Correlations Between Peripheral Levels of Inflammatory Mediators and Frontolimbic Structures in Bipolar Disorder: An Exploratory Analysis

BACKGROUND: Altered peripheral immune/inflammatory system and brain volumetric changes have been implicated in the pathophysiology of bipolar disorder (BD). This study aimed to evaluate how peripheral levels of cytokines are related to volumetric brain changes in euthymic patients with BD. METHODS: Euthymic patients with BD (n = 21) and healthy controls (n = 22) were enrolled in this exploratory study. Blood samples were collected on the same day of clinical assessment and neuroimaging. Cytokines were measured through cytometric bead array method. Neuroimaging data were acquired using a sagittal three-dimensional magnetic resonance imaging T1-weighted fast field echo sequence and was processed using FreeSurfer. RESULTS: Compared to controls, BD patients had significantly lower volumes in the cingulate, medial-orbitofrontal (MOF) and parahippocampal regions. We found a negative correlation between right MOF volume and interferon-gamma levels ( CONCLUSION: Our results support the involvement of inflammatory pathways in structural brain changes in BD

Association between resting state functional connectivity and major depressive disorder

Introduction: Major Depressive Disorder (MDD) is a cluster of symptoms, primarily diagnosed with depressed mood and loss of interest in daily activities, Globally, MDD is 4th leading cause of disability. Resting State Functional Connectivity (RSFC) uses blood oxygen level dependent signals to assess the connectivity between target brain regions, when subject is not doing any active task. Previous studies have found the important association of lateral Habenula with MDD. This study was aimed to evaluate the RSFC of Habenula with a few target areas and to assess the correlation between individual diagnostic symptoms of MDD. Methods: The data of the sample population is pulled from the parent study from Baylor School of Medicine, Houston, Texas. Case-control Study design was used. Controls were selected from the psychiatric population in the same setting. Depression scales (PHQ-9, SCID) were used to assess the severity of MDD symptoms and seed based RSFC analysis used for imaging data. CONN extension of MATLAB was used for imaging analysis and correlational coefficients. STATA and Microsoft Excel analysis software used for t-test and regression analysis. Using the evidence from literature, target areas selected to compare with lateral habenula were striatum, putamen, caudate nucleus, nucleus accumbens, raphe nucleus, paracentral lobule and locus coeruleus. SCID questionnaire was used to assess the individuality of the diagnostic symptoms and their mutual correlations. Results: Cases (n=139, 44.84%, age 30.65 ± 11.84 years) were compared to controls (n=171, 55.16 %, age=30.83 ± 12.65 years). Left and right sided habenula were found significantly connected (p\u3c 0.05) to Putamen, striatum, caudate nucleus and nucleus accumbens, even after analyzing for left and right sides of these target areas in addition to analyzing them as a whole structure. Significant correlation was found between clinical symptoms (p\u3c 0.05). Conclusion: The functional connectivity of lateral habenula with target areas was validated though the findings of this study. Positive correlation between multiple diagnostic symptoms could further help to categorize MDD for categorized management plans in future. Valid sample size, use of clinical and imaging data together, and psychiatry controls makes this study noteworthy

Rituximab in follicular lymphoma: the first chapter of the new era?

SUMMARY  Follicular lymphoma is the most common indolent B-cell lymphoma. Although there is no current standard of care adopted for all patients, clinical outcomes for patients with follicular lymphoma have significantly improved over the past few decades, which can be largely attributed to the incorporation of immunotherapy. Rituximab, a monoclonal antibody to the CD20 antigen, has been widely adopted in the treatment of B-cell lymphomas, resulting from improvements in remission duration and overall survival. We provide an evidence-based discussion of the clinical success and incorporation of immunotherapy, rituximab in the treatment of follicular lymphoma, the prototypical indolent B-cell lymphoma. This shift in the treatment paradigm has opened the door to novel, nonchemotherapy approaches in the treatment of patients with indolent B-cell lymphoma. </jats:p

Exploring the Evidence Implicating the Renin-Angiotensin System (RAS) in the Physiopathology of Mood Disorders

Mood disorders include Major Depressive Disorder (MDD), Bipolar Disorder (BD) and variations of both. Mood disorders has a public health significance with high comorbidity, suicidal mortality and economic burden on the health system. Research related to mood disorders has evolved over the years to relate it with systemic conditions. The Renin Angiotensin System (RAS) has been noticed to play major physiological roles beyond renal and cardiovascular systems. Recent studies have linked RAS not only with neuro-immunological processes, but also with psychiatric conditions like mood and anxiety disorders. In this comprehensive review, we integrated basic and clinical studies showing the associations between RAS and mood disorders. Animal studies on mood disorders models - either depression or mania - were focused on the reversal of behavioral and/or cognitive symptoms through the inhibition of RAS components like the Angiotensin- Converting Enzyme (ACE), Angiotensin II Type 1 receptor (AT1) or Mas receptors. ACE polymorphisms, namely insertion-deletion (I/D), were linked to mood disorders and suicidal behavior. Hypertension was associated with neurocognitive deficits in mood disorders, which reversed with RAS inhibition. Low levels of RAS components (renin activity or aldosterone) and mood symptoms improvement with ACE inhibitors or AT1 blockers were also observed in mood disorders. Overall, this review reiterates the strong and under-researched connection between RAS and mood disorders. </jats:sec