Brain, Behavior, & Immunity - Health

BackgroundAn overwhelming body of evidence suggests neuroimmune dysfunction as a key underlying mechanism of FASD-associated adverse CNS outcomes. While few studies have highlighted the lingering effects of prenatal alcohol exposure (PAE) on producing specific immune factors, others suggest a primed neuroimmune state in adulthood, in which a proinflammatory bias is unmasked following subsequent immune activation in later-life. However, the PAE-induced neuroimmune landscape in adulthood remains poorly defined. We hypothesized that PAE induces long-term changes in gene expression linked to neuroimmune function that may be brain region-specific. MethodsUsing long-read next-generation RNA sequencing of brain tissues from a previously established model of a moderate PAE in mice, we compared across six regions: medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), hypothalamus, hippocampus, midbrain, and medulla. A comprehensive bioinformatics analysis investigated PAE-induced changes, dysregulated gene pathways, and transcriptional regulators with a focus on neuroimmune function. ResultsOur data identified at least 60 differentially expressed genes per brain region, many of which were associated with neuroimmune function. Upregulation of multiple proinflammatory factors and pathways was observed, suggesting ongoing baseline neuroimmune activation, potentially involving PXR, TNF, TLR4, the complement pathway, and various cytokine and chemokine signaling. A comparative analysis identified multiple upstream transcriptional regulators across multiple brain regions, including MECP2, TCF7L2, and IL-4. Importantly, this unbiased analysis revealed heterogeneity across brain regions in the activation of canonical immune pathways and highlighted previously unprecedented roles of pathways such as PXR, matrix metalloproteases, and cytokine signaling (e.g., IL-15, IL-27, IL-17) in PAE. ConclusionsPAE creates a unique inflammatory signature in the adult brain, even in the absence of secondary injury, with novel patterns of region-specific changes in genes implicated in glial-immune function. These data identified potential immune targets to elucidate the mechanisms underlying behavioral dysfunction and provide a framework for future therapeutic interventions.

Introduction: Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) is a debilitating condition characterised by severe fatigue and post-exertional malaise (PEM). Reported neuropsychophysiological abnormalities suggest ME/CFS is multifactorial, but current knowledge remains fragmented. This study protocol outlines a multimodal investigation designed to (1) compare neuropsychophysiological mechanisms between ME/CFS patients and healthy participants, (2) test an integrative model of ME/CFS, (3) identify neuropsychophysiological subgroups within the patient population, and (4) identify predictors of symptom response during rehabilitation. Methods and analysis: This study will enroll 115 ME/CFS patients and 55 healthy participants. Groups will be comparable in age, sex, and education level, with a larger patient sample enabling subgroup and longitudinal analyses. A cross-sectional assessment at baseline will be carried out in both groups. Patients will then be evaluated longitudinally throughout a standardized cognitive-behavioral therapy rehabilitation program delivered as routine care. Baseline measures include systemic inflammation and general health biomarkers, measures of autonomic and central nervous system function, neuroinflammation (magnetic resonance spectroscopy, [18F]DPA714 PET in a subsample), serum short-chain fatty acid levels, gut microbiota composition and function, and neuroendocrine and self-reported responses to psychosocial stress. Fatigue severity (physical and cognitive) and PEM will be assessed through validated questionnaires, ecological momentary assessment, and laboratory tasks. These will be re-evaluated during therapy, and all non-neuroimaging measures will be repeated after the rehabilitation program. Statistical analyses will comprise multivariate analysis of variance, general linear models, classification algorithms, structural equation models, least absolute shrinkage selection operator principal component regression (LASSO-PCR), cluster analysis and latent class growth analysis (LCGA).

