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Al‐Alsheikh AS, Alabdulkader S, Miras AD, Goldstone AP. Effects of bariatric surgery and dietary interventions for obesity on brain neurotransmitter systems and metabolism: A systematic review of positron emission tomography (PET) and single-photon emission computed tomography (SPECT) studies. Obes Rev 2023; 24:e13620. [PMID: 37699864 PMCID: PMC10909448 DOI: 10.1111/obr.13620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 04/05/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023]
Abstract
This systematic review collates studies of dietary or bariatric surgery interventions for obesity using positron emission tomography and single-photon emission computed tomography. Of 604 publications identified, 22 met inclusion criteria. Twelve studies assessed bariatric surgery (seven gastric bypass, five gastric bypass/sleeve gastrectomy), and ten dietary interventions (six low-calorie diet, three very low-calorie diet, one prolonged fasting). Thirteen studies examined neurotransmitter systems (six used tracers for dopamine DRD2/3 receptors: two each for 11 C-raclopride, 18 F-fallypride, 123 I-IBZM; one for dopamine transporter, 123 I-FP-CIT; one used tracer for serotonin 5-HT2A receptor, 18 F-altanserin; two used tracers for serotonin transporter, 11 C-DASB or 123 I-FP-CIT; two used tracer for μ-opioid receptor, 11 C-carfentanil; one used tracer for noradrenaline transporter, 11 C-MRB); seven studies assessed glucose uptake using 18 F-fluorodeoxyglucose; four studies assessed regional cerebral blood flow using 15 O-H2 O (one study also used arterial spin labeling); and two studies measured fatty acid uptake using 18 F-FTHA and one using 11 C-palmitate. The review summarizes findings and correlations with clinical outcomes, eating behavior, and mechanistic mediators. The small number of studies using each tracer and intervention, lack of dietary intervention control groups in any surgical studies, heterogeneity in time since intervention and degree of weight loss, and small sample sizes hindered the drawing of robust conclusions across studies.
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Affiliation(s)
- Alhanouf S. Al‐Alsheikh
- Department of Metabolism, Digestion and Reproduction, Imperial College LondonHammersmith HospitalLondonUK
- Department of Community Health Sciences, College of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Shahd Alabdulkader
- Department of Metabolism, Digestion and Reproduction, Imperial College LondonHammersmith HospitalLondonUK
- Department of Health Sciences, College of Health and Rehabilitation SciencesPrincess Nourah Bint Abdulrahman UniversityRiyadhSaudi Arabia
| | - Alexander D. Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College LondonHammersmith HospitalLondonUK
- School of Medicine, Faculty of Life and Health SciencesUlster UniversityLondonderryUK
| | - Anthony P. Goldstone
- PsychoNeuroEndocrinology Research Group, Division of Psychiatry, Department of Brain Sciences, Imperial College LondonHammersmith HospitalLondonUK
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Rodan SC, Bryant E, Le A, Maloney D, Touyz S, McGregor IS, Maguire S. Pharmacotherapy, alternative and adjunctive therapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:112. [PMID: 37415200 DOI: 10.1186/s40337-023-00833-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The current review broadly summarises the evidence base for pharmacotherapies and adjunctive and alternative therapies in the treatment of eating disorders and disordered eating. METHODS This paper forms part of a Rapid Review series examining the evidence base in the field of eating disorders. This was conducted to inform the Australian National Eating Disorder Research and Translation Strategy 2021-2030. ScienceDirect, PubMed and Ovid/Medline were searched for included studies published between 2009 and 2021 in English. High-level evidence such as meta-analyses, large population studies and randomised control trials were prioritised, and grey literature excluded. Data from included studies relating to pharmacotherapy, and to adjunctive and alternative therapies in eating disorders, were synthesised and disseminated in the current review. RESULTS A total of 121 studies were identified, relating to pharmacotherapy (n = 90), adjunctive therapies (n = 21) and alternative therapies (n = 22). Some of the identified studies involved combinations of the above (e.g. adjunctive pharmacotherapy). Evidence of efficacy of interventions across all three categories was very limited with few relevant high quality clinical trials. There was a particular scarcity of evidence around effective treatments for anorexia nervosa (AN). With treatment of bulimia nervosa (BN), fluoxetine has exhibited some efficacy leading to regulatory approval in some countries. With binge eating disorder (BED), recent evidence supports the use of lisdexamfetamine. Neurostimulation interventions show some emerging efficacy in the treatment of AN, BN and BED but some, such as deep brain stimulation can be highly invasive. CONCLUSION Despite widespread use of medications, this Rapid Review has identified a lack of effective medications and adjunctive and alternative therapies in the treatment of EDs. An intensification of high-quality clinical trial activity and drug discovery innovation are required to better assist patients suffering from EDs.
