The CLOCK Gene and Mood Disorders: A Case-Control Study and Meta-analysis

The clock gene (CLOCK) is considered to be a good candidate gene for the pathophysiology of mood disorders, including bipolar disorder (BP) and major depressive disorder (MDD). rs1801260 (T3111C) has been detected at position 3111 in the CLOCK mRNA 3' untranslated region, and was reported to be associated with a substantial delay in preferred timing for activity and sleep in a human study. As for function, rs1801260 has been speculated to affect mRNA. Therefore, the authors investigated the association between the three tagging single-nucleotide polymorphisms (SNPs) (rs3736544, rs1801260, and rs3749474) in CLOCK and risk of BP (n?=?867) and MDD (n?=?139) compared to controls (n?=?889) in the Japanese population. In addition, we also performed an updated meta-analysis of nine published, genetic association studies investigating the relationship between rs1801260 and mood disorder risk, comprising 3321 mood disorders cases and 3574 controls. We did not detect any associations between tagging SNPs in CLOCK and BP or MDD in the allele, genotype, or haplotype analysis (global p_BP?=?.605 and global p_MDD?=?.211). Moreover, rs1801260 was also not associated with BP, MDD, or any mood disorders in the meta-analysis. In conclusion, these data suggest that CLOCK does not play a major role in the pathophysiology of mood disorders. (Author correspondence: tarok@fujita-hu.ac.jp)     

3111T/C CLOCK GENE POLYMORPHISM IS NOT ASSOCIATED WITH SLEEP DISTURBANCES IN UNTREATED DEPRESSED PATIENTS

Sleep patterns, frequently altered in depression, have been hypothesized to be under genetic control. The circadian locomotor output cycles kaput (CLOCK) T3111C variant has been studied in association with sleep disturbances in depressed patients. The aim of this study was to investigate possible effects of T3111C CLOCK on insomnia, daytime sleepiness, sleep quality, and depression severity in a sample of 100 major depressive disorder patients. Inclusion criteria were: major depressive disorder, drug-free for any antidepressant and/or benzodiazepines for at least four weeks previously to the study, and a minimum score of >17 on the Hamilton Rating Scale for Depression. The Morningness–Eveningness Questionnaire, Epworth Sleepiness Scale, Athens Insomnia Scale, and Pittsburgh Sleep Quality Index were applied. No significant difference was found concerning genotype or allele groups and Hamilton Rating Scale for Depression items or clusters. No difference was found between genotypes and comorbidity, chronotype distribution, Epworth Sleepiness Scale, Athens Insomnia Scale, or Pittsburgh Sleep Quality Index total scores. Overall, the present findings did not support the hypothesis of an effect of the T3111C CLOCK variant on sleep disturbances in major depressive disorder. Further analysis of clock machinery will clarify the contribution of clock genes to the maintenance of mental health. (Author correspondence: alessandro.serretti@unibo.it)     

The polymorphism of CLOCK gene rs4864548 A>G is associated with susceptibility of Alzheimer’s disease in Chinese population

The aim of this study was to investigate the correlation between polymorphism of circadian locomotor output cycle kaput (CLOCK) gene rs4864548 A/G and susceptibility of Alzheimer’s disease (AD). A total of 296 unrelated AD patients and 423 control subjects were enrolled in the case-control study. Genotypes of apolipoprotein E (APOE) and CLOCK gene rs4864548 A/G were determined by a Polymerase Chain Reaction (PCR) restriction fragment length polymorphism detection method. Our results showed that in the whole sample or APOE ε 4 non-carriers, prevalence of A carriers in CLOCK gene rs4864548 A/G in AD patients was remarkably higher than that in control subjects (in the whole sample: χ² = 47.614, p < 0.0001; in APOE ε 4 non-carriers: χ² = 22.493, p < 0.0001). However, among APOE ε 4 carriers, the difference in the prevalence of A carriers in CLOCK gene rs4864548 A/G between AD patients and controls was no statistically significant (χ² = 0.669, p = 0.379). These findings demonstrate that A carriers in CLOCK gene rs 4864548 A/G were closely related to a high susceptibility of AD among APOE ε 4 non-carriers while the functional polymorphism of CLOCK gene rs4864548 A/G was not associated with the susceptibility of AD among APOE ε 4 carriers.     