Background/ObjectivesNeuroinflammation-driven iron dysregulation and neurotoxic astrocyte polarization are increasingly recognized as interconnected pathological mechanisms in neurodegenerative diseases. Systemic inflammation triggered by strenuous exercise or infection can engage the central nervous system and astrocytic inflammatory responses and perturb iron homeostasis; however, targeted nutritional strategies to counteract these processes remain limited. Inflamate(R) is a multi-component botanical supplement comprising boswellic acids, astilbin, xanthohumol, and cinnamaldehyde, each with documented anti-inflammatory properties. However, whether this combined formulation can modulate the inflammatory-iron metabolic axis and astrocyte phenotypic polarization remains unexplored. This study aimed to investigate the effects of Inflamate(R) on LPS-induced pro-inflammatory gene expression, iron metabolism-related gene regulation, and A1/A2 astrocyte phenotypic polarization in mouse astrocytes. MethodsMouse astrocytes (AWT) were pre-treated with Inflamate(R) (0.0375 g/mL) or DMSO vehicle for 24 h, followed by lipopolysaccharide (LPS; 1 g/mL) stimulation for an additional 24 h. The non-cytotoxic working concentration was determined by morphological assessment, CCK-8 cell viability, and LDH cytotoxicity assays. Expression of 14 target genes spanning pro-inflammatory mediators (NOS2, IL6, C3, COX2, PLA2g15, SOCS3), iron metabolism regulators (FTH1, Hepcidin, TFRC, SLC40A1, RGMa, RGMb), and astrocyte polarization markers (S100A10, GFAP) was quantified by qRT-PCR. ResultsUnder normal culture conditions, Inflamate(R) did not significantly alter the expression of any target gene except S100A10, confirming the absence of baseline cytotoxicity or transcriptional homeostatic perturbation. Upon LPS stimulation, Inflamate(R) selectively suppressed NOS2 (approximately 64% reduction, p < 0.0001), IL6 (approximately 37% reduction, p < 0.0001), and C3 (approximately 47% reduction, p < 0.0001), while COX2, PLA2g15, and SOCS3 remained unaffected. Concurrently, Inflamate(R) significantly reduced LPS-induced Hepcidin expression to approximately 17% of the control level (p < 0.05) and attenuated FTH1 upregulation (p < 0.01), without altering the expression of iron transporters (TFRC, SLC40A1) or BMP-SMAD pathway components (RGMa, RGMb). Furthermore, Inflamate(R) upregulated the neuroprotective A2 marker S100A10 under both basal (p < 0.05) and LPS-stimulated conditions (p < 0.01), while the general reactivity marker GFAP remained unchanged. ConclusionsInflamate(R) exerts a selective, multi-target modulatory effect at the transcriptional level in LPS-stimulated astrocytes, encompassing suppression of the iNOS-NO and IL-6 signaling axes, attenuation of inflammation-driven hepcidin-ferritin iron dysregulation via the IL-6-STAT3 pathway, and promotion of a phenotypic shift from neurotoxic A1 toward neuroprotective A2 astrocyte polarization. Given that the IL-6-JAK-STAT3-hepcidin axis is also activated during exercise-induced systemic inflammation, these findings suggest that Inflamate(R) may represent a targeted nutritional strategy for preserving CNS iron homeostasis and supporting neuroprotective astrocyte function in both neurodegenerative and exercise-related neuroinflammatory contexts. Further validation in in vivo neurodegenerative and exercise models, including protein-level analyses, is warranted to confirm these transcriptional findings.

Background: The biological mechanisms linking generalized anxiety disorder (GAD) and COVID-19 remain poorly understood, despite substantial evidence of their comorbidity. To address this gap, we examined genetic and epigenetic factors underlying their co-occurrence. Methods: In a multi-ancestry sample of 893 participants, we conducted genome-wide and epigenome-wide analyses of GAD and COVID-19 severity. Integrating large-scale genome-wide datasets and information regarding methylation quantitative trait loci, complementary analytic approaches were used to identify regional methylation patterns, assess genetically regulated DNA methylation in blood and brain tissue, and evaluate causal loci shared between GAD and COVID-19. Results: GAD was associated with epigenome-wide significant variation in loci involved in chromatin regulation and synaptic signaling. Conversely, COVID-19-related epigenetic signals were enriched in immune-inflammatory and host-response pathways. Mild COVID-19 was epigenetically related to endothelial-inflammatory signals, while severe COVID-19 was linked to epigenetic changes implicated in myeloid and thrombo-inflammatory pathways. Epigenetic signals shared between GAD and COVID-19 implicated processes related to stress adaptation and tissue homeostasis. Genetically informed analyses identified 60 shared loci, including MAPT, ZFP57, and FBXL18, indicating pleiotropy between GAD and COVID-19 in genetically regulated DNA methylation variation. Brain-specific analyses further highlighted convergence in additional loci (i.e., MICB and HLA-DPB1), suggesting neuroimmune mechanisms underlying GAD-COVID-19 shared methylation patterns. Conclusions: These findings support that GAD and COVID-19 share epigenetic and genetic architecture involving pathways related to vascular integrity, immune function, and cellular adaptation, highlighting a potential neuroimmune basis for their co-occurrence.

