Brain, Behavior, & Immunity - Health

Sickness is an organismal response to inflammation, yet its immune, metabolic, neural, and behavioral components are often studied separately and predominantly in male C57BL/6 mice. In this study, we characterized these responses to systemic lipopolysaccharide (LPS) in female BALB/c mice. Mice received intraperitoneal LPS at moderate concentrations and outcomes were assessed during the acute and resolving phases of endotoxemia. LPS caused rapid disappearance of resident peritoneal macrophages, followed by neutrophil accumulation and increased circulating TNF- and IL-6. In the liver, LPS induced inflammatory, acute-phase, and anti-inflammatory transcripts while suppressing genes involved in lipid, cholesterol, and xenobiotic metabolism. Hepatic glutathione was reduced, whereas total superoxide dismutase activity was unchanged. These peripheral responses were followed by transient hypothermia, reduced food intake, and body weight loss. Regional brain mapping showed increased c-Fos labeling in the area postrema, nucleus of the solitary tract, external lateral parabrachial nucleus, paraventricular nucleus of the hypothalamus, and arcuate nucleus. In parallel, LPS selectively promoted IBA1-positive area in the median eminence and arcuate nucleus, whereas several other regions showed no changes, indicating that neuronal and microglial responses are regionally distinct. Behaviorally, LPS reduced locomotion and exploration, increased freezing, and increased forced-swim immobility. Changes in spatial exploration were most pronounced during the acute phase, whereas locomotor suppression and passive stress-coping persisted longer and varied in magnitude with the timing of inflammatory challenge. Together, these findings show that systemic LPS produces a coordinated sickness state in female BALB/c mice that links peripheral inflammation and hepatic metabolic and redox changes with region-specific neuronal and microglial responses, altered thermoregulation and feeding, and behavioral suppression.

Black carbon (BC), a combustion-derived component of fine particulate matter, has been linked to depressive symptoms, but controlled experimental evidence remains limited. We established a controlled BC inhalation model combined with chronic restraint stress (CRS) to determine whether inhaled BC alone induces depressive-like behavior and whether concurrent stress enhances behavioral and molecular vulnerability. Male C57BL/6J mice were assigned to Control, CRS, BC, or BC+CRS groups and exposed for 21 consecutive days, followed by behavioral testing and molecular analyses of plasma-depleted whole blood and stress-related brain regions. BC exposure alone induced depressive-like behavior, and the combined BC+CRS condition showed the most pronounced phenotype. These findings indicate that inhaled BC is sufficient to influence stress-relevant behavior and may heighten vulnerability under chronic stress. At the molecular level, BC shifted peripheral responses toward a stress- and inflammation-associated state with reduced plasticity-related signaling, whereas CRS preferentially engaged glucocorticoid-responsive regulation. Combined BC+CRS exposure further altered plasticity- and transcription-related regulatory programs in blood and stress-related brain regions, with prominent changes in the nucleus accumbens. These condition-dependent molecular patterns suggest that BC engages blood-brain stress-related pathways in a context- and region-specific manner. Together, these findings identify inhaled BC as a neurobehaviorally relevant environmental hazard.

The prevalence of neurodevelopmental disorders (NDDs) has increased dramatically, with growing evidence linking prenatal maternal stress exposure to NDDs. Across diverse maternal stressors, immune dysregulation emerges as a common feature, suggesting that fetal microglia may detect changes in the intrauterine environment and influence neurodevelopment. Accordingly, we utilized a mouse model of prenatal maternal cold stress to investigate the impact of maternal stress during pregnancy on fetal microglia morphology, cellular interactions, and phagocytic behaviors. Pregnant mice were exposed to cold stress from embryonic day 11.5 (E11.5) to E15.5 and fetal hypothalamic tissue was assessed from both male and female embryos. By adapting the morphology analysis toolset MicrogliaMorphology to assess fetal microglia, we demonstrate regional differences in microglial morphology in the fetal hypothalamus at baseline, with hypothalamic nuclei such as the paraventricular nucleus (PVN) containing fewer rod-like microglia compared to the broader hypothalamus. Interestingly, prenatal maternal cold stress induced a male-specific shift in microglial morphology from ameboid to ramified within the E15.5 PVN. Male embryos also displayed increased microglial-arginine vasopressin (AVP) neuronal interactions and microglial phagocytosis within the E15.5 PVN, but these changes were unique to microglia with a ramified morphology and were not observed when microglia with an ameboid or rod-like morphology were assessed. Using pHrodo bioparticles and flow cytometry, we further illustrate that prenatal maternal cold stress drives increased phagocytic activity in the E15.5 hypothalamus of male embryos, but not females. Together, these data demonstrate that prenatal maternal cold stress alters microglia morphology and drives morphology-dependent microglial interactions and phagocytic behaviors in male embryos which are unique to the hypothalamic PVN--a nuclei critical for social behaviors. Our findings also suggest that specific hypothalamic nuclei such as the PVN may be more sensitive to prenatal maternal stress, which has the potential to provide a cellular basis underlying the sex differences in microglia-dependent social deficits that were previously reported for this model.

