Marta Nováková

Salivary Melatonin Rhythm as a Marker of the Circadian System in Healthy Children and Those With Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. Problems with sleep structure, efficiency, and timing have been reported in some, but not all, studies on ADHD children. As the sleep-wake cycle belongs to circadian rhythms, the timekeeping circadian system might be involved in ADHD. To assess whether the circadian system of ADHD children differs from that of controls, the rhythm of the pineal hormone melatonin was used as a reliable marker of the system. Saliva from 34 ADHD and 43 control 6- to 12-yr-old children was sampled at 2-h intervals throughout the entire 24-h cycle, and the melatonin profiles of the ADHD and control children were compared. The nocturnal melatonin peaks of the ADHD and control group did not differ significantly. The high nocturnal interindividual variability of the peaks seen in adulthood was present already in the studied children. The 24-h melatonin profiles of all the ADHD subjects did not differ significantly from those of the control subjects. Categorization of subjects according to age, into groups of 6- to 7-yr-old (9 ADHD, 5 control), 8- to 9-yr-old (16 ADHD, 26 control), and 10- to 12-yr-old (9 ADHD, 12 control) children, revealed significant differences between the ADHD and control group in the melatonin rhythm waveform, but not in nocturnal melatonin peaks; the peaks were about the same in both groups and did not change significantly with increasing age. In the oldest, but not in the younger, children, the melatonin signal duration in the ADHD group was shorter than in the control group. The difference might be due to the fact that whereas in the control group both the evening melatonin onset and the morning offset phase delayed in the oldest children relative to those in the youngest children, in the ADHD group only the onset, but not the offset, phase delayed with increasing age. The data may indicate subtle differences between the circadian system of ADHD and control children during development. (Author correspondence: sumova@biomed.cas.cz)

Alteration of the circadian clock in children with Smith-Magenis syndrome.

CONTEXT Smith-Magenis syndrome (SMS) is associated with sleep disturbances and disrupted melatonin production. OBJECTIVES The study aimed to ascertain whether the sleep and melatonin production anomalies in SMS patients may be due to an alteration of the molecular mechanism of the circadian clock. SUBJECTS AND METHODS Five SMS patients (3-17 yr old) and five healthy age-matched control subjects were involved in the study. Saliva and buccal scrub samples were collected every 4 h during a 24-h period. Daily profiles of melatonin were determined in saliva using a direct double-antibody radioimmunoassay. Daily profiles of clock gene mRNA levels (Per1, Per2, and Rev-erbα) were determined in buccal scrub samples by RT-PCR. RESULTS In controls, melatonin levels were elevated during the nighttime and very low during the daytime. Daily profiles of clock genes, Per1, Per2, and Rev-erbα, mRNA levels in buccal mucosa exhibited significant and mutually synchronized circadian variations (Per1 and Rev-erbα: P < 0.001; Per2: P < 0.05); the mRNA levels were elevated during the daytime and decreased during the nighttime. In SMS patients, melatonin profiles were significantly altered compared with controls, being phase reversed, phase advanced, depressed, or abolished. Only Per1 and Rev-erbα mRNA profiles exhibited significant circadian rhythms (P < 0.05); the Per2 expression exhibited high variability, and the profile was out of phase with the other clock genes. CONCLUSION Our findings suggest that the anomalies in melatonin profiles of SMS patients might be due to a disturbance of the molecular circadian clockwork.

