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HIV associated neurocognitive disorders (HAND) continue to affect cognition and everyday functioning despite anti-retroviral treatment (ART). Previous studies focused on mechanisms related to monocyte/macrophage mediated inflammation. However, in the ART era, there is increasing evidence for the involvement of CD8+ T-cells in CNS pathogenesis. To investigate the relationship between T-cell responses and neurocognitive impairment (NCI), cerebrospinal fluid (CSF) and peripheral blood CD4+ and CD8+ T-cell intracellular cytokine (IFNγ, IL-2, TNFα) and lytic marker (CD107a) expression were assessed in HIV infected subjects who underwent comprehensive neurocognitive (NC) evaluation and either initiated or changed ART. Data were collected from 31 participants at 70 visits. The frequency of cytokine expressing T-cells in CSF was significantly higher than in peripheral blood for CD4+T-cells: TNFα, IL-2, IFNγ and CD8+T-cells: IL-2 and IFNγ. Analysis of T-cell activity and NCI as a function of CSF HIV RNA levels suggested a general association between NCI, high CSF CD8+ (but not CD4+T-cell) cytokine expression and CSF HIV RNA <103 copies/ml (p<0.0001). Specifically, CSF CD8+ T-cell IFNγ expression correlated with severity of NCI (r = 0.57, p = 0.004). Multivariable analyses indicated that CSF CD8+T-cell IFNγ and myeloid activation (CD163) contributed equally and independently to cognitive status and a composite variable produced the strongest correlation with NCI (r = 0.83, p = 0.0001). In contrast, CD8+ cytolytic activity (CD107a expression) was negatively correlated with NCI (p = 0.05) but was dependent on CD4 levels >400/μl and low CSF HIV RNA levels (<103 copies/ml). In our longitudinal analysis of 16 subjects, higher CSF CD8+IFNγ expression at baseline predicted NC decline at follow-up (p = 0.02). Severity of NCI at follow-up correlated with level of residual HIV RNA in CSF. Presence of IFNγ expressing CD8+ T-cells, absence of cytolytic CD8+ T-cells, high myeloid activation, and failure of ART to suppress HIV replication in CSF contribute to increased risk of HAND.

Background Depression and obesity are highly prevalent, often co-occurring conditions marked by inflammation. Microbiome perturbations are implicated in obesity-inflammation-depression interrelationships, but how the microbiome mechanistically contributes to pathology remains unclear. Metabolomic investigations into microbial neuroactive metabolites may offer mechanistic insights into host-microbe interactions. Using 16S sequencing and untargeted mass spectrometry of saliva, and blood monocyte inflammation regulation assays, we identified key microbes, metabolites and host inflammation in association with depressive symptomatology, obesity, and depressive symptomatology-obesity comorbidity. Results Gram-negative bacteria with inflammation potential were enriched relative to Gram-positive bacteria in comorbid obesity-depression, supporting the inflammation-oral microbiome link in obesity-depression interrelationships. Oral microbiome was more highly predictive of depressive symptomatology-obesity co-occurrences than of obesity or depressive symptomatology independently, suggesting specific microbial signatures associated with obesity-depression co-occurrences. Mass spectrometry analysis revealed significant changes in levels of signaling molecules of microbiota, microbial or dietary derived signaling peptides and aromatic amino acids among depressive symptomatology, obesity and comorbid obesity-depression. Furthermore, integration of the microbiome and metabolomics data revealed that key oral microbes, many previously shown to have neuroactive potential, co-occurred with potential neuropeptides and biosynthetic precursors of the neurotransmitters dopamine, epinephrine and serotonin. Conclusions Together, our findings offer novel insights into oral microbial-brain connection and potential neuroactive metabolites involved.