Persistent neurological symptoms are among the most disabling manifestations of post-COVID-19 syndrome (PCS), yet the contribution of ongoing CNS immune activation remains uncertain. CSF studies including clinically relevant COVID-19 recovered control cohorts are scarce. In this prospective single-center study, we enrolled 50 patients fulfilling the WHO criteria for PCS (COVIDpost, mean age +/- standard deviation [SD] 43.41 +/- 11.99 years, 30 % male, 70 % female) and 50 individuals who had fully recovered from COVID-19 (COVIDreco, mean age +/- SD 39.38 +/- 13.45, 42 % male, 58 % female). Both cohorts were comparable regarding age (p = 0.07), sex (p = 0.30), and education (p = 0.84). All participants underwent paired CSF and serum analyses together with comprehensive neuropsychological assessment. Routine CSF parameters, blood-CSF barrier integrity, oligoclonal bands (OCB), SARS-CoV-2 RNA in CSF and blood, pathogen-specific antibody indices, and neuronal autoantibodies were investigated. Despite marked differences in cognitive performance (p < 0.001) and fatigue severity (p < 0.001), patients with PCS showed no evidence of disease-specific CSF abnormalities compared to recovered controls. Routine CSF parameters, blood-CSF barrier dysfunction, CSF-restricted OCB, SARS-CoV-2 RNA in CSF and blood, intrathecal SARS-CoV-2 antibody synthesis, polyspecific antiviral immune responses, and neuronal autoantibodies were comparable between groups. SARS-CoV-2-specific IgG concentrations in CSF correlated positively with serum concentrations (COVIDpost: r [95%CI] = 0.78 [0.62 - 0.87]; COVIDreco: r [95%CI] = 0.86 [0.75 - 0.92]; both p < 0.001) and albumin quotient (COVIDpost: r [95%CI] = 0.52 [0.26 - 0.71], p < 0.001; COVIDreco: r [95%CI] = 0.37 [0.10 - 0.60]; p = 0.01), consistent with passive transfer across the blood-CSF barrier rather than compartmentalized intrathecal immune activation. Furthermore, SARS-CoV-2-specific antibody measures were not associated with cognitive performance (p > 0.72) or fatigue severity (p > 0.88). This study provides no evidence that persistent neurological symptoms after COVID-19 are accompanied by ongoing adaptive CNS immune activation, disease-specific neuronal autoimmunity, or intrathecal SARS-CoV-2-specific humoral immune responses. The inclusion of a carefully phenotyped COVID-19 recovered comparison cohort strengthens the conclusion that routine CSF abnormalities largely do not seem to reflect mechanisms specific to PCS. These findings argue against routine CSF diagnostics as a source of disease-specific biomarkers in unselected PCS patients and support future studies focusing on alternative mechanisms underlying persistent neurological symptoms.

Background: Major depressive disorder (MDD) is a severe mental illness associated with severe clinical consequences and substantial societal burden. It's characterized by immune-inflammatory dysregulation and immune sensitization. Objective: To determine whether in vitro ketamine attenuates phytohemagglutinin (PHA)/lipopolysaccharide (LPS)-induced immune sensitization in patients with MDD and healthy controls (HCs). Methods: Whole blood from 18 patients with MDD and 18 HCs was stimulated with PHA/LPS and exposed to ketamine (0.3 M, 0.6 M, and 6 M) for 72 hours. Cytokines, chemokines, growth factors, and composite immune profiles, including M1/M2 macrophages, T helper (Th)1/2/17, the immune-inflammatory response system (IRS), and compensatory immunoregulatory system (CIRS), were synthesized and determined. Results: Under PHA and LPS stimulation in vitro, the MDD group exhibited markedly elevated immune profiles, including M1, M2, Th1, Th2, Th17, IRS, CIRS, chemokines, and growth factors, consistent with immune sensitization. Significant group-by-treatment interactions were observed for Th1-Th2, M2, growth factors, IL-12(p70), M1, and chemokines. Ketamine produced minimal changes in HCs but broader suppression in MDD, particularly at the highest concentration, without normalizing the sensitized immune phenotype. Among the immune markers with no notable group-by-treatment interactions, ketamine exerted diagnosis-independent effects, decreasing MIP-1{beta}, IL-1&{beta}, Th1, TNF-{beta} IRS, IFN-{gamma}, and IL-2 compared to the control condition. Conclusions: Ketamine exhibited two distinct immunoregulatory patterns: selective, disease-dependent attenuation of sensitized immune pathways and broader, diagnosis-independent suppression of the stimulated immune response, predominantly at higher concentrations. However, these effects were insufficient to normalize the immune-sensitized phenotype of MDD.