Human Chronotype Is Determined in Bodily Cells Under Real-Life Conditions

Individuals differ in their preferred timing of sleep and activity, which is referred to as a chronotype. The timing shows a wide distribution; extremely early chronotypes may wake up when the extremely late chronotypes fall asleep. The chronotype is supposed to be determined by the central circadian clock located in the suprachiasmatic nuclei (SCN) of the hypothalamus because the phasing of the pineal melatonin rhythm, which is driven by the SCN, correlates with the sleep timing preference. In addition to the SCN, circadian oscillators are also present in most if not all bodily cells. These peripheral clocks are synchronized by the central SCN clock and by other tissue-specific entraining cues. At the molecular level, the circadian oscillations are based on a complex, self-sustaining mechanism that drives the rhythmical expression of clock genes and their proteins. The aim of the present field study was to elucidate whether the changes in the internal timing of early and late chronotypes, as expressed by changes in the phases of their mid-sleep and melatonin secretion, can also be detected at the molecular clockwork level in subjects examined under real-life conditions. Ninety-five adult volunteers were chronotyped using an adapted Munich chronotype questionnaire to assess their mid-sleep phase, and 6 subjects with early chronotypes and 6 with late chronotypes were chosen for the study. For the assessment of the circadian phase, the subjects provided samples of saliva for the melatonin assay and samples of oral mucosa for the determination of clock gene Per1, Per2, and Rev-erbα mRNA levels every 4 h during a 24-h period. The significant correlation between the phase of the melatonin profile and timing of mid-sleep confirmed the classification of the subjects according to their chronotype. The circadian phases of the Per1, Per2, and Rev-erbα expression profiles in the oral mucosa were advanced in the early chronotypes compared with those in the late chronotypes (p < .001) and correlated significantly with the mid-sleep phase of the individual subjects. Moreover, the circadian phases of the Per1 expression profiles of individual subjects correlated significantly with the phases of their melatonin profiles (p < .05), whereas the correlation for the Per2 and Rev-erbα phases was nonsignificant, although the trend was the same. Our results demonstrate that the individual chronotype in humans living in real-life conditions affects not only the phasing of the daily melatonin rhythm in saliva but also the phasing of Per1, Per2, and Rev-erbα clock gene expression profiles in buccal mucosa cells. This report represents the first demonstration that the human peripheral circadian clock may sense the individuals chronotype under field study conditions. The data contribute to our understanding of the mechanisms underlying human chronotypes in real life. (Author correspondence: sumova@biomed.cas.cz)

Circadian system from conception till adulthood

In mammals, the circadian system is composed of the central clock in the hypothalamic suprachiasmatic nuclei and of peripheral clocks that are located in other neural structures and in cells of the peripheral tissues and organs. In adults, the system is hierarchically organized so that the central clock provides the other clocks in the body with information about the time of day. This information is needed for the adaptation of their functions to cyclically changing external conditions. During ontogenesis, the system undergoes substantial development and its sensitivity to external signals changes. Perinatally, maternal cues are responsible for setting the phase of the developing clock, while later postnatally, the LD cycle is dominant. The central clock attains its functional properties during a gradual and programmed process. Peripheral clocks begin to exhibit rhythmicity independent of each other at various developmental stages. During the early developmental stages, the peripheral clocks are set or driven by maternal feeding, but later the central clock becomes fully functional and begins to entrain the periphery. During the perinatal period, the central and peripheral clocks seem to be vulnerable to disturbances in external conditions. Further studies are needed to understand the processes of how the circadian system develops and what degree of plasticity and resilience it possesses during ontogenesis. These data may lead to an assessment of the contribution of disturbances of the circadian system during early ontogenesis to the occurrence of circadian diseases in adulthood.

Exposure of Pregnant Rats to Restricted Feeding Schedule Synchronizes the SCN Clocks of Their Fetuses under Constant Light but Not under a Light-Dark Regime

The circadian clock in the suprachiasmatic nucleus (SCN) develops gradually during the prenatal and early postnatal period. In the rat, this period lasts from around the 15th day of gestation until the 10th day of postnatal development. The circadian system of fetuses and newborn pups is entrained mostly by nonphotic maternal cues during prenatal and early postnatal development. The aim of the present study was to ascertain whether exposure of pregnant rats to a restricted feeding (RF) regime was able to entrain the circadian clock in the SCN of their fetuses during the prenatal period. The potency of RF as an entraining cue was tested under conditions when pregnant rats were entrained to an external light/dark (LD) cycle as well as under conditions when the external timing signal was lacking, i.e., under constant light (LL). The control groups were fed ad libitum and the experimental groups had restricted access to food for 6 h during their resting time throughout pregnancy. Daily profiles of Avp and c-fos gene expression were examined by in situ hybridization in the SCN of 1-day-old pups. The data demonstrated that RF in pregnant rats kept under LD cycle did not notably affect the daily rhythms of c-fos and Avp expression in the SCN of pups. The SCN profiles of Avp and c-fos gene expression did not exhibit circadian rhythms in pups born to mothers maintained in LL and fed ad libitum, likely due to desynchrony among the pups within a litter. However, RF in the pregnant rats kept under LL restored the circadian rhythmicity of c-fos and Avp expression in the SCN of their newborn pups. The results suggest that the fetal SCN clock is dominantly entrained by rhythmic signals from the maternal SCN. However, under conditions when the rhythmic signaling might be lacking, such as LL, regular food intake of the mothers may also play an important role in synchronization of the fetal SCN clock during prenatal ontogenesis.