High sensitivity C-reactive protein (hsCRP) is a marker of systemic inflammation that has been associated with persistent depressive symptoms. Depression and anxiety are frequently associated with a chronic inflammatory state, yet the nature of this relationship has not been rigorously examined in diverse Hispanic/Latino populations. We aimed to study the association of anxiety and depressive symptoms as well as comorbid presentations, with circulating high sensitivity C-reactive protein (hsCRP) levels in a large Latino cohort of diverse heritages. We hypothesized a significant positive associations of both anxiety and depressive symptoms and hsCRP levels and potential variations among the heritage groups. Depressive symptoms and anxiety were measured by the Center for Epidemiological Studies Depression Scale (CES-D) and State-Trait Anxiety Inventory (STAI), respectively. Serum hsCRP (hsCRP) levels of 15,448 participants (age 18 to 75 years; 52.3% women) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were measured and categorized based on the established cardiovascular disease (CVD) risk reference values (< 1mg/L, low; 1-<3 mg/L, intermediate; ≥ 3mg/L, high). Mean CES-D, STAI scores, and hsCRP levels were 7.0 (SD = 5.9), 17.0 (SD = 5.7), and 3.84 (SD = 7.85), respectively. Generalized linear modeling, adjusted for sociodemographic characteristics revealed significant associations between depression (exp(β) = 1.12; p<0.01) and anxiety symptoms (exp(β) = 1.10; p<0.05) with continuous hsCRP levels. For categorical values of hsCRP, one SD increase in CES-D and STAI scores was associated with a 10% and 8% increase in the RRRs of high vs. low hsCRP, respectively. However, these relationships between CES-D or STAI and hsCRP were no longer statistically significant after adjustment for CVD risk factors and medications. We found modest associations between anxiety and depressive symptoms and systemic inflammation measured by hsCRP among diverse Hispanics/Latinos that did not appreciably differ between heritage groups.

Using heart rate variability (vmHRV) as a proxy of cardiac vagal modulation, previous studies have hinted at sex differences in the vagal control of cardiac chronotropy in young adults, but little is known in older individuals. The current study aimed at investigating for the first time the moderating role of both sex and age in the relationship between vmHRV and cardiac chronotropy in younger (n = 106, mean age: 19.9 (3.5) years) and older (n = 109, mean age: 72.8 (2.6) years) individuals. Further, we explored the effects of hormone replacement therapy on such association in a sub‐sample of post‐menopausal women (n = 17). Resting measures of the average inter‐beat interval (IBI, as index of cardiac chronotropy) and vmHRV were collected. The results indicate (i) stronger associations between vmHRV and IBI in young adults and post‐menopausal women compared to age‐matched men, (ii) a weaker or no association in older women and men, respectively, and (iii) no effects of hormone replacement therapy in post‐menopausal women. This study provides evidence of sex and age differences in the association between vmHRV and cardiac chronotropy, offering novel insight into vagal mechanisms of cardiac chronotropic control that may inform our understanding of sex‐ and age‐related vulnerability to negative health outcomes.

Despite the vasculature's role in long‐term blood pressure (BP) regulation, limited work exists on vascular baroreflex function. This study focused on hypothesized age and sex differences in the vascular‐sympathetic baroreflex limb and explored the role of hormone replacement therapy (HRT). Resting cardiac and hemodynamic measures were recorded. Baroreflex sensitivity (BRS) and baroreflex effectiveness (BEI) were calculated for each baroreflex limb (cardiac, myocardial, and vascular). In younger adults, women had significantly lower SBP, total peripheral resistance (TPR), and vascular‐BEI than men (r's > 0.245, p's < 0.012). In older adults with managed‐hypertension, post‐menopausal women had significantly higher SBP, TPR, and vBEI, than men (r's > 0.228, p's < 0.018), while younger women had significantly higher vBRS (r's > 0.199, p's < 0.027) and lower TPR (r's > 0.281, p's < 0.002). Younger men showed significantly higher vascular‐BRS and vascular‐BEI (r's > 0.318, p's < 0.002), higher TPR and TPR‐variability (r's > 0.314, p ≤ 0.003), and lower SBP (r's > 0.295, p's < 0.005) than older men. Compared to non‐HRT women, HRT‐women had only significantly lower SBP (r = 0.243, p = 0.035). We provide the first evidence of age and sex differences in vascular baroreflex‐mediated BP control using the sequence method.