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Affiliation(s)
- Sarah-Catherine Rodan
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, Australia.
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia.
- Brain and Mind Centre, University of Sydney, Sydney, Australia.
| | - Emma Bryant
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
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Riedel P, Wolff M, Spreer M, Petzold J, Plawecki MH, Goschke T, Zimmermann US, Smolka MN. Acute alcohol does not impair attentional inhibition as measured with Stroop interference scores but impairs Stroop performance. Psychopharmacology (Berl) 2021; 238:1593-1607. [PMID: 33660080 PMCID: PMC8139883 DOI: 10.1007/s00213-021-05792-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE Inhibition is a core executive function and refers to the ability to deliberately suppress attention, behavior, thoughts, and/or emotions and instead act in a specific manner. While acute alcohol exposure has been shown to impair response inhibition in the stop-signal and Go/NoGo tasks, reported alcohol effects on attentional inhibition in the Stroop task are inconsistent. Notably, studies have operationalized attentional inhibition variably and there has been intra- and inter-individual variability in alcohol exposure. OBJECTIVE This study aimed to examine the acute effects of alcohol on attentional inhibition, considering previous limitations. METHODS In a single-blind, cross-over design, 40 non-dependent participants with a medium-to-high risk drinking behavior performed a Counting Stroop task (CST) under a baseline and an arterial blood alcohol concentration (aBAC) clamp at 80 mg%. Attentional inhibition was assessed as the alteration of reaction times (RT), error rates (ER), and inverse efficiency scores (IES) between incongruent and congruent trials (interference score). Stroop performance was also assessed regardless of trial-type. RESULTS Compared to saline, acute alcohol exposure via an aBAC clamp did not affect CST interference scores but increased RTs and IES in both incongruent and congruent trials. CONCLUSIONS Attentional inhibition (Stroop interference score) was not impaired by clamped moderate alcohol exposure. Acute alcohol impaired Stroop performance evidenced by a general increase in response times. Our findings suggest that response and attentional inhibition do not share the same neurocognitive mechanisms and are affected differently by alcohol. Results could also be explained by automated behaviors known to be relatively unaffected by acute alcohol.
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Affiliation(s)
- P Riedel
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - M Wolff
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Department of General Psychology, Technische Universität Dresden, Zellescher Weg 17, 01069, Dresden, Germany
| | - M Spreer
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - J Petzold
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany
| | - M H Plawecki
- Department of Psychiatry, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN, 46202, USA
| | - T Goschke
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany
- Department of General Psychology, Technische Universität Dresden, Zellescher Weg 17, 01069, Dresden, Germany
| | - U S Zimmermann
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Department of Addiction Medicine and Psychotherapy, kbo-Isar-Amper-Klinikum München-Ost, Vockestraße 72, 85540, Haar, Germany
| | - M N Smolka
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany.