Clock Gene Expression Levels and Relationship With Clinical and Pathological Features in Colorectal Cancer Patients

The clock gene machinery controls cellular metabolism, proliferation, and key functions, such as DNA damage recognition and repair. Dysfunction of the circadian clock is involved in tumorigenesis, and altered expression of some clock genes has been found in cancer patients. The aim of this study was to evaluate the expression levels of core clock genes in colorectal cancer (CRC). Quantitative real-time polymerase chain reaction (qPCR) was used to examine ARNTL1, CLOCK, PER1, PER2, PER3, CRY1, CRY2, Timeless (TIM), TIPIN, and CSNK1Ε expression levels in the tumor tissue and matched apparently healthy mucosa of CRC patients. In the tumor tissue of CRC patients, compared to their matched healthy mucosa, expression levels of ARNTL1 (p?=?.002), PER1 (p?=?.002), PER2 (p?=?.011), PER3 (p?=?.003), and CRY2 (p?=?.012) were lower, whereas the expression level of TIM (p?=?.044) was higher. No significant difference was observed in the expression levels of CLOCK (p?=?.778), CRY1 (p?=?.600), CSNK1Ε (p?=?.903), and TIPIN (p?=?.136). As to the clinical and pathological features, a significant association was found between low CRY1 expression levels in tumor mucosa and age (p?=?.026), and female sex (p?=?.005), whereas high CRY1 expression levels in tumor mucosa were associated with cancer location in the distal colon (p?=?.015). Moreover, high TIM mRNA levels in the tumor mucosa were prevalent whenever proximal lymph nodes were involved (p?= .013) and associated with TNM stages III–IV (p?=?.005) and microsatellite instability (p?=?.015). Significantly poorer survival rates were evidenced for CRC patients with lower expression in the tumor tissue of PER1 (p?=?.010), PER3 (p?= .010), and CSNKIE (p?=?.024). In conclusion, abnormal expression levels of core clock genes in CRC tissue may be related to the process of tumorigenesis and exert an influence on host/tumor interactions. (Author correspondence: g.mazzoccoli@tin.it)     

HEART-RATE VARIABILITY IN WOMEN DURING 40-HOUR PROLONGED WAKEFULNESS

Heart-rate variability patterns of 18 women during a 40-h constant routine of prolonged wakefulness under controlled laboratory conditions were analyzed. The authors tested the circadian timing of the autonomic nervous system and the relationship between the sympathetic and vagal branches in women with both a functional disorder of vascular regulation (main symptom: cold hands and feet) and prolonged sleep onset and controls without these symptoms. Spectral analysis of R-R intervals during paced breathing episodes revealed significantly lower power values in the high-frequency band (HF; 0.15–0.4?Hz) but not in the low-frequency band (LF; 0.04–0.15?Hz), leading to a significantly elevated LF/HF ratio in the former group. A significant circadian rhythm in LF power and heart rate occurred in both groups, and a significant correlation was found between sleepiness and sympathovagal balance (r?=?.53, p?<?.05). These findings indicate not only an autonomic imbalance in the first group compared with controls, but also two strategies of the autonomic nervous system to fight against fatigue in women. One implies circadian control and the other homeostatic control, and both are reflected by the LF/HF ratio. (Author correspondence: Kurt.Kraeuchi@upkbs.ch)     

Alterations of Locomotor Activity Rhythm and Sleep Parameters in Patients With Advanced Glaucoma