Chronic stress is a major risk factor for psychiatric disorders such as depression and anxiety, yet the biological basis of individual differences in stress susceptibility and resilience remains poorly understood. Here, we examined physiological, behavioral, and medial prefrontal cortex (mPFC) transcriptomic responses to chronic restraint stress (CRS) in male BALB/c and C57BL/6J mice. After 21 days of CRS, BALB/c mice exhibited greater stress-related changes than C57BL/6J mice, including greater body weight loss, elevated serum corticosterone, reduced serum antioxidant capacity, and more pronounced depression-like behaviors. RNA sequencing showed largely strain-specific transcriptional changes in the mPFC. Strain x stress interaction analysis, followed by canonical pathway analysis using Ingenuity Pathway Analysis (IPA), identified strain-dependent molecular signatures. The most prominent differences involved extracellular matrix (ECM) organization and remodeling and neuroinflammatory signaling pathways, with greater predicted activation in BALB/c mice. IPA upstream regulator analysis further predicted multiple candidate regulators associated with these pathways, including TGF-{beta}/SMAD, C4a/C4b, and MAPK14. Among genes associated with these pathways, several ECM-related genes were preferentially upregulated in BALB/c mice, whereas activity-dependent immediate early genes were preferentially downregulated in C57BL/6J mice. These findings suggest that the strain-dependent mPFC transcriptional programs identified here may contribute to differential stress susceptibility and resilience.

Background: The systemic immune responses associated with persistent respiratory symptoms (PRS) after exposure to airborne environmental pollutants remain poorly understood. Objective: To identify immune disturbances associated with PRS, defined as persistent wheeze, cough, or breathlessness, we examined systemic immune responses and airway function in a cross-sectional cohort with detailed histories of airborne pollutant exposure. Methods: Never-smoking post-deployment Veterans with PRS (n=16) or without PRS (n=24) underwent chest computed tomography, pulmonary function testing, and oscillometry to assess structural and functional airway abnormalities. Peripheral blood mononuclear cells (PBMCs) were stimulated with anti-CD3/CD28 antibodies, lipopolysaccharide, or {beta}-glucan, and cytokine production was measured. Correlation analyses evaluated associations between cytokine responses and physiological measures of airway function. Results: Oscillometry, but not conventional pulmonary function testing or chest computed tomography, detected small-airway abnormalities in participants with PRS, including significantly greater frequency dependence of resistance and higher resonant frequency. Baseline PBMC cytokine concentrations were similar between groups. After stimulation, however, PBMCs from participants with PRS showed increased IL-17A production consistent with a type 17 (T17) response; innate stimulation also increased the type 2 (T2) cytokines IL-33 and IL-4. T2/T17 cytokine responses correlated positively with oscillometric measures of small-airway dysfunction. Conclusion: Individuals with PRS exhibited a stimulus-dependent systemic T2/T17 immune signature that was associated with early small-airway dysfunction. Clinical Implication: Stimulus-dependent systemic immune profiling, combined with oscillometry, may help identify early respiratory abnormalities in pollutant-exposed individuals whose conventional pulmonary tests remain normal.