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Methocinnamox (MCAM) antagonizes the behavioral suppressant effects of morphine without impairing delayed matching-to-sample accuracy in rhesus monkeys. Psychopharmacology (Berl) 2020; 237:3057-3065. [PMID: 32772146 PMCID: PMC8114947 DOI: 10.1007/s00213-020-05592-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022]
Abstract
RATIONALE Opioid abuse remains a serious public health problem. The pseudoirreversible mu opioid receptor antagonist methocinnamox (MCAM) might be useful for treating opioid abuse and overdose. Because endogenous opioid systems can modulate cognition and decision-making, it is important to evaluate whether long-term blockade of mu opioid receptors by MCAM adversely impacts complex operant behavior involving memory. OBJECTIVE This study tested the effects of MCAM in rhesus monkeys responding under a delayed matching-to-sample task, with correct responses reinforced by sucrose pellets. Because MCAM did not alter performance, antagonism of the rate-decreasing effects of morphine was used to confirm that an effective dose of MCAM was administered. Moreover, the muscarinic receptor antagonist scopolamine and the N-methyl-D-aspartate antagonist phencyclidine were studied as positive controls to demonstrate sensitivity of this procedure to memory disruption. RESULTS Neither MCAM (0.32 mg/kg) nor morphine (1-5.6 mg/kg) impaired delayed matching-to-sample accuracy. Morphine dose-dependently decreased the number of trials completed before MCAM administration, and a single injection of MCAM blocked the behavioral suppressant effects of morphine for at least 7 days. Scopolamine (0.01-0.056 mg/kg) and phencyclidine (0.1-0.56 mg/kg) dose-dependently decreased delayed matching-to-sample accuracy and the number of trials completed. CONCLUSIONS MCAM did not impair memory (as measured by accuracy in a delayed matching-to-sample task) and did not decrease responding for or consumption of sucrose pellets. This dose of MCAM attenuates self-administration of opioids and reverses as well as prevents opioid-induced respiratory depression. These results provide further support for a favorable adverse effect profile for MCAM.
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Ralph-Nearman C, Achee M, Lapidus R, Stewart JL, Filik R. A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism. Brain Behav 2019; 9:e01458. [PMID: 31696674 PMCID: PMC6908865 DOI: 10.1002/brb3.1458] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The current systematic and methodological review aimed to critically review existing literature utilizing implicit processing, or automatic approach- and/or avoidance-related attentional biases between eating disorder (ED) and nonclinical samples, which (a) highlights how psychophysiological methods advance knowledge of ED implicit bias; (b) explains how findings fit into transdiagnostic versus disorder-specific ED frameworks; and (c) suggests how research can address perfectionism-related ED biases. METHOD Three databases were systematically searched to identify studies: PubMed, Scopus, and PsychInfo electronic databases. Peer-reviewed studies of 18- to 39-year-olds with both clinical ED and healthy samples assessing visual attentional biases using pictorial and/or linguistic stimuli related to food, body, and/or perfectionism were included. RESULTS Forty-six studies were included. While behavioral results were often similar across ED diagnoses, studies incorporating psychophysiological measures often revealed disease-specific attentional biases. Specifically, women with bulimia nervosa (BN) tend to approach food and other body types, whereas women with anorexia nervosa (AN) tend to avoid food as well as overweight bodies. CONCLUSIONS Further integration of psychophysiological and behavioral methods may identify subtle processing variations in ED, which may guide prevention strategies and interventions, and provide important clinical implications. Few implicit bias studies include male participants, investigate binge-eating disorder, or evaluate perfectionism-relevant stimuli, despite the fact that perfectionism is implicated in models of ED.
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Affiliation(s)
- Christina Ralph-Nearman
- Laureate Institute for Brain Research, Tulsa, OK, USA.,School of Psychology, University of Nottingham, Nottingham, UK
| | - Margaret Achee
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | | | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, USA.,Department of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Ruth Filik
- School of Psychology, University of Nottingham, Nottingham, UK
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Abstract
Obesity is a severe worldwide epidemic. Obesity comorbidities, such as type 2 diabetes mellitus, hypertension, and atherosclerosis, are costly for patients and governments. The treatment of obesity involves several facets, including lifestyle changes, bariatric surgery, and pharmacotherapy. As changes in lifestyle require considerable patient commitment that is sometimes unachievable, and surgery is expensive and invasive, pharmacotherapy is the primary option for most patients. This review describes the pharmacotherapy currently available in the USA, Europe, and Brazil, focusing on its limitations. We then analyze the results from clinical trials of new drug candidates. Most drugs cause weight loss of < 4 kg compared with controls, and severe adverse effects have caused a number of drugs to be withdrawn from the market in several countries. Drugs under development have not shown more significant weight loss or reduced adverse effects. We conclude that a significant portion of obese patients have few treatment options because of the adverse effects and minimal weight loss associated with current pharmacotherapy. However, drugs currently under development appear unable to change this scenario in the near future. Thus, it is essential that new compounds are developed and new molecular targets studied so obesity can be efficiently treated in all patients in the future.