The aim of this study was to evaluate the effect of advanced glaucoma on locomotor activity rhythms and related sleep parameters. Nine normal subjects and nine age-matched patients with bilateral advanced primary open-angle glaucoma, >10 yrs since diagnosis, were included in this observational, prospective, case-control study. Patients were required to record the timing and duration of their sleep and daily activities, and wore an actigraph on the wrist of the nondominant arm for 20 d. Activity rhythm period, MESOR (24-h time-series mean), amplitude (one-half peak-to-trough variation), and acrophase (peak time), plus long sleep episodes during the wake state, sleep duration, efficiency, and latency, as well as mean activity score, wake minutes, and mean wake episodes during the sleep interval were assessed in controls and glaucomatous patients. Glaucomatous patients exhibited significant decrease in nighttime sleep efficiency, and significant increase in the mean activity score, wake minutes, and mean wake episode during the night. These results suggest that alterations of circadian physiology could be a risk to the quality of life of patients with glaucoma. (Author correspondence: ruthr@fmed.uba.ar)     

Short- and Long-day Responses in the Pre-adult Developmental Duration of Two Species of Camponotus Ants

We assessed the effect of different day/night lengths on the pre-adult developmental time of two species of Camponotus ants that normally develop in dark underground nests. We assayed larval (egg-to-pupal formation), pupal (pupal formation-to-adult emergence), and pre-adult (egg-to-adult emergence) durations in these ants under three different light/dark (LD) cycles of 12:12?h, 10:14?h, and 14:10?h. We observed that the pre-adult development time of ants under these day lengths was significantly different. Although both species developed fastest under 12:12?h LD, when asymmetric LD cycles were compared, night-active species (Camponotus compressus) developed faster under short days (10:14?h) and day-active species (C. paria) developed faster under long days (14:10?h). This day/night-length-mediated difference in pre-adult developmental duration was mostly due to modulation of larval duration; however, in day-active species it was also via altered pupal duration. These results thus indicate that the two species of Camponotus ants respond differently to short and long days, suggesting that seasonal timers regulate pre-adult development time in tropical ant species living in dark underground nests. (Author correspondence: vsharma@jncasr.ac.in/vksharmas/gmail.com)     

Robustness of Circadian Timing Systems Evolves in the Fruit Fly Drosophila melanogaster as a Correlated Response to Selection for Adult Emergence in a Narrow Window of Time

Robustness is a fundamental property of biological timing systems that is likely to ensure their efficient functioning under a wide range of environmental conditions. Here we report the findings of our study aimed at examining robustness of circadian clocks in fruit fly Drosophila melanogaster populations selected to emerge as adults within a narrow window of time. Previously, we have reported that such flies display enhanced synchrony, accuracy, and precision in their adult emergence and activity/rest rhythms. Since it is expected that accurate and precise circadian clocks may confer enhanced stability in circadian time-keeping, we decided to examine robustness in circadian rhythms of flies from the selected populations by subjecting them to a variety of environmental conditions comprising of a range of photoperiods, light intensities, ambient temperatures, and constant darkness. The results revealed that adult emergence and activity/rest rhythms of flies from the selected stocks were more robust than controls, as they displayed enhanced stability under a wide variety of environmental conditions. These results suggest that selection for adult emergence within a narrow window of time results in the evolution of robustness in circadian timing systems of the fruit fly D. melanogaster. (Author correspondence: vsharma@jncasr.ac.in or vksharmas@gmail.com)     