Physical activity levels among breast cancer survivors are typically low, and knowledge of the correlates of increased physical activity among cancer survivors is limited. The purpose of this study was to examine factors that are associated with physical activity or inactivity among breast cancer survivors. Data from 3088 women participating in the Women's Healthy Eating and Living (WHEL) Study, collected prior to randomization, were the focus of the current analyses. Self-reports of physical activity levels, quality of life, depression, and dietary intakes were collected. Pearson correlation analyses were employed to examine the associations among these variables, and multiple regression analyses were performed to examine the relationship between selected health behaviors and physical activity levels, after controlling for demographic, breast cancer-related, and psychosocial variables. Demographic and psychosocial variables were related to physical activity levels (P < 0.001 for all). Cancer treatment type and cancer stage were correlated with survivors' physical activity levels (P < 0.01), but the associations were no longer significant after controlling for demographic variables. Physical activity levels were strongly associated with other health behaviors, especially dietary intakes (P < 0.001), even after controlling for demographic, cancer-related, and psychosocial factors. Low physical activity levels in breast cancer survivors are associated with specific behavioral and other factors, which can be considered as indicators of women at higher risk. Findings of significant differences in physical activity levels based on demographic characteristics suggest the importance of promoting physical activity particularly among breast cancer survivors of ethnic minority or lower education levels.

Nicotinic acetylcholine receptors (nAChRs) are important regulators of brain and immune function that play critical roles in the neuropathology and progression of Alzheimer’s disease and related dementias (ADRD). However, quantifying nAChRs in the brain remains elusive, and little is known about peripheral measures of nAChR in older adults or their relationship to cognition. Here, we examined associations between nAChR expression and immunoregulatory function in peripheral blood monocytes and cognitive performance among 167 older adults (age 72.3 ± 7.6 years; 71% female). Penalized linear and logistic regression were used to identify nAChR-related features in classical, intermediate, and nonclassical monocytes, as well as immunophenotypes, clinical and sociodemographic factors, associated with cognitive status (Montreal Cognitive Assessment; MoCA). Intermediate monocytes had the highest expression of alpha-7 nAChRs and greater ex vivo inflammatory responses (83.7% TNF-ɑ + cells) relative to classical (68.4%, d  = 1.98, P  < 0.001) or nonclassical monocytes (58.9%, d  = 3.20, P  < 0.001). Participants with mild cognitive impairment (MCI: N  = 76) had higher soluble CD14 levels (1777 ± 377 pg/uL) and greater anticholinergic medication burden (ACB; mean = 1.76) than normocognitive participants (NC: N  = 91; 1638 ± 352 pg/uL sCD14, t 155  = 2.78, P  = 0.006; mean ACB: 1.05, t 143  = 3.13, P  = 0.002). Multivariate regression models indicated that stronger nAChR-mediated immunoregulation in intermediate monocytes was associated with higher MoCA scores (beta = 0.13) and 14% lower odds of MCI, as well as lower ACB (beta = − 2.10; 95% CI − 4.14, − 0.61). This study demonstrates that peripheral monocytes exhibit subset-specific differences in nAChR phenotypes in older adults and provides preliminary evidence for their association with cognitive function and a potential mediating role between ACB and cognitive impairment.

Objective The objective of this study was to determine potential inflammatory predictors of fatigue in obstructive sleep apnea (OSA). Materials and methods Fifty-six women and men untreated OSA patients had their sleep monitored with polysomnography. Fatigue was assessed by the Multidimensional Fatigue Symptom Inventory-Short Form. Depressed mood was assessed by the Center for Epidemiologic Studies-Depression Scale. Blood was drawn to assess circulating levels of Interleukin-6 (IL-6) and soluble tumor necrosis factor receptor I (sTNF-RI). Age, gender, body mass index (BMI), blood pressure, OSA severity, depressed mood, and inflammatory biomarkers were entered into a hierarchical multiple linear regression analysis predicting self-reported fatigue. Results Approximately 42% of the patients reported significant amounts of fatigue. Higher BMI ( p  = 0.014), greater depressed mood ( p  = 0.004), and higher sTNF-RI levels ( p  = 0.033) were independent predictors of fatigue in the final model (full model R 2  = .571; p  = .003). Age, gender, blood pressure and apnea severity were unrelated to fatigue. Conclusion The findings suggest that in addition to depressed mood, fatigue in OSA may be associated with increased body weight and elevated levels of the proinflammatory cytokine receptor sTNF-RI. The findings support a linkage between the widely reported fatigue in OSA and a sleep-related component of inflammation.