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7
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Moore CF, Panciera JI, Sabino V, Cottone P. Neuropharmacology of compulsive eating. Philos Trans R Soc Lond B Biol Sci 2019; 373:rstb.2017.0024. [PMID: 29352024 DOI: 10.1098/rstb.2017.0024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 12/22/2022] Open
Abstract
Compulsive eating behaviour is a transdiagnostic construct observed in certain forms of obesity and eating disorders, as well as in the proposed construct of 'food addiction'. Compulsive eating can be conceptualized as comprising three elements: (i) habitual overeating, (ii) overeating to relieve a negative emotional state, and (iii) overeating despite adverse consequences. Neurobiological processes that include maladaptive habit formation, the emergence of a negative affect, and dysfunctions in inhibitory control are thought to drive the development and persistence of compulsive eating behaviour. These complex psychobehavioural processes are under the control of various neuropharmacological systems. Here, we describe the current evidence implicating these systems in compulsive eating behaviour, and contextualize them within the three elements. A better understanding of the neuropharmacological substrates of compulsive eating behaviour has the potential to significantly advance the pharmacotherapy for feeding-related pathologies.This article is part of a discussion meeting issue 'Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.
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Affiliation(s)
- Catherine F Moore
- Laboratory of Addictive Disorders, Departments of Pharmacology and Psychiatry, Boston University School of Medicine, 72 E. Concord Street, R-618, Boston, MA 02118, USA.,Graduate Program for Neuroscience, Boston University School of Medicine, 72 E. Concord Street, R-618, Boston, MA 02118, USA
| | - Julia I Panciera
- Laboratory of Addictive Disorders, Departments of Pharmacology and Psychiatry, Boston University School of Medicine, 72 E. Concord Street, R-618, Boston, MA 02118, USA.,MS in Medical Sciences Program, Graduate Medical Sciences, Boston University School of Medicine, 72 E. Concord Street, R-618, Boston, MA 02118, USA.,Master of Public Health Program, Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA
| | - Valentina Sabino
- Laboratory of Addictive Disorders, Departments of Pharmacology and Psychiatry, Boston University School of Medicine, 72 E. Concord Street, R-618, Boston, MA 02118, USA
| | - Pietro Cottone
- Laboratory of Addictive Disorders, Departments of Pharmacology and Psychiatry, Boston University School of Medicine, 72 E. Concord Street, R-618, Boston, MA 02118, USA
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8
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Abstract
The failure of traditional antidepressant medications to adequately target cognitive impairment is associated with poor treatment response, increased risk of relapse, and greater lifetime disability. Opioid receptor antagonists are currently under development as novel therapeutics for major depressive disorder (MDD) and other stress-related illnesses. Although it is known that dysregulation of the endogenous opioid system is observed in patients diagnosed with MDD, the impact of opioidergic neurotransmission on cognitive impairment has not been systematically evaluated. Here we review the literature indicating that opioid manipulations can alter cognitive functions in humans. Furthermore, we detail the preclinical studies that demonstrate the ability of mu-opioid receptor and kappa-opioid receptor ligands to modulate several cognitive processes. Specifically, this review focuses on domains within higher order cognitive processing, including attention and executive functioning, which can differentiate cognitive processes influenced by motivational state.