CHRONIC SLEEP DEFICIT AND PERFORMANCE OF A SUSTAINED ATTENTION TASK—AN ELECTROOCULOGRAPHY STUDY

Electrooculography (EOG) was used to explore performance differences in a sustained attention task during rested wakefulness (RW) and after 7 days of partial sleep deprivation (SD). The RW condition was based on obtaining regular sleep, and the SD condition involved sleep restriction of 3?h/night for a week resulting in a total sleep debt of 21?h. The study used a counterbalanced design with a 2-wk gap between the conditions. Participants performed a sustained attention task for 45?min on four occasions: 10:00–11:00, 14:00–15:00, 18:00–19:00, and 22:00–23:00?h. The task required moving gaze and attention as fast as possible from a fixation point to a target. In each session, 120 congruent and 34 incongruent stimuli were presented, totaling 1232 observations/participant. Correct responses plus errors of omission (lapses) and commission (false responses) were recorded, and the effect of time-of-day on sustained attention following SD was investigated. The analysis of variance (ANOVA) model showed that SD affected performance on a sustained attention task and manifested itself in a higher number of omission errors: congruent stimuli (F_(1,64)?=?13.3, p?<?.001) and incongruent stimuli (F_(1,64)?=?14.0, p?<?.001). Reaction times for saccadic eye movements did not differ significantly between experimental conditions or by time-of-day. Commission errors, however, exhibited a decreasing trend during the day. The visible prevalence of omissions in SD versus RW was observed during the mid-afternoon hours (the so-called post-lunch dip) for both congruent and incongruent stimuli (F_(1,16)?=?5.3, p?=?.04 and F_(1,16)?=?5.6, p?=?.03, respectively), and at 18:00?h for incongruent stimuli (F_(1,13)?=?5.7, p?=?.03). (Author correspondence: magda.fafrowicz@uj.edu.pl)     

MORNINGNESS PROPENSITY IN YOUNG ADULTS BORN PREMATURELY: THE HELSINKI STUDY OF VERY LOW BIRTH WEIGHT ADULTS

The authors explored morningness-eveningness propensity in adults born prematurely at very low birth weight (VLBW; <?1500g) and in controls born at term. At age 21 to 29 yrs, 184 participants completed the Morningness-Eveningness Questionnaire (MEQ). Compared with controls, VLBW adults scored higher in morningness propensity (group difference: 2.8 scores, 95% confidence interval: 0.1 to 5.5; p?=?.042). This finding was confined to those VLBW adults whose birth weight was not small for gestational age, and remained similar when adjusting for age, sex, and working conditions. The finding is potentially important, since morningness is associated with beneficial health outcomes. (Author correspondence: sonja.strang@helsinki.fi)     

Medical History of Optic Chiasm Compression in Patients With Pituitary Insufficiency Affects Skin Temperature and Its Relation to Sleep

The hypothalamus is crucially involved in the circadian timing of the sleep-wake rhythm, yet also accommodates the most important thermoregulatory neuronal network. We have shown before that adults with pituitary insufficiency and history of chiasm compression due to a tumor with suprasellar extension fall asleep later and sleep shorter than those without such history and presumed hypothalamic involvement. To solidify the hypothesized link between vigilance and thermoregulation by the hypothalamus, we aimed to test the hypothesis that the presumed hypothalamic impairment in these patients also affects skin temperature and its association with sleep onset. In a case-control study of 50 patients (54.7?±?14.5 yrs of age, 30 males) with pituitary insufficiency, 33 of whom had a history of chiasm compression, ambulatory distal and proximal skin temperatures were assessed continuously for 24?h. Sleep parameters were assessed via questionnaire. Group differences in mean skin temperature, calculated over the wake and sleep periods separately, and group differences in the strength of association between pre-sleep skin temperature and sleep onset latency were compared. Results showed that patients with a medical history of chiasm compression had lower proximal skin temperature during the day (34.1°C?±?.7°C vs. 34.6°C?±?.7°C, p?=?.045). Additionally, the typical association between sleep onset latency and pre-sleep distal-to-proximal skin temperature gradient was absent in these patients (r?=??.01, p?=?.96), whereas it was unimpaired in those without chiasm compression (r?=??.61, p?=?.02). Thus, patients with history of chiasm compression show impaired skin temperature regulation in association with disturbed sleep. The findings support the hypothesis that a medical history of chiasm compression affects hypothalamic regulation of both vigilance and temperature, possibly by chronically affecting relevant nuclei, including the ventrolateral preoptic area and anterior hypothalamic preoptic area. (Corresponding Author: n.romeijn@nin.knaw.nl)     