Long COVID is a chronic condition characterized by symptoms such as fatigue, dyspnea, and cognitive impairment that persist or relapse months after an acute infection with the SARS-CoV-2 virus. Many distinct symptoms have been attributed to Long COVID; however, little is known about the potential clustering of these symptoms and risk factors that may predispose patients to certain clusters. In this study, an electronic survey was sent to patients in the UC San Diego Health (UCSDH) system who tested positive for COVID-19, querying if patients were experiencing symptoms consistent with Long COVID. Based on survey results, along with patient demographics reported in the electronic health record (EHR), linear and logistic regression models were used to examine putative risk factors, and exploratory factor analysis was performed to determine symptom clusters. Among 999 survey respondents, increased odds of Long COVID (n = 421; 42%) and greater Long COVID symptom burden were associated with female sex (OR = 1.73, 99% CI: 1.16–2.58; β = 0.48, 0.22–0.75), COVID-19 hospitalization (OR = 4.51, 2.50–8.43; β = 0.48, 0.17–0.78), and poorer pre-COVID self-rated health (OR = 0.75, 0.57–0.97; β = −0.19, −0.32–−0.07). Over one-fifth of Long COVID patients screened positive for depression and/or anxiety, the latter of which was associated with younger age (OR = 0.96, 0.94–0.99). Factor analysis of 16 self-reported symptoms suggested five symptom clusters—gastrointestinal (GI), musculoskeletal (MSK), neurocognitive (NC), airway (AW), and cardiopulmonary (CP), with older age (β = 0.21, 0.11–0.30) and mixed race (β = 0.27, 0.04–0.51) being associated with greater MSK symptom burden. Greater NC symptom burden was associated with increased odds of depression (OR = 5.86, 2.71–13.8) and anxiety (OR = 2.83, 1.36–6.14). These results can inform clinicians in identifying patients at increased risk for Long COVID-related medical issues, particularly neurocognitive symptoms and symptom clusters, as well as informing health systems to manage operational expectations on a population-health level.

Recent cannabis exposure has been associated with lower rates of neurocognitive impairment in people with HIV (PWH). Cannabis's anti-inflammatory properties may underlie this relationship by reducing chronic neuroinflammation in PWH. This study examined relations between cannabis use and inflammatory biomarkers in cerebrospinal fluid (CSF) and plasma, and cognitive correlates of these biomarkers within a community-based sample of PWH. 263 individuals were categorized into four groups: HIV- non-cannabis users (n = 65), HIV+ non-cannabis users (n = 105), HIV+ moderate cannabis users (n = 62), and HIV+ daily cannabis users (n = 31). Differences in pro-inflammatory biomarkers (IL-6, MCP-1/CCL2, IP-10/CXCL10, sCD14, sTNFR-II, TNF-α) by study group were determined by Kruskal-Wallis tests. Multivariable linear regressions examined relationships between biomarkers and seven cognitive domains, adjusting for age, sex/gender, race, education, and current CD4 count. HIV+ daily cannabis users showed lower MCP-1 and IP-10 levels in CSF compared to HIV+ non-cannabis users (p = .015; p = .039) and were similar to HIV- non-cannabis users. Plasma biomarkers showed no differences by cannabis use. Among PWH, lower CSF MCP-1 and lower CSF IP-10 were associated with better learning performance (all ps < .05). Current daily cannabis use was associated with lower levels of pro-inflammatory chemokines implicated in HIV pathogenesis and these chemokines were linked to the cognitive domain of learning which is commonly impaired in PWH. Cannabinoid-related reductions of MCP-1 and IP-10, if confirmed, suggest a role for medicinal cannabis in the mitigation of persistent inflammation and cognitive impacts of HIV.