez Myin-Germeys
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (DRT 10), Maastricht 6200 MD, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (DRT 10), Maastricht 6200 MD, The Netherlands
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