Restricted feeding regime affects clock gene expression profiles in the suprachiasmatic nucleus of rats exposed to constant light.

The master circadian clock located in the suprachiasmatic nuclei (SCN) is dominantly entrained by external light/dark cycle to run with a period of a solar day, that is, 24 h, and synchronizes various peripheral clocks located in the bodys cells and tissues accordingly. A daily restricted normocaloric feeding regime synchronizes the peripheral clocks but has no effect on SCN rhythmicity. The aim of this study was to elucidate whether feeding regime may affect the molecular mechanism generating SCN rhythmicity under conditions in which the rhythmicity is disturbed, as occurs under constant light. The rats were maintained under constant light for 30 days and were either fed ad libitum during the whole period, or their access to food was restricted to only 6 h a day during the last 2 weeks in constant light. Locomotor activity was monitored during the whole experiment. On the last day in constant light, daily expression profiles of the clock genes Per1, Per2, Bmal1, and Rev-erbα were determined in the SCN of both groups by in situ hybridization. Due to their exposure to constant light, the rats fed ad libitum became completely arrhythmic, while those exposed to the restricted feeding were active mostly during the time of food availability. In the SCN of behaviorally arrhythmic rats, no oscillations in Rev-erbα and Bmal1 gene expression were detected, but very low amplitude, borderline significant, oscillations in Per1 and Per2 persisted. Restricted feeding induced significant circadian rhythms in Rev-erbα and Bmal1 gene expression, but did not affect the low amplitude oscillations of Per1 and Per2 expression. These findings demonstrate that, under specific conditions, when the rhythmicity of the SCN is disturbed and other temporal entraining cues are lacking, the SCN molecular clockwork may likely sense temporal signals from changes in metabolic state delivered by normocaloric food.

Early Chronotype and Tissue-Specific Alterations of Circadian Clock Function in Spontaneously Hypertensive Rats

Malfunction of the circadian timing system may result in cardiovascular and metabolic diseases, and conversely, these diseases can impair the circadian system. The aim of this study was to reveal whether the functional state of the circadian system of spontaneously hypertensive rats (SHR) differs from that of control Wistar rat. This study is the first to analyze the function of the circadian system of SHR in its complexity, i.e., of the central clock in the suprachiasmatic nuclei (SCN) as well as of the peripheral clocks. The functional properties of the SCN clock were estimated by behavioral output rhythm in locomotor activity and daily profiles of clock gene expression in the SCN determined by in situ hybridization. The function of the peripheral clocks was assessed by daily profiles of clock gene expression in the liver and colon by RT-PCR and in vitro using real time recording of Bmal1-dLuc reporter. The potential impact of the SHR phenotype on circadian control of the metabolic pathways was estimated by daily profiles of metabolism-relevant gene expression in the liver and colon. The results revealed that SHR exhibited an early chronotype, because the central SCN clock was phase advanced relative to light/dark cycle and the SCN driven output rhythm ran faster compared to Wistar rats. Moreover, the output rhythm was dampened. The SHR peripheral clock reacted to the dampened SCN output with tissue-specific consequences. In the colon of SHR the clock function was severely altered, whereas the differences are only marginal in the liver. These changes may likely result in a mutual desynchrony of circadian oscillators within the circadian system of SHR, thereby potentially contributing to metabolic pathology of the strain. The SHR may thus serve as a valuable model of human circadian disorders originating in poor synchrony of the circadian system with external light/dark regime.

