Β-Amyloid Accumulation in the Human Brain After One Night of Sleep Deprivation
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β-Amyloid accumulation in the human brain after one night of sleep deprivation Ehsan Shokri-Kojoria,1, Gene-Jack Wanga,1, Corinde E. Wiersa, Sukru B. Demirala, Min Guoa, Sung Won Kima, Elsa Lindgrena, Veronica Ramireza, Amna Zehraa, Clara Freemana, Gregg Millera, Peter Manzaa, Tansha Srivastavaa, Susan De Santib, Dardo Tomasia, Helene Benvenistec, and Nora D. Volkowa,1 aLaboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892; bPiramal Pharma Inc., Boston, MA 02108; and cDepartment of Anesthesiology, Yale School of Medicine, New Haven, CT 06510 Edited by Michael E. Phelps, University of California, Los Angeles, CA, and approved March 13, 2018 (received for review December 14, 2017) The effects of acute sleep deprivation on β-amyloid (Aβ) clearance of sleep to Aβ clearance from the brain and the regional speci- in the human brain have not been documented. Here we used PET ficity of such effects. and 18F-florbetaben to measure brain Aβ burden (ABB) in Here we evaluated the effects of one-night SD on ABB in 20 healthy controls tested after a night of rested sleep (baseline) healthy controls to investigate whether sleep affects clearance of and after a night of sleep deprivation. We show that one night of Aβ from the human brain. For this purpose, we used positron sleep deprivation, relative to baseline, resulted in a significant in- emission tomography (PET) with which it is now possible to crease in Aβ burden in the right hippocampus and thalamus. These measure ABB in the living human brain. There are several val- increases were associated with mood worsening following sleep idated PET radiotracers for this purpose, including 18F- deprivation, but were not related to the genetic risk (APOE geno- florbetaben (FBB) (22, 23). It is believed that such radio- type) for Alzheimer’s disease. Additionally, baseline ABB in a tracers predominantly bind to insoluble Aβ42 plaques (24–27), range of subcortical regions and the precuneus was inversely as- but there is recent evidence that they also bind to soluble Aβ sociated with reported night sleep hours. APOE genotyping was 42 forms (28). Thus, we reasoned that PET and FBB could be used also linked to subcortical ABB, suggesting that different Alz- to detect increases in ABB because of acute SD, directly in the heimer’s disease risk factors might independently affect ABB in human brain (3). First, we aimed to assess the effect of one-night nearby brain regions. In summary, our findings show adverse ef- n = – fects of one-night sleep deprivation on brain ABB and expand on SD on brain ABB with PET-FBB in healthy controls ( 20, 22 prior findings of higher Aβ accumulation with chronic less sleep. 72 y old, 10 females) (Table S1), and compared the measures to baseline brain ABB captured at the same time of the day but beta amyloid | sleep | hippocampus | Alzheimer’s disease | glymphatic following a night of rested sleep [referred to as rested- system wakefulness (RW)]. Second, we aimed to replicate in our sam- ple the previously reported association between sleep history and – eta-amyloid (Aβ) is present in the brain’s interstitial fluid brain ABB (when measured after RW) (6 8). For our first aim, B(ISF) and is considered a metabolic “waste product” (1). we hypothesized that one night of SD would increase ABB in the Mechanisms by which Aβ is cleared from the brain are not hippocampus, which shows some of the earliest structural and completely understood (2), although there is evidence that sleep functional changes in AD (29, 30). For our second aim, we hy- plays an important role in Aβ clearance (3). In rodents, chronic pothesized that history of poor sleep would be associated with sleep restriction led to increases in ISF Aβ levels (4) and in a Drosophila model of Alzheimer’s disease (AD), chronic sleep Significance deprivation (SD) resulted in higher Aβ accumulation (5). In healthy humans, imaging studies have revealed associations be- There has been an emerging interest in sleep and its associa- NEUROSCIENCE tween self-reports of less sleep duration or poor sleep quality and tion with β-amyloid burden as a risk factor for Alzheimer’s higher Aβ burden (ABB) in the brain (6–8), which is a risk factor disease. Despite the evidence that acute sleep deprivation el- for AD. This association has been considered bidirectional be- evates β-amyloid levels in mouse interstitial fluid and in human cause increased ABB could also lead to impairments in sleep (9, cerebrospinal fluid, not much is known about the impact of 10). Notably, increased ABB in the brain has been associated sleep deprivation on β-amyloid