Expression of Clock Genes in Human Subcutaneous and Visceral Adipose Tissues

Disrupted circadian rhythms are associated with obesity and metabolic alterations, but little is known about the participation of peripheral circadian clock machinery in these processes. The aim of the present study was to analyze RNA expression of clock genes in subcutaneous (SAT) and visceral (VAT) adipose tissues of male and female subjects in AM (morning) and PM (afternoon) periods, and its interactions with body mass index (BMI). Ninety-one subjects (41?±?11 yrs of age) presenting a wide range of BMI (21.4 to 48.6?kg/m²) were included. SAT and VAT biopsies were obtained from patients undergoing abdominal surgeries. Clock genes expressions were evaluated by qRT-PCR. The only clock gene that showed higher expression (p?<?.0001) in SAT in comparison to VAT was PER1 of female (372%) and male (326%) subjects. Different patterns of expression between the AM and PM periods were observed, in particular REV-ERBα, which was reduced (p?<?.05) at the PM period in SAT and VAT of both women and men (women: ～53% lower; men: ～78% lower), whereas CLOCK expression was not altered. Relationships between clock genes were different in SAT vs. VAT. BMI was negatively correlated with SATPER1 (r?=??.549; p?=?.001) and SATPER2 (r?=??.613; p?=?.0001) and positively with VATCLOCK (r?=?.541; p?=?.001) and VATBMAL1 (r?=?.468; p?=?.007) only in women. These data suggest that the circadian clock machinery of adipose tissue depots differs between female and male subjects, with a sex-specific effect observed for some genes. BMI correlated with clock genes, but at this moment it is not possible to establish the cause-effect relationship. (Author correspondence: mzanquetta@gmail.com)     

Impact of Nightshift Work on Overweight and Abdominal Obesity Among Workers of a Poultry Processing Plant in Southern Brazil

The authors examined the associations of shiftwork with overweight and abdominal obesity through a cross-sectional study of 1206 employees 18 to 50 yrs of age who were working on a production line in a poultry processing plant. Night-shift workers (n?=?800) were considered exposed, whereas day shiftworkers (n?=?406) were considered nonexposed. Overweight was defined as a body mass index ≥25?kg/m² and abdominal obesity as a waist circumference ≥88?cm in women and ≥102?cm in men. The mean age of the workers was 30.5 yrs (standard deviation?=?8.7 yrs), and 65.2% were women. Nightshift workers compared to dayshift workers showed higher prevalences of overweight (42.2% vs. 34.3%; p?=?.020) and abdominal obesity (24.9% vs. 19.5%; p?=?.037). After adjusting for sociodemographics, parental overweight status, behavioral characteristics, and sleep characteristics, including hours of sleep, the prevalence ratios for overweight and abdominal obesity were 1.27 (95% confidence interval [ CI]: 1.00–1.61) and 1.45 (95% CI: 1.10–1.92), respectively, for the nightshift workers compared to the dayshift workers. A consistent finding in our study was the independent contribution of night shiftwork to overweight and abdominal obesity among Brazilian workers. Further studies are needed to understand the biological mechanisms involved and the complex behavioral and social adaptations experienced by night-shift workers. (Author correspondence: mtolinto@gmail.com)     

Epigenetic Impact of Long-Term Shiftwork: Pilot Evidence From Circadian Genes and Whole-Genome Methylation Analysis

Epigenetic association studies have demonstrated differential promoter methylation in the core circadian genes in breast cancer cases relative to cancer-free controls. The current pilot study aims to investigate whether epigenetic changes affecting breast cancer risk could be caused by circadian disruption through exposure to light at night. Archived DNA samples extracted from whole blood of 117 female subjects from a prospective cohort conducted in Denmark were included in this study. A polymerase chain reaction (PCR)-based method was used for detection of gene-promoter methylation, whereas genome-wide methylation analysis was performed using the Illumina Infinium Methylation Chip. Long-term shiftwork resulted in the same promoter hypomethylation of CLOCK and hypermethylation of CRY2, as was previously observed in breast cancer case-control studies. Genome-wide methylation analysis further discovered widespread methylation alterations in shiftworkers, including changes in many methylation- and cancer-relevant genes. Pathway analysis of the genes with altered methylation patterns revealed several cancer-related pathways. One of the top three networks generated was designated as “DNA replication, recombination, and repair, gene expression, behavior” with ESR1 (estrogen receptor α) featured most prominently in the network, underscoring the potential breast cancer relevance of the genes differentially methylated in long-term shiftworkers. These results, although exploratory, demonstrate the first evidence of the cancer-relevant epigenetic effects of night shiftwork, which warrant further investigation. Considering there are millions of shiftworkers worldwide, understanding the effects of this exposure may lead to novel strategies for cancer prevention and new policies regulating shiftwork. (Author correspondence: yong.zhu@yale.edu)     