Background: Vascular contributions to cognitive impairment and dementia (VCID) are thought to arise from distributed neurovascular unit (NVU) dysfunction rather than focal pathology, yet the transcriptional architecture of human VCID brain tissue and the status of endogenous counter-regulatory signaling within it remain incompletely characterized. Defining whether protective pathways are engaged and why they may be insufficient is critical for identifying therapeutic entry points in a disease lacking approved treatments. Methods: We performed differential gene expression analysis (DESeq2 v1.38.0) and pre-ranked gene set enrichment analysis (fgsea v1.24.0) on bulk RNA-sequencing data from superior parietal lobe tissue (GEO:GSE303449; n = 40; 19 VCID, 21 controls; model: age_scaled + Sex + condition), followed by Spearman correlation analysis, PI3K-Akt pathway level, leading-edge decomposition, and single-nucleus RNA-seq endothelial cell characterization (GEO:GSE282111). Results: No individual gene reached FDR < 0.05 for differential expression between VCID and control across 51,962 genes tested. Gene set enrichment analysis nonetheless identified eight significantly enriched pathway programs (all FDR < 0.05) that were upregulated, encompassing inflammatory, stress-response, cytoskeletal, and apoptotic signaling, consistent with distributed network-level dysregulation rather than dominant single-gene effects. The MAS1/ANG1-7 associated signaling gene set (54 genes) was the only counter-regulatory pathway achieving significance (NES = 1.381, FDR = 0.0127). MAS1 receptor expression was strongly (absolute Spearman's rho >= 0.64) and inversely associated with NF-kB pathway drivers TLR4 (Spearman's rho = -0.804) and IKBKB (Spearman's rho = -0.797; both FDR = 4.73 x 10^-9). Further, 9 of 12 correlations between MAS1 downstream effectors and endothelial activation markers were FDR-significant and positive, indicating that the downstream protective effector program is co-activated by inflammatory stress rather than directed by its receptor. Single-nucleus RNA-seq supports endothelial enrichment of the MAS1 pathway enrichment signal in VCID brain tissue. PI3K-Akt leading-edge decomposition revealed 96% gene-level non-overlap between inflammatory and vasoprotective arms. Conclusions: Human VCID brain tissue exhibits coordinated pathway-level dysregulation in the absence of dominant individual-gene effects, consistent with a disease driven by distributed transcriptional network stress. The MAS1/ANG1-7 vasoprotective axis is transcriptionally engaged and endothelially enriched, yet receptor expression is inversely associated with inflammatory signaling while downstream effectors remain transcriptionally engaged. This pattern suggests a failed compensatory state in the VCID superior parietal lobe. This architecture is consistent with a transcriptionally primed but receptor-constrained protective program. These findings suggest that therapeutic strategies restoring MAS1 receptor-level input to an already engaged downstream program may represent a plausible therapeutic strategy for VCID, pending experimental validation.

Despite their prevalence, the pathophysiology of depression and anxiety remains poorly understood. Although adversity is a known risk factor, the mechanisms and biological contexts through which it contributes to mood disorder symptoms remain unclear. Immune and mitochondrial adaptations have both been implicated in mood disorders, suggesting the biological embedding of adversity may involve both systems. However, inconsistencies in the literature remain, partly due to reliance on mixed peripheral blood mononuclear cell (PBMC) populations despite substantial variability in mitochondrial biology across immune cell subtypes. We therefore investigated associations between adversity, mood disorder symptoms, immune cell proportions, and immune cell-specific mitochondrial bioenergetics (enzyme activities and respirometry) in participants from the Mitochondrial Stress, Brain Imaging, and Epigenetics (MiSBIE) study (n=105, age 18-60, 68% female, 35% with mitochondrial disease). Depressive and anxiety symptoms were positively associated with the monocyte-to-lymphocyte ratio, suggesting a shift toward greater innate relative to adaptive immunity. Associations between mood disorder symptoms and immune cell count were stronger in those exposed to greater early life adversity. Mood disorder symptoms were negatively associated with lymphocyte maximal mitochondrial respiratory capacity (MRC). As expected, the associations between mood disorder symptoms and lymphocyte mitochondrial bioenergetics (enzyme-based MRC and respiratory measurements) were stronger and more consistent among individuals exposed to higher lifetime adversity compared to those with lower lifetime adversity. Overall, these results suggest a complex interplay between adversity, immune cell mitochondrial bioenergetics, and mood disorder symptoms, highlighting immune mitochondrial biology as a potential allostatic pathway linking adversity to psychiatric disorders.

Early adversity increases vulnerability for adult psychopathology. Across multiple pre-clinical models of early adversity, there are reports of glial dysfunction and disrupted amino acid neurotransmission, along with maladaptive behavioral responses in adulthood. Disrupted G-protein coupled receptor signaling is known to phenocopy specific consequences of early life adversity. Enhanced Gq signaling in the forebrain excitatory neurons in early postnatal life programs anxio-depressive behaviors in adulthood, accompanied by altered neuronal glutamate and GABA metabolism in mouse models. We hypothesized that enhancing Gq signaling in forebrain excitatory neurons in early postnatal life may also impact glial function in adulthood. Our results show that postnatal hM3Dq-mediated chemogenetic activation of CaMKII-positive forebrain excitatory neurons not only increases anxiety-like behavior, but also evokes bidirectional transcriptional regulation of multiple glia-associated genes in the neocortex and hippocampi. While Gfap, Aldh1l1, S100{beta}, Eaat1, Eaat2 and Eaat3, mRNA levels were reduced in the neocortex, they were enhanced in the hippocampus, and a similar pattern was noted for GFAP protein levels. Transient, postnatal chemogenetic activation of CaMKII-positive neurons did not alter astrocyte cell density in both the neocortex and the hippocampus. Using (1H-(13C)) NMR spectroscopy, we observed a significant decline in astrocyte-specific glutamate and GABA neurotransmitter turnover, and a reduction in astrocyte metabolic flux within the neocortex and the hippocampus in adulthood in animals with a history of postnatal chemogenetic activation of forebrain excitatory neurons. Our findings indicate that chemogenetically driving Gq signaling transiently during the postnatal window in forebrain excitatory neurons results in persistent changes well into adulthood, with enhanced anxiety-like behaviors and disrupted glial function and metabolism, phenocopying specific changes in glial function noted following early adversity.

