Estrogen-related receptor gene expression associates with sex differences in cortical atrophy in isolated REM sleep behavior disorder

Marie Filiatrault, Violette Ayral, Christina Tremblay, Celine Haddad, Véronique Daneault, Alexandre Pastor-Bernier, Jean François Gagnon, Ronald B. Postuma, Petr Dušek, Stanislav Mareček, Zsoka Varga, Johannes C. Klein, Michele T. Hu, Isabelle Arnulf, Pauline Dodet, Marie Vidailhet, Jean Christophe Corvol, Stéphane Lehéricy, ICEBERG Study Group, Simon LewisElie Matar, Kaylena A. Ehgoetz Martens, Lachlan Churchill, Per Borghammer, Karoline Knudsen, Allan K. Hansen, Dario Arnaldi, Beatrice Orso, Pietro Mattioli, Luca Roccatagliata, Shady Rahayel

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Abstract

Isolated REM sleep behavior disorder, characterized by dream-enacting movements during REM sleep, is a male-predominant parasomnia and the strongest prodromal marker of synucleinopathies. Individuals with this disorder show cortical atrophy whose regional distribution covaries with gene expression patterns measured in the healthy human brain. However, the effect of sex on these brain changes remains unknown. The study objective is to comprehensively assess sex differences in cortical morphology and to characterize the healthy-brain gene expression correlates of brain abnormalities using the largest international multicentric MRI dataset of polysomnography-confirmed patients. Males have significantly more extensive and severe cortical thinning compared to females, despite similar age and clinical features. Imaging transcriptomics analyses indicate that regions affected in female patients map onto areas with higher expression of estrogen-related receptor genes, particularly ESRRG and ESRRA, in the healthy brain. These findings support  potential sex-specific neuroprotection in the prodromal stages of synucleinopathies and may inform personalized and targeted therapeutic strategies.

Original languageEnglish
Article number9016
Pages (from-to)1-15
Number of pages15
JournalNature Communications
Volume16
Issue number1
DOIs
Publication statusPublished - 10 Oct 2025

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