EPIGENETIC EFFECTS OF SHIFTWORK ON BLOOD DNA METHYLATION

In the present study, the authors investigated the effects of shiftwork exposure on DNA methylation using peripheral blood DNA from subjects working in two chemical plants in Northern Italy. The investigation was designed to evaluate (a) DNA methylation changes in Alu and long interspersed nuclear element-1 (LINE-1) repetitive elements as a surrogate of global methylation and (b) promoter methylation of glucocorticoid receptor (GCR), tumor necrosis factor alpha (TNF-α), and interferon-gamma (IFN-γ). One hundred and fifty white male workers (mean?±?SD: 41.0?±?9 yrs of age) were examined: 100 3?×?8 rotating shiftworkers (40.4?±?8.7 yrs of age) and 50 day workers (42.2?±?9.4 yrs of age). The authors used bisulfite-pyrosequencing to estimate repetitive elements and gene-specific methylation. Multiple regression analysis, adjusted for age, body mass index (BMI), and job seniority, did not show any significant association between the five DNA methylation markers and shiftwork. However, job seniority, in all subjects, was significantly associated with Alu (β?=??0.019, p?=?.033) and IFN-γ (β?=??0.224, p?<?.001) methylation, whereas TNF-α methylation was inversely correlated with age (β?=??0.093, p?<?.001). Considering only shiftworkers, multiple regression analysis, adjusted for age, BMI, and job seniority, showed a significant difference between morning and evening types in TNF-α methylation (mean morning type [MT] 11.425 %5mC versus evening type [ET] 12.975 %5mC; β?=?1.33, p?=?.022). No difference was observed between good and poor tolerance to shiftwork. Increasing job seniority (<5, 5–15, >15 yrs) was associated with significantly lower Alu (β?=??0.86, p?=?.006) and IFN-γ methylation (β?=??6.50, p?=?.007) after adjustment for age, BMI, and morningness/eveningness. In addition, GCR significantly increased with length of shiftwork (β?=?3.33, p?=?.05). The data showed alterations in blood DNA methylation in a group of shiftworkers, including changes in Alu repetitive elements methylation and gene-specific methylation of IFN-γ and TNF-α promoters. Further studies are required to determine the role of such alterations in mediating the effects of shiftwork on human health. (Author correspondence: giovanni.costa@unimi.it)     

Orcadian Rhythm of Serotonin Binding in Rat Brain—I. Effect of the Light-Dark Cycle

Moving rapidly from a supine to a standing posture is a common daily activity, yet a significant physiological challenge. Syncope can result from the development of initial orthostatic hypotension (IOH) involving a transient fall in systolic/diastolic blood pressure (BP) of >40/20?mm Hg within the first 15 s, and/or a delayed orthostatic hypotension (DOH) involving a fall in systolic/diastolic BP of >20/10?mm Hg within 15?min of posture change. Although epidemiological data indicate a heightened syncope risk in the morning, little is known about the diurnal variation in the IOH and DOH mechanisms associated with postural change. The authors hypothesized that the onset of IOH and DOH occurs sooner, and the associated cardiorespiratory and cerebrovascular changes are more pronounced, in the early morning. At 06:00 and 16:00?h, 17 normotensive volunteers, aged 26?±?1 yrs (mean?±?SE), completed a protocol involving supine rest, an upright stand, and a 60° head-up tilt (HUT) during which continuous beat-to-beat measurements of middle cerebral artery velocity (MCAv), mean arterial BP (MAP), heart rate, and end-tidal Pco₂ (P_ETco₂) were obtained. Mean MCAv was ～12% lower at baseline in the morning (p?≤?.01) and during the HUT (p?<?.01), despite a morning elevation in P_ETco₂ by ～2.2?mm Hg (p?=?.01). The decline in MAP during initial standing (morning vs. afternoon: 50%?±?4% vs. 49%?±?3%) and HUT (39%?±?3% vs. 38%?±?3%) did not vary with time-of-day (p?>?.30). In conclusion, although there is a marked reduction in MCAv in the morning, there is an absence of diurnal variation in the onset of and associated physiological responses associated with IOH and DOH. These responses, at least in this population, are unlikely contributors to the diurnal variation in orthostatic tolerance. (Author correspondence: N.C.Lewis@2004.ljmu.ac.uk)     