burden in the human brain. with impairment of brain function (11, 12). Thus, strategies that Using positron emission tomography, here we show that acute prevent Aβ accumulation in the brain could promote healthy sleep deprivation impacts β-amyloid burden in brain regions brain aging and be useful in preventing AD. In this respect, there that have been implicated in Alzheimer’s disease. Our obser- is increasing evidence that sleep disturbances might contribute to vations provide preliminary evidence for the negative effect of AD, in part by facilitating accumulation of Aβ in the brain (13). sleep deprivation on β-amyloid burden in the human brain. To better characterize ABB dynamics, studies have focused on the effects of sleep patterns on ABB in the CNS. In rodents, it Author contributions: N.D.V. conceived study; E.S.-K., G.-J.W., C.E.W., S.B.D., S.W.K., has been shown that Aβ clearance from the brain’s ISF pre- S.D.S., D.T., H.B., and N.D.V. designed research; E.S.-K., G.-J.W., C.E.W., S.B.D., M.G., S.W.K., E.L., V.R., A.Z., C.F., G.M., P.M., T.S., S.D.S., D.T., H.B., and N.D.V. performed re- dominately occurred during sleep (4), which was ascribed to the search; E.S.-K. analyzed data; and E.S.-K. and N.D.V. wrote the paper. glymphatic pathway, operating most efficiently during sleep (3, β Conflict of interest statement: S.D.S. was an employee of Piramal Pharma Inc., which 14, 15). Clinical studies have also shown that A levels in the partly supported the radiotracer for this study. cerebrospinal fluid (CSF) are the highest before sleep and the This article is a PNAS Direct Submission. β lowest after wakening, while CSF A clearance was counteracted This open access article is distributed under Creative Commons Attribution-NonCommercial- by SD (16). However, there are some inconsistencies between NoDerivatives License 4.0 (CC BY-NC-ND). β animal models and findings in humans (17), and A increases in 1To whom correspondence may be addressed. Email: [email protected], gene- human CSF could reflect factors other than ABB increases in the [email protected], or [email protected]. brain itself (18–21). Notably, the effects of acute SD on Aβ This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10. clearance in the human brain have not been documented. This 1073/pnas.1721694115/-/DCSupplemental. observation will be important for understanding the contribution Published online April 9, 2018. www.pnas.org/cgi/doi/10.1073/pnas.1721694115 PNAS | April 24, 2018 | vol. 115 | no. 17 | 4483–4488 Downloaded by guest on September 27, 2021 higher ABB in the hippocampus, precuneus, and medial pre- the effects of SD on mood were correlated with increases in ABB frontal cortex (6, 8, 31). in the right hippocampal cluster. This analysis showed that mood worsening was negatively associated with changes in FBB SUVr Results [r (16) = −0.50, P = 0.03] (Fig. 1C) such that participants with Acute SD Effects. To compare the differences in FBB binding larger increases in ABB in the hippocampal cluster (Fig. 1A) had [quantified as relative standard uptake value (SUVr) and used as more mood worsening after SD. Because the quantification of a marker of ABB] (Methods) after acute SD versus that obtained ABB using FBB SUVr can be sensitive to blood perfusion ef- after RW, we used a voxelwise paired t test in statistical para- fects, we quantified FBB accumulation using measures of bind- metric mapping (SPM) (Methods). This analysis showed that ing potential (BPnd), which are less sensitive to blood perfusion images obtained after SD compared with those obtained after effects than SUVr measures. BPnd in the cluster where we ob- RW had significantly higher FBB binding (ABB increases) in a served the SD effect (Methods and Fig. 1A) was also significantly right lateralized cluster (Fig. 1A) that comprised hippocampal, higher in SD relative to RW [t(19) = 3.57, P = 0.002] (Fig. S2A). parahippocampal, and thalamic regions (Table S2). Of note, the Moreover, SD-related changes in BPnd were significantly cor- increases in FBB SUVr in this cluster were robust and observed related with those observed with FBB SUVr [r(18) = 0.53, P = in 19 of 20 participants (Fig. 1B) from RW (mean = 1.35, 0.016] (Fig. S2B), further supporting that SD-related increases in standard deviation = 0.06) to SD (mean = 1.42, standard de- FBB SUVr are not primarily driven by perfusion effects. viation = 0.07; a 5% increase, P < 0.0001). To further confirm this finding, we quantified FBB SUVr in an a priori hippocampal Sleep, APOE, and ABB. Prior studies had reported an association region of interest (ROI) (Methods and Fig. 1D) and compared between reported SH and sleep quality and (cortical) ABB in the measures after SD to those after RW.