Increased Sensitivity of the Circadian System to Temporal Changes in the Feeding Regime of Spontaneously Hypertensive Rats - A Potential Role for Bmal2 in the Liver

The mammalian timekeeping system generates circadian oscillations that rhythmically drive various functions in the body, including metabolic processes. In the liver, circadian clocks may respond both to actual feeding conditions and to the metabolic state. The temporal restriction of food availability to improper times of day (restricted feeding, RF) leads to the development of food anticipatory activity (FAA) and resets the hepatic clock accordingly. The aim of this study was to assess this response in a rat strain exhibiting complex pathophysiological symptoms involving spontaneous hypertension, an abnormal metabolic state and changes in the circadian system, i.e., in spontaneously hypertensive rats (SHR). The results revealed that SHR were more sensitive to RF compared with control rats, developing earlier and more pronounced FAA. Whereas in control rats, the RF only redistributed the activity profiles into two bouts (one corresponding to FAA and the other corresponding to the dark phase), in SHR the RF completely phase-advanced the locomotor activity according to the time of food presentation. The higher behavioral sensitivity to RF was correlated with larger phase advances of the hepatic clock in response to RF in SHR. Moreover, in contrast to the controls, RF did not suppress the amplitude of the hepatic clock oscillation in SHR. In the colon, no significant differences in response to RF between the two rat strains were detected. The results suggested the possible involvement of the Bmal2 gene in the higher sensitivity of the hepatic clock to RF in SHR because, in contrast to the Wistar rats, the rhythm of Bmal2 expression was advanced similarly to that of Bmal1 under RF. Altogether, the data demonstrate a higher behavioral and circadian responsiveness to RF in the rat strain with a cardiovascular and metabolic pathology and suggest a likely functional role for the Bmal2 gene within the circadian clock.

Melatonin is a redundant entraining signal in the rat circadian system

The role of melatonin in maintaining proper function of the circadian system has been proposed but very little evidence for such an effect has been provided. To ascertain the role, the aim of the study was to investigate impact of long-term melatonin absence on regulation of circadian system. The parameters of behavior and circadian clocks of rats which were devoid of the melatonin signal due to pinealectomy (PINX) for more than one year were compared with those of intact age-matched controls. PINX led to a decrease in spontaneous locomotor activity and a shortening of the free-running period of the activity rhythm driven by the central clock in the suprachiasmatic nuclei (SCN) in constant darkness. However, the SCN-driven rhythms in activity and feeding were not affected and remained well entrained in the light/dark cycle. In contrast, in these conditions PINX had a significant effect on amplitudes of the clock gene expression rhythms in the duodenum and also partially in the liver. These results demonstrate the significant impact of long-term melatonin absence on period of the central clock in the SCN and the amplitudes of the peripheral clocks in duodenum and liver and suggest that melatonin might be a redundant but effective endocrine signal for these clocks.

Moderate Changes in the Circadian System of Alzheimer's Disease Patients Detected in Their Home Environment.

Alzheimers disease (AD) is a neurodegenerative disease often accompanied with disruption of sleep-wake cycle. The sleep-wake cycle is controlled by mechanisms involving internal timekeeping (circadian) regulation. The aim of our present pilot study was to assess the circadian system in patients with mild form of AD in their home environment. In the study, 13 elderly AD patients and 13 age-matched healthy control subjects (the patients spouses) were enrolled. Sleep was recorded for 21 days by sleep diaries in all participants and checked by actigraphy in 4 of the AD patient/control couples. The samples of saliva and buccal mucosa were collected every 4 hours during the same 24 h-interval to detect melatonin and clock gene (PER1 and BMAL1) mRNA levels, respectively. The AD patients exhibited significantly longer inactivity interval during the 24 h and significantly higher number of daytime naps than controls. Daily profiles of melatonin levels exhibited circadian rhythms in both groups. Compared with controls, decline in amplitude of the melatonin rhythm in AD patients was not significant, however, in AD patients more melatonin profiles were dampened or had atypical waveforms. The clock genes PER1 and BMAL1 were expressed rhythmically with high amplitudes in both groups and no significant differences in phases between both groups were detected. Our results suggest moderate differences in functional state of the circadian system in patients with mild form of AD compared with healthy controls which are present in conditions of their home dwelling.