CHRONOKINETICS OF CEFTAZIDIME AFTER INTRAMUSCULAR ADMINISTRATION TO DOGS

Ceftazidime, a third-generation cephalosporin, is widely used for the treatment of Pseudomonas aeruginosa infections. The aims of the present study were to characterize the pharmacokinetics of ceftazidime and to estimate the T?>?MIC against P. aeruginosa, after its intramuscular (im) administration at two different dosing times (08:30?h and 20:30?h) to dogs, in order to determine whether time-of-day administration modifies ceftazidime pharmacokinetics and/or predicted clinical antipseudomonal efficacy. Six female healthy beagle dogs were administered ceftazidime pentahydrate by the intramuscular route in a single dose of 25?mg/kg at both 08:30 and 20:30?h, two weeks apart. Plasma ceftazidime concentrations were determined by microbiological assay. Pharmacokinetic parameters and time above the minimum inhibitory concentration (T?>?MIC) and 4xMIC for Pseudomonas aeruginosa were calculated from the disposition curve of each dog. No differences between the daytime and nighttime administrations were found for the main pharmacokinetic parameters, including C_max, t_max, t_{½ λ}, AUC, and MRT; however, the high interindividual variability shown by these values and the small number of individuals may account for this lack of difference. Rate of absorption (k_a) was significantly higher after the 20:30?h than 08:30?h administration. No significant differences between T?>?MIC were found when comparing the 08:30?h and 20:30?h administrations. Mean T?>?MIC values predicted a favorable bacteriostatic effect for all susceptible strains of P. aeruginosa for the 12?h dosing interval at both dosing times. Our results suggest that similar antipseudomonal activity may be expected when ceftazidime is administered at 8:30 and 20:30?h; however, as only two timepoints of drug administration were explored, we are unable to draw any conclusions for other treatment times during the 24?h. (Author correspondence: rebuelto@fvet.uba.ar).     

CLOCK,PER2 and BMAL1 DNA Methylation: Association with Obesity and Metabolic Syndrome Characteristics and Monounsaturated Fat Intake

The circadian clock system instructs 24-h rhythmicity on gene expression in essentially all cells, including adipocytes, and epigenetic mechanisms may participate in this regulation. The aim of this research was to investigate the influence of obesity and metabolic syndrome (MetS) features in clock gene methylation and the involvement of these epigenetic modifications in the outcomes. Sixty normal-weight, overweight and obese women followed a 16-weeks weight reduction program. DNA methylation levels at different CpG sites of CLOCK, BMAL1 and PER2 genes were analyzed by Sequenom's MassARRAY in white blood cells obtained before the treatment. Statistical differences between normal-weight and overweight?+?obese subjects were found in the methylation status of different CpG sites of CLOCK (CpGs 1, 5-6, 8 and 11-14) and, with lower statistical significance, in BMAL1 (CpGs 6-7, 8, 15 and 16-17). The methylation pattern of different CpG sites of the three genes showed significant associations with anthropometric parameters such as body mass index and adiposity, and with a MetS score. Moreover, the baseline methylation levels of CLOCK CpG 1 and PER2 CpGs 2-3 and 25 correlated with the magnitude of weight loss. Interestingly, the percentage of methylation of CLOCK CpGs 1 and 8 showed associations with the intake of monounsaturated and polyunsaturated fatty acids. This study demonstrates for the first time an association between methylation status of CpG sites located in clock genes (CLOCK, BMAL1 and PER2) with obesity, MetS and weight loss. Moreover, the methylation status of different CpG sites in CLOCK and PER2 could be used as biomarkers of weight-loss success, particularly CLOCK CPGs 5-6. (Author correspondence: garaulet@um.es)     