Background: Aberrations in neuro-immune, metabolic, and oxidative stress (NIMETOX) pathways are implicated in major depressive disorder (MDD). First-episode simple dysmood disorder (FE-SDMD) without metabolic syndrome offers a unique model to investigate early lipid alterations underlying NIMETOX pathophysiology. Methods: Plasma samples were collected from 88 university students (44 FE-SDMD, 44 healthy controls). Participants underwent comprehensive psychiatric and psychological assessments, including adverse childhood experiences (ACEs), negative life events (NLEs), depression, anxiety, suicidal behaviors, and insomnia. Untargeted lipid profiling was performed using LC-QTOF-MS, while indices of oxidative and nitrosative stress (ONS) and lecithin-cholesterol acyltransferase (LCAT) activity were assessed. Data was analyzed using machine learning approaches with recursive feature elimination and cross-validation. Results: FE-SDMD was characterized by increased ceramides (CER), diacylglycerides (DAG), triacylglycerides (TG), sphingomyelins (SM), bis-monoacylglycerol phosphates (BMP), cholestone, and fatty-acyl amino acids (FAAA). DAG, CER, and BMP were the strongest predictors of depression severity and physiosomatic symptoms, whereas cholestone, CER, and SM predicted suicidal behaviors. These lipid modules, together with lowered LCAT and increased ONS, explained substantial variance in depression severity (46.4%), physiosomatic symptoms (42.4%), cognitive-affective symptoms (37.9%), suicidal behaviors (30.1%), insomnia (32%), and anxiety (19.5%). ACEs and NLEs were strongly associated with CER (p<0.001), DAG (p<0.01), and cholestone (p<0.01). Conclusion: Early-stage MDD is characterized by distinct lipid dysregulations linked to psychosocial stress exposure, oxidative and nitrosative stress, and an indicant of impaired reverse cholesterol transport. These lipid modules may serve as early biomarkers and therapeutic targets in vulnerable populations.

Background Preterm birth (PTB) rates among Hispanic/Latina individuals in the United States have risen over the past decade. Data suggests this rise may be driven in part by psychosocial stress. Leukocyte telomere length (LTL), a marker of cumulative cellular aging that shortens under chronic stress, may capture stress-related biological vulnerability, but has not been examined as a potential population-level contributor to PTB in Hispanic/Latina pregnancies. Objective To examine the association between mid-pregnancy maternal LTL and PTB in a population-based Hispanic/Latina cohort. Methods In a case-control study nested within a California singleton birth cohort (n = 436 Hispanic/Latina individuals; 215 PTB, 221 term births), LTL was measured by quantitative PCR from biobank specimens collected from 15 to 20 weeks of gestation. Covariates from linked birth certificate and hospital discharge records were included. Logistic regression estimated ORs and 95% CIs of PTB by LTL examined continuously and by percentile category (<=10th, 11th-89th, >=90th) with and without adjustment for covariates. Results Mean and median LTL did not differ between PTB and term births. LTL at or below the 10th percentile was associated with elevated odds of PTB relative to full-term birth (12.6% versus 4.3%; ORc = 3.2, 95% CI 1.3-7.9), persisting after partial (ORadj1 = 3.2, 95% CI 1.3-8.3) and full covariate adjustment (ORadj2 = 3.4, 95% CI 1.3-9.3). Subgroup analyses showed consistent directional patterns across PTB subgroups and for early term birth (ORadj2 = 5.1, 95% CI 1.5-17.0). Conclusions Mid-pregnancy maternal LTL <=10th percentile was associated with more than three times the odds of PTB, with risk concentrated at the extreme low tail of the distribution. Consistent with a cumulative allostatic load model, markedly short LTL at mid-gestation may reflect elevated stress-related biological risk for preterm delivery. These findings support upstream investment in stress reduction and prospective LTL research in high-burden populations.

Abnormalities in the gut microbiome, intestinal permeability, and the gut-immune-brain axis are increasingly linked to neuropsychiatric disorders, neurodegenerative disorders, inflammatory bowel disease (IBD), and other immunologic/autoimmune conditions. We investigated these phenomena in 128 youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and individuals with autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDD) characterized by profound, unexplained deteriorations/regressions in developmental, neuropsychiatric, and behavioral functioning. Previous studies we have carried out showed that immune dysregulation and DNA damage response (DDR) gene mutations are implicated in a subset of these patients. The current study examines the role of genetic variants affecting intestinal homeostasis. We report a series of patients exhibiting both neuropsychiatric deterioration and gastrointestinal symptoms. Genetic analysis identified ultrarare (minor allele frequency < 0.001) pathogenic or likely pathogenic variants in eight genes primarily expressed in the intestines and associated with IBD, dysbiosis, or intestinal permeability. Across thirteen patients, mutations were identified in DUOX2 (n=4), SLC10A2 (n=2), UNC45A, TTC7A, LGALS4, SI, CCR9, MEP1B, and BACH2. While these findings suggest a potential role for genetic variants governing intestinal homeostasis in these cases of neuropsychiatric decline, their presence in only a small subgroup necessitates larger, prospective cohorts to determine whether these variants are statistically significant and play a definitive role in the pathogenesis of these disorders.