Treatment-resistant depression (TRD) affects approximately one-third of depressed patients, yet the molecular mechanisms underlying this therapeutic non-responsiveness remain unclear. Pharmacological antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine, exert immunomodulatory effects, partially by shifting macrophages towards an anti-inflammatory phenotype. Clinical aberrations in lipid metabolism have been associated with fluoxetine non-responsiveness in depressed populations. As macrophage polarization is highly sensitive to changes in lipid metabolism, pathological alterations in lipid metabolism may directly interfere with the therapeutic efficacy of SSRIs such as fluoxetine. However, how metabolic and immunomodulatory effects of antidepressants relate to each other in the context of TRD remains largely unexplored. We studied the interplay between immunomodulatory capacity of fluoxetine and the macrophage lipid landscape. Human monocyte-derived macrophages (MoDMs) and murine bone marrow-derived macrophages (BMDMs) were utilized as experimental models to evaluate these localized immunometabolic effects. Under baseline conditions in wild-type macrophages, the characteristic anti-inflammatory effect of fluoxetine coincided with distinct intracellular lipid accumulation. Conversely, disrupting this lipid environment yielded opposite immunological outcomes. BMDMs deficient in the low-density lipoprotein receptor (Ldlr-/-) or wild-type BMDMs exposed to inflammatory oxidized phosphocholine-containing phospholipids (OxPLs) failed to undergo anti-inflammatory polarization and exhibited a robust pro-inflammatory response upon fluoxetine treatment instead. Collectively, these data demonstrate a critical link between the macrophage lipid landscape and immunomodulatory efficacy of fluoxetine. These findings suggest that deficiencies in the endogenous LDLR pathway and exposure to circulating lipid peroxidation products can modulate the immunological response to fluoxetine. Our observations highlights microenvironmental lipid stress as a potential contributor to the underlying biology of antidepressant resistance in TRD.

PurposeIt is well established that volatile anesthetics and surgery induce acute and subacute changes in the cellular and molecular landscape of the brain and peripheral circulation and can impair neurological function. However, the chronic neurological sequelae of isoflurane (Iso) anesthesia combined with surgical operation (OP), as well as the underlying mechanisms of postoperative neurological dysfunction, remain poorly understood. MethodsYoung adult male (M) and female (F) C57BL/6 mice underwent 4 h of 2% Iso plus laparotomy or sham treatment. At 12 weeks, olfactory and cognitive function were assessed by odor memory, buried food, Y-maze, and active avoidance tests. Olfactory bulbs (OB) and hippocampi (HI) were collected for RNAseq, while plasma extracellular vesicles (EVs) were isolated, characterized by NanoFCM, and profiled by Olink proteomics. Lastly, EVs were injected into the HI of naive male mice, and cytokine/chemokine responses were measured 24 h later. ResultsBoth sexes showed olfactory impairment after chronic Iso/OP, with greater deficits in females. Iso/OP mice, especially females, exhibited impaired odor recognition in the OM test and longer latencies to locate buried food. Female mice also showed greater hippocampal-dependent spatial working memory deficits in the Y-maze, with more arm returns and fewer alternations than Sham/F mice, whereas Iso/OP/M mice performed similarly to controls. Likewise, female, but not male, Iso/OP mice displayed impaired associative learning in the active avoidance test, evidenced by fewer avoided trials and more escape responses. These long-term behavioral abnormalities were accompanied by sex-divergent transcriptomic remodeling in the OB and HI, including altered synaptic, neurodevelopmental, extracellular matrix, stress-response, and chemotaxis-related pathways. Iso/OP reduced plasma EV particle numbers in both sexes and shifted EV size distributions, with prominent reductions in the 40-100 nm EV fraction. Proteomics revealed distinct sex-and condition-specific EV profiles, with several EV-associated proteins showing opposing sex-dependent expression patterns. Hippocampal injection of Iso/OP-derived EVs induced donor sex-dependent cytokine remodeling, confirming inflammatory bioactivity. ConclusionsFour-hour isoflurane (Iso) exposure combined with laparotomy in young adult mice induces chronic, sex-dependent neurological deficits with distinct transcriptomic remodeling across brain subregions. Persistent alterations in circulating EV abundance and inflammatory cargo may drive chronic neuroinflammation and long-term brain dysfunction.

