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- Bednarska, Olga, 1973-
(författare)
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Peripheral and Central Mechanisms in Irritable Bowel Syndrome : in search of links
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Irritable bowel syndrome (IBS) is a chronic visceral pain disorder with female predominance, characterized by recurrent abdominal pain and disturbed bowel habits in the absence of an identifiable organic cause. This prevalent and debilitating disease, which accounts for a substantial economic and individual burden, lacks exact diagnostic tools and effective treatment, since its pathophysiology remains uncertain. The bidirectional and multilayered brain-gut axis is a well-established disease model, however, the interactions between central and peripheral mechanisms along the brain-gut axis remain incompletely understood. One of the welldescribed triggering factors, yet accounting for only a fraction of IBS prevalence, is bacterial gastroenteritis that affects mucosal barrier function. Altered gut microbiota composition as well as disturbed intestinal mucosal barrier function and its neuroimmune regulation have been reported in IBS, however, the impact of live bacteria, neither commensal nor pathogenic, on intestinal barrier has not been studied yet. Furthermore, abnormal central processing of visceral sensations and psychological factors such as maladaptive coping have previously been suggested as centrally-mediated pathophysiological mechanisms of importance in IBS. Brain imaging studies have demonstrated an imbalance in descending pain modulatory networks and alterations in brain regions associated with interoceptive awareness and pain processing and modulation, particularly in anterior insula (aINS), although biochemical changes putatively underlying these central alterations remain poorly understood. Most importantly, however, possible associations between these documented changes on central and peripheral levels, which may as complex interactions contribute to disease onset and chronification of symptoms, are widely unknown.This thesis aimed to investigate the peripheral and central mechanisms in women with IBS compared to female healthy controls (HC) and to explore possible mutual associations between these mechanisms.In Paper I, we studied paracellular permeability and passage of live bacteria, both commensal and pathogenic through colonic biopsies mounted in Ussing chambers. We explored the regulation of the mucosal barrier function by mast cells and the neuropeptide vasoactive intestinal polypeptide (VIP) as well as a correlation between mucosal permeability and gastrointestinal and psychological symptoms. We observed increased paracellular permeability and the passage of commensal and pathogenic live bacteria in patients with IBS compared with HC, which was diminished by blocking the VIP receptors as well as after stabilizing mast cells in both groups. Moreover, higher paracellular permeability was associated with less somatic and psychological symptoms in patients.In Paper II, we aimed to determine the association between colonic mucosa paracellular permeability and structural and resting state functional brain connectivity. We demonstrated different patterns of associations between mucosa permeability and functional and structural brain connectivity in IBS patients compared to HC. Specifically, lower paracellular permeability in IBS, similar to the levels detected in HC, was associated with more severe IBS symptoms and increased functional and structural connectivity between intrinsic brain resting state network and descending pain modulation brain regions. Our findings further suggested that this association between mucosa permeability and functional brain connectivity was mainly mediated by coping strategies.In Paper III, we investigated putative alterations in excitatory and inhibitory neurotransmission of aINS, as the brain’s key node of the salience network crucially involved in cognitive control, in IBS patients relative to HC and addressed possible connections with both symptoms and psychological factors. We found decreased concentrations of the excitatory neurotransmitter Glx in bilateral aINS in IBS patients compared to HC, while inhibitory neurotransmitter GABA+ levels were comparable. Further, we demonstrated hemisphere-specific associations between abdominal pain, coping and aINS excitatory neurotransmitter concentration.In conclusion, this thesis broadens the knowledge on peripheral and central mechanisms in IBS and presents novel findings that bring together the ends of brain-gut axis. Our results depict association between mucosal permeability, IBS symptoms and functional and structural connectivity engaging brain regions involved in emotion and pain modulation as well as underlying neurotransmitter alterations.
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| 2. |
- Drissi, Natasha Morales, 1980-
(författare)
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Brain Networks and Dynamics in Narcolepsy
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Narcolepsy is a chronic sleep disorder, characterised by excessive daytime sleepiness with frequent uncontrollable sleep attacks. In addition to sleeprelated problems, changes in cognition have also been observed in patients with narcolepsy and has been linked to the loss of Orexin-A in a number of studies. Results from previous functional and structural neuroimaging studies would suggest that the loss of Orexin-A has numerous downstream effects in terms of both resting state glucose metabolism and perfusion and reduction in cortical grey matter.Specifically, studies investigating narcolepsy with positron emission tomography (PET) and single photon emission computed tomography (SPECT) have observed aberrant perfusion and glucose metabolism in the hypothalamus and thalamus, as well as in prefrontal cortex. A very recent PET study in a large cohort of adolescents with type 1 narcolepsy further observed that the hypoand hypermetabolism in many of these cortico-frontal and subcortical brain regions also exhibited significant correlations with performance on a number of neurocognitive tests. These findings parallel those found in structural neuroimaging studies, where a reduction of cortical grey matter in frontotemporal areas has been observed.The Aim of this thesis was to investigate mechanisms and aetiology behind the symptoms in narcolepsy through the application of different neuroimaging techniques. I present in this thesis evidence supporting that the complaints about subjective memory deficits in narcolepsy are related to a misallocation of resources.I further describe how this has its seat in defective default mode network activation, possibly involving alterations to GABA and Glutamate signaling. In addition to this, I present our findings of a structural deviation in an area of the brainstem previously not described in the aetiology of narcolepsy.This finding may have implications for further understanding the aetiology of the disease and the specific neuronal populations involved.In addition to this, I show evidence from adipose tissue measurements in specific compartments, confirming that weight gain in narcolepsy is characterized by centrally located weight gain and may be specifically related to OX changes, but maybe not brown adipose tissue volume.The findings presented in this thesis provides new insights to the pathophysiology of narcolepsy beyond the well-known depletion of OX producing neurons in the hypothalamus.