Background: Wide-spread mast cell (MC)-associated symptoms and MC activation syndrome (MCAS) are often reported in patients with hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD). The goal of this study was to develop a novel MC score based on 11 self-reported MC-related conditions with clinical and research utility to better understand MC symptoms in hEDS and HSD patients. Methods: From November 1, 2019, to June 13, 2025, patients (n=2,141) filled out an Intake Questionnaire at the Mayo Clinic Florida EDS Clinic that included 11 self-reported questions related to categories of MC-related conditions for a MC score ranging from 0/11 to 11/11. Based on the MC score distribution in hEDS and HSD patients, a MC score of 0-1 was considered a low MC score and [&ge;]5 was considered a high MC score. Symptoms/comorbidities were compared between patients with high vs. low MC scores. Results: From the 2,141 hEDS/HSD patients, 535 (25.0%) had a MC score [&ge;]5 (Hi MC). MCAS-specific symptoms such as nausea and vomiting were reported more often in hEDS/HSD patients with a high vs. low MC score (p<0.0001). Random clinical blood tryptase and urinary MC markers were not elevated in patients with high MC scores (n=50/group), although high MC scores were found to significantly reduce urinary creatinine levels indicating that the protein used to normalize data was affected by MC activity. In contrast, random blood IgE, tryptase and major basic protein (MBP) by ELISA were increased in patients with high MC scores (e.g., IgE hEDS p=0.0004, HSD p=0.003). Of note, the percentage of patients reporting abuse or post-traumatic stress disorder was nearly doubled in patients with high vs. low MC scores (Abuse and PTSD: hEDS p < 0.0001; HSD p < 0.0001). Overall, 109/135 (80.7%) in hEDS and 129/135 (95.6%) in HSD reported more symptoms/comorbidities if they had a high MC score. Conclusions: We found that hEDS/HSD patients with high MC scores self-reported more widespread symptoms/comorbidities and higher MC-related blood markers than patients with low MC scores indicating the utility of this tool to evaluate the level of widespread MC activity in hEDS, HSD and other patients.

Background: Psychiatric disorders and neurodegenerative diseases, including bipolar disorder (BD), schizophrenia spectrum disorders (SSD), Parkinson's disease (PD), and Alzheimer's disease (AD), are associated with substantial impairments in functioning and quality of life. Increasing evidence suggests that low-grade systemic inflammation and gut microbiome dysregulation are shared mechanisms across these brain disorders, providing a rationale for transdiagnostic interventions targeting the gut-brain axis. Objective: This study was designed to evaluate the efficacy of an anti-inflammatory dietary pattern (AIDP), termed the BrAIN diet, on global functioning and a comprehensive set of secondary clinical, cognitive, inflammatory, and gut-health outcomes across relevant patient populations. Methods: We designed an open-label, randomized controlled, two-period crossover trial with 12-week intervention periods, a 24-week washout period and 12-week follow-up. We aimed to enrol 100 adult outpatients (25 per diagnosis: BD, SSD, PD, and AD) aged 18-80 years, recruited through outpatient clinics and patient organisations in the northern Netherlands. Participants were randomized 1:3 to either start the BrAIN diet immediately (Group 1, BrAIN/diet-as-usual [DaU] sequence) or after 36-weeks (Group 2, DaU/BrAIN sequence). The BrAIN diet is based on Shivappa's Dietary Inflammatory Index, components of the MIND diet, and Dutch dietary guidelines, and is delivered through weekly home-delivered food boxes, recipes, and weekly dietitian counselling. The primary outcome is global functioning measured with the Outcome Questionnaire-45 (OQ-45). The treatment effect is estimated from the timepoint x treatment interaction in a linear mixed-effects model that uses all observed timepoints, with participant as a random intercept and period and sequence as fixed effects. Secondary outcomes include Global Assessment of Functioning (GAF), cognition (Brief Assessment of Cognition, Stroop, Trail Making), quality of life (EQ-5D), fatigue (FSS), gastrointestinal symptoms (GSRS), gut-permeability biomarkers, faecal microbiome composition, inflammatory and metabolic markers, and disease-specific symptom scales. Assessments occur at weeks 0 (V1, baseline period 1), 12 (V2, end of period 1), 24 (V3, mid-washout), 36 (V4, baseline period 2), 48 (V5, end of period 2), and 60 (V6, follow-up). The trial protocol was developed in 2021 and approved by the accredited Medical Research Ethics Committee on 11 January 2022. The trial is reported in accordance with the SPIRIT 2013 guideline in effect at the time of protocol development. Results: The trial received favourable ethical opinion from Medical Research Ethics Committee BeBo Assen (NL78755.056.21) on 11 January 2022 and was registered prospectively at OMON (NL-OMON52339). Recruitment commenced in February 2022; the first participant was enrolled on 7 March 2022 and the last on 6 May 2024. Follow-up was completed on 5 September 2025. A total of 107 participants were enrolled. Data analysis is ongoing; primary results are expected to be submitted for publication in summer 2026. Conclusions: This study provides evidence on whether an anti-inflammatory dietary intervention targeting shared inflammatory and gut-microbiome pathways can improve global functioning and a broad set of clinical and mechanistic outcomes in psychiatric and neurodegenerative populations. The crossover design ensures all participants ultimately receive the intervention while serving as their own controls, maximising statistical power within a heterogeneous patient population. If effective, the BrAIN diet could provide a safe, accessible adjunct to standard care in neuropsychiatric and neurodegenerative populations.