Post-traumatic stress disorder (PTSD) has been associated with impairments in cognitive function, including working memory, and may involve altered glutamatergic regulation in the prefrontal cortex. In this study, we used 7T functional magnetic resonance spectroscopy (fMRS) to examine dorsolateral prefrontal cortex (DLPFC) glutamate during working memory in individuals with PTSD, trauma exposure without PTSD (TE), and no trauma exposure (NT). Eighty participants (27 PTSD, 27 TE, 26 NT) underwent baseline MRS followed by fMRS during a letter n-back task. A linear mixed-effects model was used to evaluate glutamate concentrations across baseline, 0-back, 1-back, 2-back, and post-task fixation conditions. Behavioral performance was assessed using repeated-measures ANOVA for percentage correct, reaction time, and the discrimination index (d) across the 0-back, 1-back, and 2-back conditions. Glutamate differed significantly by group, condition, and the group x condition interaction. Individuals with PTSD exhibited lower glutamate than NT at baseline and during the 0-back, 1-back, and 2-back conditions. TE participants also showed lower glutamate than NT during the 1-back and 2-back conditions. Within-group analyses showed higher glutamate during the 0-back, 1-back, and 2-back conditions than at baseline in the NT group, whereas these baseline-to-task differences were limited in the PTSD and TE groups. Accuracy decreased and reaction time increased with increasing working memory load, and discrimination (d) was lower in PTSD than NT. These findings demonstrate altered DLPFC glutamate dynamics during working memory in PTSD and trauma-exposed individuals. Functional MRS provides complementary information beyond resting-state MRS by characterizing glutamatergic responses during cognitive engagement and may improve our understanding of neurochemical alterations associated with trauma and PTSD.

Major Depressive Disorder (MDD) shows marked gender differences in prevalence and molecular signatures. Transcriptomic studies of post-mortem human brain tissue have reported alterations in the expression of synapse-related genes in MDD, including gender-specific patterns. But it remains unclear whether transcriptional changes observed in the brains of women with MDD are detectable in peripheral blood and conserved in experimental stress models. Whole-blood RNA sequencing was performed in women with MDD (n = 6) and matched healthy controls (n = 4). Differentially expressed genes (DEGs) were compared with previously reported female-specific blood and post-mortem brain transcriptomic datasets where selected overlapping synapse-associated genes were evaluated in the hippocampus and prefrontal cortex of female mice exposed to Chronic Variable Mild Stress (CVMS). Peripheral blood analysis identified DEGs enriched for synaptic organization, neuronal structure, and ion transport pathways. A substantial proportion of DEGs overlapped with previously reported datasets from peripheral blood, female MDD brain transcriptomic studies, and genes showing exclusive/enriched expression in the normal human brain. Network-based prioritization identified seven synapse-associated genes (SHANK2, SHANK3, CACNG8, GPHN, PICK1, NRXN2 and DNM2) for further analysis. In the female CVMS model, several of these genes showed altered expression in the hippocampus and/or prefrontal cortex, alongside behavioural changes and reduced dendritic spine density. These findings highlight shared transcriptional signals across human blood and human brain datasets, as well as in the mouse brain. However, larger studies are required to confirm and validate these observations.

Objective: To evaluate long-term neurological, mental, and menstrual health outcomes using a mixed-methods approach among women approximately 2 years after concussion compared with non-head-injured controls. Setting: Participants were recruited from [University X] sites, including the Concussion Clinic, Emergency Departments, Student Health Clinic, and [University X] + Me registry (April 2023 to September 2025). Follow-up occurred October to November 2025. Participants: Eligible participants were assigned female at birth, aged 18 to 45 years, not using hormonal birth control, and, for the concussion group, diagnosed within 7 days of injury. Of 45 concussion patients and 29 controls recruited, 11 concussion patients (mean age 30.4 +/- 8.4 years) and 16 controls (31.3 +/- 7.4 years) completed follow-up. Main Measures: Post-concussion symptoms were assessed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), depression using the Patient Health Questionnaire-9 (PHQ-9), and anxiety using the Generalized Anxiety Disorder-7 (GAD-7). Menstrual health was assessed using study-specific measures. Qualitative data captured perceived impacts on daily life, with recurring themes summarized using word clouds. Results: At follow-up, concussion patients reported significantly greater symptom burden (RPQ: 31.6 +/- 13.5 vs 9.4 +/- 9.8; p=0.0002; Hedges g=1.90), depression (PHQ-9: 9.5 +/- 6.5 vs 2.3 +/- 2.2; p=0.0005; g=1.60), and anxiety (GAD-7: 9.8 +/- 6.8 vs 2.8 +/- 3.0; p=0.0057; g=1.42). Qualitative findings highlighted persistent headaches, sleep difficulties, reduced interest, and effects on relationships and daily functioning. Conclusions: This study demonstrates significant long-term differences in symptom burden among women with concussions compared to controls. Findings highlight the importance of understanding real-world impacts to improve long-term care.