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| 3. |
- Georgiopoulos, Charalampos, 1984-
(författare)
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Imaging Studies of Olfaction in Health and Parkinsonism
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Olfactory loss is a common non-motor symptom of Parkinson’s disease (PD), often preceding the cardinal motor symptoms of the disease. The aim of this thesis was to: (a) evaluate whether olfactory examination can increase diagnostic accuracy, and (b) study the structural and functional neural basis of olfactory dysfunction in PD with different applications of Magnetic Resonance Imaging (MRI).Paper I was a comparison of the diagnostic accuracy between a simple smell identification test and DaTSCAN Single Photon Emission Computerized Tomography (SPECT), a nuclear medicine tomographic imaging technique that is commonly used in patients with suspected parkinsonism. The results indicate that smell test is inferior to DaTSCAN SPECT, but the combination of these two methods can lead to improved diagnostic accuracy.Paper II showed that diffusion MRI could detect discrete microstructural changes in the white matter of brain areas that participate in higher order olfactory neurotransmission, whereas MRI with Magnetization Transfer contrast could not.Paper III was a methodological study on how two different acquisition parameters can affect the activation pattern of olfactory brain areas, as observed with functional MRI (fMRI). The results indicate that brief olfactory stimulation and fast sampling rate should be preferred on olfactory fMRI studies.Paper IV used olfactory fMRI and resting-state fMRI in order to elucidate potentially altered activation patterns and functional connectivity within olfactory brain areas, between PD patients and healthy controls. Olfactory fMRI showed that olfactory impairment in PD is associated with significantly lower recruitment of the olfactory network. Resting-state fMRI did not detect any significant changes in the functional connectivity within the olfactory network of PD patients.In conclusion, the included studies provide evidence of: (a) disease-related structural and functional changes in olfactory brain areas, and (b) beneficial addition of olfactory tests in the clinical work-up of patients with parkinsonism.
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| 4. |
- Sten, Sebastian, 1993-
(författare)
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Mathematical modeling of neurovascular coupling
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The brain is critically dependent on the continuous supply of oxygen and glucose, which is carried and delivered by blood. When a brain region is activated, metabolism of these substrates increases rapidly, but is quickly offset by a substantially higher increase in blood flow to that region, resulting in a brief oversupply of these substrates. This phenomenon is referred to as functional hyperemia, and forms the foundation of functional neuroimaging techniques such as functional Magnetic Resonance Imaging (fMRI), which captures a Blood Oxygen Level-Dependent (BOLD) signal. fMRI exploits these BOLD signals to infer brain activity, an approach that has revolutionized the research of brain function over the last 30 years. Due to the indirect nature of this measure, a deeper understanding of the connection between brain activity and hemodynamic changes — a neurovascular coupling (NVC) — is essential in order to fully interpret such functional imaging data. NVC connects the synaptic activity of neurons with local changes in cerebral blood flow, cerebral blood volume, and cerebral metabolism of oxygen, through a complex signaling network, consisting of multiple different brain cells which release a myriad of distinct vasoactive messengers with specific vascular targets. To aid with this complexity, mathematical modeling can provide vital help using methods and tools from the field of Systems Biology. Previous models of the NVC exist, conventionally describing quasi-phenomenological steps translating neuronal activity into hemodynamic changes. However, no mechanistic mathematical model that describe the known intracellular mechanisms or hypotheses underlying the NVC, and which can account for a wide variety of NVC related measurements, currently exists. Therefore, in this thesis, we apply a Systems Biology approach to develop such intracellular mechanisms based models using in vivo experimental data consisting of different NVC related measures in rodents, primates, and humans.Paper I investigates two widely discussed hypotheses describing the NVC: the metabolic feedback hypothesis, and the vasoactive feed-forward hypothesis. We illustrate through multiple model rejections that only a model describing a combination of the two hypotheses can capture the qualitative features of the BOLD signal, as measured in humans. This combined model can describe data used for training, as well as predict independent validation data not previously seen by the model before.Paper II extends this model to describe the negative BOLD response, where the blood oxygenation drops below basal levels, which is commonly observed in clinical and cognitive studies. The model explains the negative BOLD response as the result of neuronal inhibition, describing and adequately predicting experimental data from two different experiments.In Paper III, we develop a first model including the cell-specific contributions of GABAergic interneurons and pyramidal neurons to functional hyperemia, using data of optogenetic and sensory stimuli in rodents for both awake and anesthesia conditions. The model captures the effect of the anesthetic as purely acting on the neuronal level if a Michaelis-Menten expression is included, and it also correctly predicts data from experiments with different pharmacological inhibitors.Finally, in Paper IV, we extend the model in Paper III to describe and predict a majority of the relevant hemodynamic NVC measures using data from rodents, primates, and humans. The model suggests an explanation for observed bi-modal behaviors, and can be used to generate new insights regarding the underpinnings of other complicated observed behaviors. This model constitutes the most complete mechanistic model of the NVC to date.This new model-based understanding opens the door for a more integrative approach to the analysis of neuroimaging data, with potential applications in both basic science and in the clinic.
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