Introduction: Incomplete recovery from relapses contributes to long-term disability accumulation in relapsing remitting multiple sclerosis (RRMS), yet the relationship between immune regulation and relapse recovery remains poorly defined. Objective: To longitudinally characterize regulatory/effector immune cell dynamics in untreated RRMS patients and assess their association with immune balance and relapse recovery. Methods: Monocytic myeloid-derived suppressor cells (M MDSCs), regulatory T cells (Treg), and effector CD4 T cell subsets were measured in blood from 69 untreated RRMS patients sampled during relapse or remission and reevaluated after 12 months. Associations with clinical recovery after relapse were examined. Results: During relapse, patients exhibited higher M MDSC and Treg frequencies than in remission, while effector T cell subsets remained unchanged. Over one year, M-MDSCs increased consistently regardless of baseline clinical status, whereas Treg frequencies remained stable. Effector to M MDSC ratios were markedly elevated during relapse and declined over time, while effector-to-Treg ratios showed minimal variation. M MDSC levels during relapse were associated with sustained regulatory features at 12 month follow up. Importantly, higher baseline M MDSC levels, but not Treg frequencies, were associated with complete relapse recovery at one year. Conclusion: These findings suggest that circulating M-MDSCs, but not Treg, reflect interindividual differences in immune regulation and clinical recovery after relapse in early RRMS.

Background: The determinants of immunoglobulin E (IgE) remain poorly understood in older adults, a population with an increasing burden of chronic diseases. Identifying IgE's determinants may improve its clinical interpretation in the evaluation of allergic and IgE-related conditions. Objective: To investigate age, sex, smoking, alcohol, body mass index (BMI), corticosteroid use, and season as potential determinants of total IgE (tIgE) and inhaled allergen-specific IgE (sIgE). Methods: Using Rotterdam Study data, we investigated the determinants of tIgE and sIgE using multivariable linear regression. Longitudinal changes and the effects of corticosteroids were assessed with linear mixed models. Results: We included 8769 participants, of which 478 had repeated IgE measurements. Age showed a U-shaped relationship with tIgE and L-shaped relationship with sIgE (both p<0.001). Women had lower tIgE (OR [95%CI]: 0.69 [0.65-0.74]), whereas current smokers (1.34 [1.23-1.46]), higher BMI (1.01 [1.01-1.02]), topical corticosteroid users (1.27 [1.07-1.50]) and inhaled corticosteroid users (1.93 [1.64-2.26]) showed higher tIgE. Women (0.96 [0.92-1.00]), former smokers (0.87 [0.83-0.91]) and current smokers (0.72 [0.68-0.76]) had lower sIgE, whereas topical corticosteroid users (1.20 [1.07-1.35]) and inhaled corticosteroid users (1.20 [1.07-1.35]) showed higher sIgE. Over time, tIgE and sIgE decreased (p<0.001) but did not significantly change after corticosteroid use. Conclusion: We identified age, sex, smoking, BMI, season and topical and inhaled corticosteroids as determinants of tIgE and sIgE. Incorporating these determinants may improve IgE's clinical interpretation for the diagnosis and management of allergic and IgE-related conditions. Future research should investigate how these determinants shape IgE's relationship with chronic diseases in aging populations.

Background: Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP), established biomarkers of neuroaxonal injury and astroglial pathology, are frequently only assessed in blood, which limits conclusions regarding their origin. Bi-compartmental analyses of CSF and serum may help differentiate central or peripheral origin of biomarker elevation. Moreover, studies on NfL and GFAP in distinct neuroinfectious disease (NID) phenotypes are limited. Methods: This retrospective monocentric study analyzed CSF and serum from patients with (meningo-)encephalitis/myelitis (TI+; n=48), meningitis (TI-; n=80), (cranial) nerve palsies/polyradiculitis (PND; n=61), and 113 non-neuroinflammatory/non-neurodegenerative controls. A bi-compartmental model using scatter plots and simple linear regression was applied to assess the origin of blood biomarker levels and discriminate between central and peripheral pathology. Results: CSF and serum NfL and GFAP z-scores were significantly higher in TI+ compared with TI- (CSF-GFAP p<0.001/sGFAP p=0.0083; CSF-NfL p=0.003/sNfL p=0.0004). TI+ and PND differed only in GFAP levels, which were higher in TI+ (CSF-GFAP p=0.0049/sGFAP p=0.003). Bi-compartmental analysis revealed simultaneous elevation of CSF and serum NfL in TI+, indicating predominantly central origin, whereas PND demonstrated a shift toward higher sNfL levels suggesting peripheral origin. Higher clinical severity (modified Rankin Scale 3-5) was associated with elevated serum and CSF GFAP and NfL (sGFAP p=0.012/sNfL p=0.002; CSF-GFAP p<0.0001/CSF-NfL p=0.0001), which also predicted unfavorable outcome at discharge (sGFAP p=0.006/sNfL p=0.004; CSF-GFAP p=0.003/CSF-NfL p=0.012). Conclusions: NfL and GFAP were associated with brain/myelon involvement in NID, predominantly reflecting central pathology. Despite strong CSF-serum correlations, bi-compartmental approaches provide additional insight into biomarker origin and disease compartment.