Psilocybin acutely alters neurotrophic, neurochemical, and immune markers, but the relationships between these responses and circulating microRNAs (miRNAs), i.e. non-coding RNAs that regulate post-transcriptional gene expression, remain unclear. In a randomized, double-blind, placebo-controlled study of 62 healthy adults who received psilocybin (0.17 mg/kg) or placebo, we previously demonstrated that let-7g-5p and miR-150-5p were transiently differentially expressed 360 minutes after psilocybin administration. Here, we examined whether changes in these miRNAs were associated with concurrent neurotrophic, inflammatory, pharmacokinetic, and glutamatergic measures. Expression changes from baseline to 360 min and 7 days were analysed using linear regression against changes in BDNF, TNF-, IL-6, C-reactive protein, cortisol, medial prefrontal cortex glutamate/total creatine, and psilocin concentrations. Psilocybin increased let-7g-5p and decreased miR-150-5p expression. Changes in let-7g-5p were positively associated with psilocin concentrations, suggesting sensitivity to inter-individual pharmacokinetic variability, whereas miR-150-5p showed no concentration-dependent association. In both groups, miRNA changes were negatively related to baseline expression: lower baseline let-7g-5p predicted larger increases, whereas higher baseline miR-150-5p predicted larger decreases. BDNF changes were associated with both miRNAs under placebo but not psilocybin, consistent with reduced between-subject variability and a flattened BDNF-miRNA relationship following treatment. Medial prefrontal glutamate was negatively associated with miR-150-5p change under psilocybin. No associations were found with immune biomarkers. Together, these findings support the predicted involvement of let-7g-5p and miR-150-5p in neuroplasticity and their potential as accessible blood-based biomarkers of individual neurobiological responsiveness to psilocybin and other psychedelics.

Background: Postoperative delirium is a common syndrome of acute changes in attention, cognition, and consciousness that may result from inflammation and/or neuroinflammation, but few studies have distinguished the relationships of preoperative and 24-hour postoperative systemic inflammation (i.e. in blood) versus neuroinflammation (i.e. in cerebrospinal fluid, or CSF) in postoperative delirium. Methods: We measured CSF and plasma cytokine levels before and 24-hours after non-cardiac/non-neurologic surgery in 199 patients age [&ge;] 60 years who were enrolled in two prospective cohort studies. Delirium was assessed with the confusion assessment method (CAM), 3-minute diagnostic interview for CAM-defined delirium, or the CAM for the Intensive Care Unit (CAM-ICU) in patients who remained intubated postoperatively and validated chart review. Cytokines were measured with immunoassays for IL-6, IL-7, IL-8, IL-10, IL-16, TARC, MCP-1, and IP-10. Associations of CSF and plasma cytokine levels with postoperative delirium were assessed with univariable and multivariable logistic regression analyses with Holm correction for family-wise error. Results: Surgery was associated with significant changes in nearly all measured CSF and plasma cytokines (p < 0.05) except plasma IL-16 and MCP-1. In multivariable analyses adjusted for preoperative Mini-Mental Status Exam (MMSE) score and surgery duration, higher preoperative CSF IL-6 (OR 1.80, 95% CI 1.18-2.75, Holm p=0.049) and CSF IL-8 (OR 1.94, 95% CI 1.22-3.06, Holm p = 0.040) levels were independently associated with postoperative delirium. Higher 24-hour postoperative CSF IL-10 was nominally associated with delirium (OR 1.57, 95% CI 1.06-2.33, p = 0.026) in a multivariable regression controlling MMSE and surgery duration, but this association did not remain significant after multiple-comparison correction (Holm p = 0.21). No other preoperative or 24-hour postoperative CSF or plasma cytokine levels were associated with delirium (p > 0.05). Conclusions: Surgery elicited robust postoperative changes in CSF and plasma cytokines, but 24-hour postoperative cytokine elevations were not significantly associated with postoperative delirium after multiple-comparison correction. In contrast, elevated preoperative CSF IL-6 and IL-8 levels were associated with postoperative delirium independent of baseline cognitive status and surgery duration. Thus, our findings support an important role for preoperative neuroinflammation in postoperative delirium in older elective surgery patients.

