Background: Radiation-induced cognitive impairment (RICI) and emotional disorder (RIED) are comorbidity which seriously affect the quality of life in radiation-induced brain injury (RIBI) patients.
Purpose: Longitudinal observation on occurrence and development process of RICI and RIED was made in RIBI animal model and RIBI clinical cohort after IMRT.
Methods: RIBI mice and sham control were subjected to three cycles of behavior tests for cognitive and emotional function at post-irradiation 1w, 5w, 9w which corresponded with early, middle and late stage after IMRT. And 139 patients who underwent IMRT after NPC and firstly diagnosed with radiation-induced brain injury were enrolled. Pre-treatment and follow-up neuropsychological assessment of cognition, anxiety and depression were completed.
Results: Compared with control, significant decline in working memory, object recognition memory and social memory was observed in RIBI mice at post-irradiation 5w (middle stage, p < 0.001, p < 0.05 and 0.0781) and post-irradiation 9w (late stage, all p < 0.01). From longitudinal observations, memory impairment mostly occurred at middle stage (both p < 0.05) and maintained to late stage. Anxiety-like behaviors were only observed at post-irradiation 9w (late stage, all p < 0.05). In the clinical cohort, RICI had parallel tendency of cumulative curve and close median onset compared with RIBI. RICI intensively occurred in post-IMRT 2-6 years and progressively deteriorated to post-IMRT > 6 years while RIED occurred and gradually increased at post-IMRT > 6 years. During two-year follow-up visits, half of patients with RICI combined with RIBI benefited from conventional treatment to obtain stable or improved cognition, while the other half of patients had no response or cognition aggravation.
Conclusions: RICI intensively occurred in post-irradiation middle stage and progressed to late stage while RIED occurred mostly in late stage in RIBI. Consistency of RICI and RIED development process was observed.
Objectives: The purpose of this study was to examine variations in gut microbes and their metabolites between patients with original and recurrent stroke, providing insights and justification for the diagnosis and prevention of ischemic stroke progression from the perspective of the gut microbiota-metabolite-brain axis.
Methods: In this study, fecal samples were collected from 95 patients with Original stroke (Os) and 39 patients with Recurrent stroke (Rs) to assess differences in gut microbiota between two groups. Then LC-MS non-targeted metabolomics was used to screen out the different metabolites and to reveal the physiological changes related to the progression of ischemic stroke.
Results: Beta diversity analysis revealed significant differences in community composition between two groups. Compared with Os patients, 26 genera were dysregulated in Rs patients. For example, Prevotella, Lachnospiraceae_UCG-010, Holdemanella, and Coprococcus were significantly depleted in the Rs group. Correlation analysis showed that the risk of stroke recurrence was negatively correlated with Lachnospiraceae_UCG-010. A total of 38 differential metabolites were identified in both groups. In Rs group, 8 metabolites were up-regulated, including carbohydrates and terpene lactones, and 30 metabolites were down-regulated, including sesquiterpenes, triterpenes, and fatty acids and their couplings. These metabolites are significantly enriched in the pathways of arachidonic acid metabolism, betaine biosynthesis, and linoleic acid metabolism.
Conclusions: Compared with the Os, Rs was mainly characterized by severe destruction of anaerobic bacteria and significant depletion of SCFAs-producing bacteria. In addition, the related compounds involved in arachidonic acid metabolism and linoleic acid metabolism pathway may be biomarkers related to ischemic stroke progression.