Background: Non-invasive diagnosis, reliable recurrence surveillance remain critical unmet needs in gliomas. Glioma induces profound systemic immune alterations despite its anatomical confinement to the central nervous system. Circulating immune cells, particularly monocytes, are key mediators of tumor-host crosstalk and may retain tumor-induced transcriptional imprints. However, their potential clinical utility as blood-based biomarkers for detection and monitoring, remain largely unexplored. Methods and findings: In this study, we performed integrated single-cell RNA sequencing of blood immune cells and demonstrated that circulating CD14+ monocytes are significantly expanded in glioma patients, exhibiting features of differentiation arrest and increased transcriptional plasticity. These cells harbor glioma-specific molecular signatures distinct from those observed in healthy controls and patients with other tumors. Leveraging these findings, we developed an ensemble machine learning diagnostic model based on transcriptomic profiles of circulating CD14+ monocytes (training cohort, n=107), which achieved a mean area under the receiver operating characteristic curve (AUC) of 0.971 during cross-validation. In an independent cohort of 567 participants, the model maintained high diagnostic accuracy, yielding an AUC of 0.877 for distinguishing glioma from controls and other tumors. And it achieved a recurrence detection AUC of 0.969 in 51 postoperative samples. Moreover, in a prospective follow-up study involving 30 glioma patients, lower model-derived scores of postoperation were significantly associated with prolonged progression-free survival (log-rank test, P=0.043), supporting its prognostic utility. Conclusion: We demonstrate circulating CD14+ monocytes undergo glioma-specific transcriptional reprogramming, generating systemic tumor-associated signal captured via transcriptomic profiling. This blood-based diagnostic model provides non-invasive, scalable approach for glioma detection, recurrence surveillance, outcome prediction.

Importance: Alzheimer disease (AD) pathogenesis begins decades before clinical symptoms, yet environmental determinants of early disease risk, particularly during fetal development, remain largely uncharacterized. Prenatal exposure to dichlorodiphenyldichloroethylene (DDE), the primary persistent metabolite of DDT, is a biologically plausible early-life contributor to AD risk given long half-life in human tissue and higher levels observed in AD patients. However, prospective human evidence linking prenatal DDE to midlife AD-relevant outcomes is absent. Objective: To determine whether prenatal DDE exposure is associated with plasma AD biomarkers and cognitive performance in early midlife offspring, and whether APOE {epsilon}4 genotype modifies these associations. Design: Observational cohort analysis nested within the Child Health and Development Studies (CHDS), a population-based birth cohort. Setting: CHDS enrolled pregnant women between 1959-1967 in the San Francisco Bay Area. Participants: Among 367 eligible adult offspring who participated in a follow-up study (2010-2013) at mean age 49.3 years, 179 with available prenatal DDE measurements were included. Main Outcomes and Measures: Prenatal DDE levels from maternal serum. Primary outcomes were plasma A{beta}42/40 ratio and Digit Symbol Substitution Test (DSST) performance. Secondary outcomes included plasma pTau217, GFAP, NfL and APOE genotype. Results: Among 179 participants (56% female; 26% APOE {epsilon}4 carriers), mean prenatal DDE was 47.4 (25.4) ng/mL. Higher prenatal DDE was associated with lower DSST scores ({beta}=-0.021, 95% CI, -0.041 to -0.001, P=0.039) and lower plasma A{beta}42/40 ratio ({beta}=-0.079, 95% CI, -0.133 to -0.024, P=0.005) per ng/mL DDE, adjusting for sex, race, education, and APOE {epsilon}4 status. Associations were strongest among APOE {epsilon}4 non-carriers for DSST ({beta}=-0.033, 95% CI, -0.050 to -0.016, P=0.001) and A{beta}42/40 ratio ({beta}=-0.101, 95% CI, -0.161 to -0.040, P=0.001). No significant associations were observed for pTau217, GFAP, or NfL. Conclusions and Relevance: In this prospective birth cohort study, prenatal exposure to a persistent environmental toxicant was associated with lower plasma A{beta}42/40 ratio and worse cognitive performance in early midlife, consistent with DDE accelerating the preclinical trajectory of AD-related biological changes decades before symptom onset. These findings support a life-course framework for AD risk and identify prenatal DDE as a potentially modifiable determinant of early AD-related pathology amenable to prevention.