BackgroundPsilocybin, a classic psychedelic, produces acute alterations in brain function, and has shown sustained therapeutic effects in psychiatric disorders. However, most studies focus on acute brain imaging readouts (e.g., fMRI) and rarely assess longer-term molecular changes. MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression, are enriched in the brain, and can be released into blood, potentially indexing brain-relevant molecular processes. We hypothesised that a single psilocybin dose would show acute changes in miRNAs with predicted relevance to neuroplasticity related signalling and immune/inflammatory regulation in healthy adults. MethodsIn a randomised, double-blind, placebo-controlled study (N=62; 31 psilocybin, 31 placebo), volunteers received psilocybin (0.17 mg/kg) or placebo. Blood was collected at baseline, 360 minutes, and 7 days after dosing. Plasma miRNAs were quantified by small RNA sequencing. Elastic net regression was used for feature selection, followed by differential expression analysis and validation with linear mixed models. Pathway enrichment used Reactome and Gene Ontology. ResultsTwo circulating miRNAs (let-7g-5p and miR-150-5p) met criteria for differentially expressed at 360 minutes following psilocybin administration, with no significant differences detected at 7 days or in the placebo condition under the statistical thresholds used. Over representation analysis suggested enrichment of molecular processes involved in neuroplasticity (e.g., TrkA, MAPK), inflammation (e.g., IL-6, TGF-{beta}), and transcriptional regulation (e.g., RNA polymerase II, SMAD2/3/4). ConclusionsA single oral dose of psilocybin was associated with transient alterations in circulating miRNA expression, consistent with an acute shift in circulating gene-regulatory miRNA signals, without sustained miRNA changes at 7 days. These findings provide initial evidence that circulating miRNA changes after psilocybin may reflect acute molecular process responses and support further investigation of circulating miRNAs as potential biomarkers of psychedelic-induced molecular responses.

Background: Biological sex and endocrine signaling influence cancer biology, immune response, and therapeutic outcomes. Recent evidence suggests that testosterone signaling may exert brain context dependent protective effects in glioblastoma through the hypothalamic-pituitary-adrenal axis, reduced glucocorticoid-mediated immune suppression, and altered tumor-immune interactions. We assessed whether testosterone replacement therapy (TRT) exposure was associated with survival in solid tumor central nervous system (CNS) metastases and glioblastoma (GBM, IDHwildtype, WHO grade 4), settings in which post-diagnosis survival and TRT timing can be clinically defined. Methods: We performed a retrospective Mayo Clinic cohort study of adult patients with molecularly confirmed glioblastoma and solid tumor CNS metastases confirmed from neuroimaging reports using large language model-assisted adjudication. TRT exposure was defined by testosterone-specific prescription evidence within prespecified peri-diagnostic windows. Overall survival was evaluated using propensity score-matched Cox models, 24 month administratively censored Cox models, time-dependent Cox sensitivity analyses, and 24 month restricted mean survival time. Results: In the pooled solid tumor CNS metastasis cohort, TRT exposure was associated with improved overall survival after propensity score matching (HR 0.80, 95% CI 0.65 to 0.98, p=0.029) and a 3.22-month improvement in 24 month restricted mean survival time. In glioblastoma, TRT exposure was similarly associated with improved overall survival after propensity score matching (HR 0.56, 95% CI 0.38 to 0.82, p=0.003) and a 5.81-month improvement in 24 month restricted mean survival time. Conclusions: TRT exposure was associated with improved survival in CNS metastases and glioblastoma. These hypothesis-generating findings support prospective studies incorporating TRT timing, hormone levels, corticosteroid exposure, immune correlates, and tumor-specific stratification.

Objectives: To estimate the prevalence of Post-Exertional Malaise (PEM) among adults with prior COVID-19 and associated mental health and disability outcomes. Methods: We conducted a cross-sectional analysis of data from a survey of 9,620 adults with prior COVID-19 in New York City, collected May - June 2024. PEM was measured with the DePaul Symptom Questionnaire - Post Exertional Malaise, categorized by symptom duration (< 14 vs. [&ge;]14 hours). Weighted prevalence estimates were stratified by socio-demographic and clinical characteristics. Modified Poisson regression was used to assess the association of PEM with depression, anxiety, and disability. Results: The prevalence of PEM symptoms was 20.9% overall and 4.0% with symptom duration [&ge;]14 hours, representing over 800,000 New Yorkers affected and over 150,000 who meet a diagnostic criterion for ME/CFS. PEM prevalence was higher among women, transgender and non-binary adults, people of color, and lower educational attainment, chronic comorbidities, or disabilities. PEM was associated with 3 - 4 times higher prevalence of mental health outcomes and 4 - 5 times higher disability scores. Conclusions: PEM symptoms were common and strongly associated with disability and adverse mental health. Screening, pathways to care, and supportive policies are needed to mitigate long-term consequences, particularly among marginalized populations.