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9
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Abstract
Binge-eating disorder (BED) is the most prevalent eating disorder with estimates of 2-5% of the general adult population. Nonetheless, its pathophysiology is poorly understood. Furthermore, there exist few therapeutic options for its effective treatment. Here we review the current state of binge-eating neurobiology and pharmacology, drawing from clinical therapeutic, neuroimaging, cognitive, human genetic and animal model studies. These studies, which are still in their infancy, indicate that while there are many gaps in our knowledge, several key neural substrates appear to underpin binge-eating and may be conserved between human and animals. This observation suggests that behavioral intermediate phenotypes or endophenotypes relevant to BED may be modeled in animals, facilitating the identification and testing of novel pharmacological targets. The development of novel, safe and effective pharmacological therapies for the treatment of BED will enhance the ability of clinicians to provide optimal care for people with BED.
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Affiliation(s)
- Peter H Hutson
- Department of Neurobiology, CNS Discovery, Teva Pharmaceuticals, West Chester, PA, USA.
| | - Iris M Balodis
- Peter Boris Centre for Addiction Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Marc N Potenza
- Department of Psychiatry, Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA; National Center on Addiction and Substance Abuse, USA; Connecticut Mental Health Center, New Haven, CT, USA
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10
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Pathological Overeating: Emerging Evidence for a Compulsivity Construct. Neuropsychopharmacology 2017; 42:1375-1389. [PMID: 27922596 PMCID: PMC5436113 DOI: 10.1038/npp.2016.269] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 12/11/2022]
Abstract
Compulsive eating behavior is a transdiagnostic construct that is characteristic of medical and psychiatric conditions such as forms of obesity and eating disorders. Although feeding research is moving toward a better understanding of the proposed addictive properties of food, the components and the mechanisms contributing to compulsive eating are not yet clearly defined or understood. Current understanding highlights three elements of compulsive behavior as it applies to pathological overeating: (1) habitual overeating; (2) overeating to relieve a negative emotional state; and (3) overeating despite aversive consequences. These elements emerge through mechanisms involving pathological habit formation through an aberrant learning process, the emergence of a negative emotional state, and dysfunctions in behavioral control. Dysfunctions in systems within neurocircuitries that comprise the basal ganglia, the extended amygdala, and the prefrontal cortex result in compulsive eating behaviors. Here, we present evidence to relate compulsive eating behavior and addiction and to characterize their underlying neurobiological mechanisms. A major need to improve understanding of compulsive eating through the integration of complex motivational, emotional, and cognitive constructs is warranted.
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11
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Ziauddeen H, Nestor LJ, Subramaniam N, Dodds C, Nathan PJ, Miller SR, Sarai BK, Maltby K, Fernando D, Warren L, Hosking LK, Waterworth D, Korzeniowska A, Win B, Richards DB, Vasist Johnson L, Fletcher PC, Bullmore ET. Opioid Antagonists and the A118G Polymorphism in the μ-Opioid Receptor Gene: Effects of GSK1521498 and Naltrexone in Healthy Drinkers Stratified by OPRM1 Genotype. Neuropsychopharmacology 2016; 41:2647-57. [PMID: 27109624 PMCID: PMC5026731 DOI: 10.1038/npp.2016.60] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/31/2016] [Accepted: 04/06/2016] [Indexed: 02/02/2023]
Abstract
The A118G single-nucleotide polymorphism (SNP rs1799971) in the μ-opioid receptor gene, OPRM1, has been much studied in relation to alcohol use disorders. The reported effects of allelic variation at this SNP on alcohol-related behaviors, and on opioid receptor antagonist treatments, have been inconsistent. We investigated the pharmacogenetic interaction between A118G variation and the effects of two μ-opioid receptor antagonists in a clinical lab setting. Fifty-six overweight and moderate-heavy drinkers were prospectively stratified by genotype (29 AA homozygotes, 27 carriers of at least 1 G allele) in a double-blind placebo-controlled, three-period crossover design with naltrexone (NTX; 25 mg OD for 2 days, then 50 mg OD for 3 days) and GSK1521498 (10 mg OD for 5 days). The primary end point was regional brain activation by the contrast between alcohol and neutral tastes measured using functional magnetic resonance imaging (fMRI). Secondary end points included other fMRI contrasts, subjective responses to intravenous alcohol challenge, and food intake. GSK1521498 (but not NTX) significantly attenuated fMRI activation by appetitive tastes in the midbrain and amygdala. GSK1521498 (and NTX to a lesser extent) significantly affected self-reported responses to alcohol infusion. Both drugs reduced food intake. Across all end points, there was less robust evidence for significant effects of OPRM1 allelic variation, or for pharmacogenetic interactions between genotype and drug treatment. These results do not support strong modulatory effects of OPRM1 genetic variation on opioid receptor antagonist attenuation of alcohol- and food-related behaviors. However, they do support further investigation of GSK1521498 as a potential therapeutic for alcohol use and eating disorders.