Objective: Neuropsychiatric presentations are common across neurological and mental health services but they are often inadequately covered by core clinical psychology and clinical neuropsychology training. Consequently, we aimed to identify components for a neuropsychiatry curriculum for clinical psychologists using a Delphi process. Method: We completed a three-round e-Delphi study with 19 experts (clinical psychologists, neuropsychologists, psychiatrists, neurologists, individuals with lived experience of neuropsychiatric disorders). Round 1 collected ratings on 80 syllabus items derived from textbook reviews, conference topics, and a scoping review of neuropsychiatry syllabuses. Items failing to reach consensus were refined, and new topics added via free-text suggestions. Rounds 2 and 3 repeated rating and thematic analysis, culminating in a consensus meeting where items were classified as core or supplementary. Consensus thresholds were set at mean>=2.0, mean distance from the mean<=0.2, and => 75% agreement for final decisions. Results: The process yielded 40 core and 38 supplementary syllabus items. Core topics include autoimmune and neuroinflammatory disorders, delirium, functional neurological disorders, neuropsychiatric sequelae of epilepsy, stroke, traumatic brain injury, dementia, and multidisciplinary working, among others. Supplementary items covered background knowledge of less frequent but still prevalent disorders as well as competencies in interpreting clinical data alongside conceptual and historical issues. The final component list reflects both clinical competencies and emerging areas of practice, emphasising assessment, formulation, psychological interventions, cultural considerations, and medicolegal aspects. Conclusions: The e-Delphi derived curriculum provides a framework for neuropsychiatric competencies for postgraduate psychology training with modification needed for application in diverse healthcare settings.

ImportancePrenatal exposure to gestational diabetes mellitus (GDM) has been associated with adverse metabolic, neurodevelopmental, and psychiatric outcomes in offspring. However, whether GDM-exposed youth exhibit heterogeneous neuroanatomical patterns remains unclear. ObjectiveTo identify distinct cortical thickness subtypes among GDM-exposed youth and examine their associations with anthropometric, neurocognitive, psychiatric/behavioral and neuroimaging measures both cross-sectionally and longitudinally. Design, Setting, and ParticipantsThis cohort study used the Adolescent Brain Cognitive Development (ABCD)(R)data, a multisite longitudinal population study. Subtype and Stage Inference (SuStaIn), an unsupervised machine learning framework, was applied to cross-sectional structural MRI data to identify cortical thickness patterns in 573 GDM-exposed youth and 2854 healthy controls. Posthoc longitudinal analyses included 1,853 observations from a subset of GDM-exposed youth with 1-, 2-, and 4-year follow-up visits to examine subtype differences in developmental trajectories over time. Exposure(s)Prenatal exposure to GDM. Main Outcome(s) and Measure(s)The primary outcomes included identification of cortical thickness subtypes and their inferred regional ordering patterns. Secondary outcomes included subtype-specific anthropometric, neurocognitive, psychiatric/behavioral and neuroimaging measures. ResultsThe GDM-exposed sample had a mean age of 119.02 {+/-} 7.34 months and was 47.5% female. Two cortical thickness subtypes were identified. Between subtypes, Subtype 1 (63.2%) was characterized by earlier inferred insula involvement and was associated with greater height (d = 0.36, pFDR < 0.001) and weight (d = 0.26, pFDR = 0.007), whereas Subtype 2 exhibited earlier inferred frontal involvement and nominally higher Attention-Deficit/Hyperactivity Disorder (ADHD) prevalence (d = 0.08, p = 0.036), steeper longitudinal cortical thinning across all six cortical regions of interest ({beta} range: -0.05 to -0.13, all pFDR < 0.05), and a smaller decline in Obsessive-Compulsive Disorder (OCD) prevalence over time ({beta} = -1.02, pFDR = 0.049). Conclusions and RelevanceGDM exposure was associated with two distinct offspring cortical thickness subtypes, each showing different inferred regional ordering patterns and clinical associations. One subtype showed an insula-cingulate-predominant pattern associated with anthropometric measures, whereas the other showed a frontal-predominant pattern associated with nominally higher psychiatric measures and faster cortical thinning over time.

Evidence from many countries shows that later life cognitive health is shaped by childhood poverty. However, whether it is associated with neurodegenerative biomarkers measured in population settings remains unclear. Methods We conducted a pooled analysis of 5,473 adults aged [&ge;]50 years from Denmark, Sweden and Germany participating in Wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe. Neurodegenerative biomarkers (neurofilament light chain, glial fibrillary acidic protein and phosphorylated tau) were assayed from dried blood spots. Childhood poverty was constructed as a latent variable from retrospective life histories. Weighted Poisson regression models estimated associations adjusting for age, sex, education, marital status and wealth in later life. Marginal predictions along age and across country were derived. Results Childhood poverty was strongly associated with higher NfL concentrations ({beta}=1.66, p<0.001), but not with GFAP or p-tau217. Predicted values indicated substantially elevated NfL among the childhood poor (10.3 pg/mL vs 2.0 pg/mL for the non-poor). Age profiles showed widening disparities: the childhood poor in midlife exhibited higher NfL levels than the oldest old who grew up not poor. No consistent differences were observed for GFAP or p-tau217. Findings were robust and similar across all three countries with different histories and health systems. Conclusions Childhood poverty is associated with markedly elevated levels of NfL in later life, suggesting long-term neuroaxonal injury consistent with life course shaping of brain health. Moreover, the evidence implies substantial acceleration of neurobiological ageing. These findings emphasise the importance of early-life interventions for brain health in ageing populations.