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Abstract
The coronavirus disease 2019 (COVID-19) pandemic continues to exert a significant impact on global health care systems, causing devastating mortality and morbidity. As time passes and our understanding of this novel respiratory virus deepens, it is increasingly clear that its effects extend beyond that of the respiratory system. The coronavirus responsible for COVID-19, severe acute respiratory syndrome coronavirus 2, obtains cellular access through the angiotensin-converting enzyme 2 (ACE2) receptor in a process requiring the transmembrane serine protease 2 (TMPRSS2) protein. Both ACE2 and TMPRSS2 are widely expressed in many endocrine glands. This, along with several case reports of thyroid and pituitary disruption in patients with COVID-19, has resulted in significant interest in its impact on the endocrine system. Indeed, as mortality is abated by the increasing availability of effective vaccines, there is increasing focus on the long-term effects on health in COVID-19 survivors. This review summarizes data investigating the effects of COVID-19 on each of the endocrine axes to guide appropriate investigations and optimal management.
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Affiliation(s)
- Sophie A Clarke
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Ali Abbara
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Waljit S Dhillo
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
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Lorenz R, Johal M, Dick F, Hampshire A, Leech R, Geranmayeh F. A Bayesian optimization approach for rapidly mapping residual network function in stroke. Brain 2021; 144:2120-2134. [PMID: 33725125 PMCID: PMC8370405 DOI: 10.1093/brain/awab109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
Post-stroke cognitive and linguistic impairments are debilitating conditions, with limited therapeutic options. Domain-general brain networks play an important role in stroke recovery and characterizing their residual function with functional MRI has the potential to yield biomarkers capable of guiding patient-specific rehabilitation. However, this is challenging as such detailed characterization requires testing patients on multitudes of cognitive tasks in the scanner, rendering experimental sessions unfeasibly lengthy. Thus, the current status quo in clinical neuroimaging research involves testing patients on a very limited number of tasks, in the hope that it will reveal a useful neuroimaging biomarker for the whole cohort. Given the great heterogeneity among stroke patients and the volume of possible tasks this approach is unsustainable. Advancing task-based functional MRI biomarker discovery requires a paradigm shift in order to be able to swiftly characterize residual network activity in individual patients using a diverse range of cognitive tasks. Here, we overcome this problem by leveraging neuroadaptive Bayesian optimization, an approach combining real-time functional MRI with machine-learning, by intelligently searching across many tasks, this approach rapidly maps out patient-specific profiles of residual domain-general network function. We used this technique in a cross-sectional study with 11 left-hemispheric stroke patients with chronic aphasia (four female, age ± standard deviation: 59 ± 10.9 years) and 14 healthy, age-matched control subjects (eight female, age ± standard deviation: 55.6 ± 6.8 years). To assess intra-subject reliability of the functional profiles obtained, we conducted two independent runs per subject, for which the algorithm was entirely reinitialized. Our results demonstrate that this technique is both feasible and robust, yielding reliable patient-specific functional profiles. Moreover, we show that group-level results are not representative of patient-specific results. Whereas controls have highly similar profiles, patients show idiosyncratic profiles of network abnormalities that are associated with behavioural performance. In summary, our study highlights the importance of moving beyond traditional 'one-size-fits-all' approaches where patients are treated as one group and single tasks are used. Our approach can be extended to diverse brain networks and combined with brain stimulation or other therapeutics, thereby opening new avenues for precision medicine targeting a diverse range of neurological and psychiatric conditions.
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Affiliation(s)
- Romy Lorenz
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Stanford University, Stanford, CA 94305, USA
- Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig 04303, Germany
| | - Michelle Johal
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Frederic Dick
- Birkbeck/UCL Centre for Neuroimaging, Birkbeck University, London WC1H 0AP, UK
| | - Adam Hampshire
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Robert Leech
- Centre for Neuroimaging Science, King’s College London, London SE5 8AF, UK
| | - Fatemeh Geranmayeh
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, London W12 0NN, UK
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Izzi-Engbeaya C, Jones S, Crustna Y, Machenahalli PC, Papadopoulou D, Modi M, Panayi C, Starikova J, Eng PC, Phylactou M, Mills E, Yang L, Ratnasabapathy R, Sykes M, Plumptre I, Coumbe B, Wing VC, Pacuszka E, Bech P, Minnion J, Tharakan G, Tan T, Veldhuis J, Abbara A, Comninos AN, Dhillo WS. Effects of Glucagon-like Peptide-1 on the Reproductive Axis in Healthy Men. J Clin Endocrinol Metab 2020; 105:5735220. [PMID: 32052032 PMCID: PMC7082082 DOI: 10.1210/clinem/dgaa072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/06/2019] [Accepted: 02/10/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Glucagon-like peptide-1 (GLP-1) potently reduces food intake and augments glucose-stimulated insulin secretion. Recent animal data suggest that GLP-1 may also influence reproduction. As GLP-1 receptor agonists are currently widely used in clinical practice to treat obesity/type 2 diabetes, it is necessary to determine the effects of GLP-1 on the reproductive system in humans. OBJECTIVE To investigate the effects of GLP-1 administration on the reproductive axis in humans. DESIGN Single-blind, randomized, placebo-controlled crossover study. SETTING Clinical Research Facility, Imperial College Healthcare NHS Trust. PARTICIPANTS Eighteen healthy men (mean age 24.7 ± 0.1years, mean BMI 22.1 ± 0.4kg/m2). INTERVENTION Eight-hour intravenous infusion of 0.8 pmol/kg/min GLP-1 or rate-matched vehicle infusion. MAIN OUTCOME MEASURES Number of luteinizing hormone (LH) pulses, LH, follicle-stimulating hormone (FSH), and testosterone levels. RESULTS The number of LH pulses (number of LH pulses/500 min: vehicle 4.2 ± 0.4, GLP-1 4.5 ± 0.3, P = 0.46), LH area under the curve (AUC) (vehicle 1518 ± 88min.IU/L, GLP-1 1524 ± 101min.IU/L, P = 0.95), follicle-stimulating hormone AUC (vehicle 1210 ± 112 min IU/L, GLP-1 1216 ± 112 min IU/L, P = 0.86), and testosterone AUC (vehicle 10893 ± 615 min nmol/L, GLP-1 11088 ± 792 min nmol/L, P = 0.77) did not significantly differ during vehicle and GLP-1 administration. Glucagon-like peptide-1 significantly reduced food intake (vehicle 15.7 ± 1.3 kcal/kg, GLP-1 13.4 ± 1.3 kcal/kg, P = 0.01). CONCLUSIONS In contrast to the animal literature, our data demonstrate that acute GLP-1 administration does not affect reproductive hormone secretion in healthy men.
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Affiliation(s)
- Chioma Izzi-Engbeaya
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Sophie Jones
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Yoshibye Crustna
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Pratibha C Machenahalli
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Deborah Papadopoulou
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Manish Modi
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Christos Panayi
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Jessica Starikova
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Pei Chia Eng
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Edouard Mills
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Lisa Yang
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Risheka Ratnasabapathy
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Mark Sykes
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Isabella Plumptre
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Ben Coumbe
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Victoria C Wing
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Ewa Pacuszka
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Paul Bech
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - James Minnion
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - George Tharakan
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
- Department of Acute Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Tricia Tan
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Correspondence and Reprint Requests: Waljit S. Dhillo, MBBS, PhD, Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, W12 0NN, UK. E-mail:
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