Background Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a poorly understood, debilitating multisystem condition. Converging evidence implicates impaired cellular bioenergetics, neuroinflammation and defective neurovascular coupling that may manifest as "virtual hypoxia" only under physiological stress. Methods We performed a single-session multimodal 3T MRI study combining brain volumetry, arterial spin labelling (ASL) and multivoxel proton magnetic resonance spectroscopy under normoxia and two controlled hypoxic challenges (oxygen saturation 87 {+/-} 3%) in 26 ME/CFS patients and 27 age- and sex-matched healthy controls. Results After intracranial-volume normalization, patients showed a reduced brainstem volume (1.46 0.14 vs. 1.55 {+/-} 0.18 % of eTIV; p = 0.013, FDR-p = 0.039), whereas deep grey matter and whole-brain parenchymal fraction did not differ between groups. Whole-brain cerebral blood flow (CBF) rose under hypoxia in both groups (controls +4.8 {+/-} 13.0%, patients +3.7 {+/-} 11.7%), with greater initial inter-individual variability in patients (patient-to-control variance ratio up to 6.94; FDR-p = 0.001). Thalamic lactate-to-creatine (Lac/tCr) ratios increased with hypoxia in controls (FDR-p = 0.028) but were already elevated at normoxia in patients (0.171 vs. 0.135; FDR-p = 0.021) and did not rise further (FDR-p = 0.38). In exploratory analyses, patients showed exaggerated inverse coupling between thalamic total N-acetylaspartate (tNAA/tCr) and white-matter CBF. Conclusions These findings provide in vivo evidence of impaired neuro-metabolic and vascular adaptive capacity in ME/CFS, supporting the virtual hypoxia hypothesis and highlighting candidate imaging markers for stratification that warrant validation.

Brain development, especially developmental myelination, continues through young adulthood. Concordantly, children may be particularly vulnerable to neural-immune challenges. To investigate the consequences of major childhood immune challenges, juvenile mice were exposed to respiratory influenza (H1N1) infection. White matter-specific microglial reactivity accompanied by oligodendrocyte loss was evident until two months following infection. Mice exhibited hyperlocomotion and impaired attention, but not anxiety-like behavior, at one month following infection. Linking the oligodendroglial and behavioral deficits, genetic disruption of oligodendrocyte development at the same juvenile timepoint recapitulated this behavioral phenotype. Microglial reactivity and oligodendrocyte numbers normalized by young adulthood. However, myelin development was disrupted, with persistently decreased myelinated axon density and reduced myelin sheath thickness. Hyperlocomotion resolved, but anxiety-related behaviors emerged at two months after infection. At 6 months, anxiety resolved but cognitive deficits persisted. Elevated CSF chemokines and microglial chemokine expression prompted testing the role of the multi-chemokine receptor CCR3. CCR3 inhibition rescued these cellular and behavioral aberrations after juvenile H1N1 infection. Together, these findings underscore the potential for disruption of myelin development and lasting cognitive and neuropsychiatric sequelae following major immune challenges during the juvenile period and highlight chemokine signaling as an important therapeutic target.

The longstanding association between psychological trauma or stress and subsequent chronic inflammatory disorders is well-documented, but the mechanism by which psychopathology causes these immune changes has yet to be elucidated. We have previously reported that sympathetic innervation to lymphoid organs and beta adrenergic receptor signaling are essential for T-lymphocyte interleukin 17A (IL-17A) production and TH17 polarization, though the exact mechanistic contribution of this signaling to the development of TH17 cells remained unclear. Therefore, we hypothesized that norepinephrine (NE) is a novel and direct regulator of T-lymphocyte IL-17A expression. Herein, we indeed observed that NE regulates baseline IL-17A in vivo. We further identified a novel mechanism by which transforming growth factor beta (TGF{beta}) and NE together result in TH17 polarization and IL-17A production in CD4+ T-lymphocytes. Additionally, we found that cAMP, PKA, and CREB are induced by NE signaling, which ultimately increases CBP/p300 activity to initiate ROR{gamma}t transcription. Surprisingly, our data also demonstrate that STAT3, a transcription factor previously described as necessary for canonical TH17 polarization, is not involved in this novel pathway and may even be downregulated. Combined with bulk RNA sequencing data, our data highlight robust differences between the novel and canonical pathways to TH17 polarization. Altogether, our data reveal a novel, noncanonical mechanism that links sympathetic nervous system activity with IL-17A related inflammation, which may have significant relevance to sympathoexcitation-related disorders that stem from psychological trauma or stress.