Circadian Variation in Patient Characteristics and Outcomes in ST-Segment Elevation Myocardial Infarction

A morning peak in ST-segment elevation myocardial infarction (STEMI) has been described. The authors explored the relationship between variation of symptom onset, patient characteristics, and outcomes in two worldwide fibrinolytic trials. A total of 35 492 patients with STEMI were grouped into 8-h intervals by time of symptom onset: early (06:00 to 13:59?h), late-day (14:00 to 21:59?h), overnight (22:00 to 05:59?h). The authors correlated timing with patient characteristics and outcomes (adjusted for thrombolysis in myocardial infarction [TIMI] risk score) first in InTIME II-TIMI 17 trial (N?=?15 031), and confirmed in the ExTRACT-TIMI 25 trial (N?=?20 461). Timing was similar in the derivation (early 49%, late-day 30%, and overnight 21%; p?<?.001) and validation set (48%, 31%, and 21%, respectively; p?<?.001). Some patient characteristics consistently varied with time of symptom onset. Patients in the early cohort were older with poorer renal function. The late-day group had more smokers with higher initial heart rate and systolic blood pressure. Those with overnight symptom onset had higher rates of obesity, prior myocardial infarction, and treatment delays. Prior use of aspirin and beta-blockers was also highest in the overnight group. Relative to the early cohort, adjusted mortality was higher with late-day onset (derivation odds ratio [OR]: 1.19, p?=?.04; validation OR: 1.18, p?=?.01), but there was no excess in mortality overnight compared with early (derivation OR: .97, p?=?.72; validation OR: 1.01, p?=?.90). Composite endpoints followed similar patterns. This study indicates that circadian patterns in onset of STEMI continue to exist with patient characteristics differing by time of day. Despite a potential physiologic resistance to morning thrombolysis, outcomes were best in the early cohort, intermediate overnight, and worst with late-day symptom onset. Efforts to reduce smoking and improve control of blood pressure could reduce the number of patients with late-day onset of STEMI who experience the worst outcomes. (Author correspondence: owen@mogabgab.com)     

Adipokine Levels Are Altered by Shiftwork: A Preliminary Study

Shiftwork is often associated with metabolic diseases, and in the past few years, several cytokines have been postulated to contribute to various diseases, including insulin resistance. The aim of this study was to compare the concentrations of adiponectin, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in samples of young adult men exposed to a fixed (i) night shift (n?=?9), working from 22:00 to 06:00?h; (ii) early morning shift (n?=?6), working from 06:00 to 14:00?h; and (iii) day shift (n?=?7), working from 08:00 to 17:00?h. The fixed night-shift and early-morning-shift samples were considered collectively as a shiftworker group given their work times. Blood samples were collected during the regular working day at 4-h intervals over the course of 24?h, thus totaling six samples. Morphological and physical activity parameters did not differ between the three groups. Total energy intake was lowest on the early morning shifts (p?<?.03). Both shiftworker groups ingested a significantly higher percentage of fat (p?<?.003) and a lower percentage of carbohydrate (p?<?.0005) than the day group. The early morning group had a lower mean 24-h level of adiponectin than the other two groups (p?=?.016), and both the early morning and night groups exhibited higher mean 24-h levels of TNF-α than the day group (p?=?.0001). The 24-h mean levels of IL-6 did not differ significantly between the groups (p?=?.147). None of the groups exhibited a significant circadian effect on adiponectin (p?=?.829), TNF-α (p?=?.779), or IL-6 (p?=?.979) levels. These results indicate that individuals who are enrolled in shiftwork are susceptible to alterations in the secretion of cytokines that are involved in insulin resistance and cardiovascular disease, both of which are known to affect this population. (Author correspondence: tmello@demello.net.br)