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Affiliation(s)
- Hisham Ziauddeen
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Wellcome Trust MRC Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, UK
| | - Liam J Nestor
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Centre for Neuropsychopharmacology, Imperial College, London, UK
| | - Naresh Subramaniam
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Wellcome Trust MRC Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Chris Dodds
- Department of Psychology, University of Exeter, Exeter, UK
| | - Pradeep J Nathan
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Neuroscience Center of Excellence, inVentiv Health Clinical, Maidenhead, UK
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | | | | | - Kay Maltby
- GSK Clinical Unit, Cambridge Biomedical Campus, Cambridge, UK
| | - Disala Fernando
- GSK Clinical Unit, Cambridge Biomedical Campus, Cambridge, UK
| | - Liling Warren
- Acclarogen, St John's Innovation Centre, Cambridge, UK
| | | | - Dawn Waterworth
- Genetics, Target Science, GlaxoSmithKline, King of Prussia, PA, USA
| | | | - Beta Win
- GSK, Global Clinical Safety & Pharmacovigilance, Stockley Park, UK
| | - Duncan B Richards
- Academic Discovery Performance Unit, GlaxoSmithKline R&D, Stevenage, UK
| | | | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Wellcome Trust MRC Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, UK
| | - Edward T Bullmore
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, UK
- Academic Discovery Performance Unit, GlaxoSmithKline R&D, Stevenage, UK
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12
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Abstract
Binge eating disorder (BED) is the most common of eating disorders and is characterized by excessive, out-of-control, rapid food intake. This review focuses on cognitive impairments in BED, which represent an endophenotype that mediates brain function and behavior. Here we focus on reviewing impulsivity, compulsivity, attentional biases to food cues, and executive function. Behavioral regulation in BED appears to be influenced by the context of motivationally salient food cues and the degree of obesity. Deficits in delay discounting and risk taking under ambiguity are impaired in obesity irrespective of BED status. However, in BED subjects with milder obesity, greater risk seeking under explicit probabilistic risk is observed to monetary rewards, whereas this shifts to risk aversion and enhanced delay discounting in more severe obesity. Relative to non-BED obese subjects, BED is characterized by enhanced behavioral inflexibility or compulsivity across multiple domains, with subjects selecting the same choices despite change in relevance (set shifting), being no longer rewarding (habit formation), or irrespective of outcome (perseveration). The context of food cues was associated with multiple attentional and early and late inhibitory impairments and enhanced memory bias, although BED patients also have generalized cognitive interference in working memory. These findings may help explain the phenotype of binge eating. Motivationally salient food cues provoke attentional and memory biases along with impairing response inhibitory processes. Those with BED are also more susceptible to cognitive interference and have impaired decisional impulsivity, with the tendency to inflexibly stick with the same choices irrespective of changes in context. These findings suggest critical cognitive domains that may guide therapeutic interventions.
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13
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Abstract
Binge eating disorder is characterized by excessive, uncontrollable consumption of palatable food within brief periods of time. Excessive intake of palatable food is thought to be driven by hedonic, rather than energy homeostatic, mechanisms. However, reward processing does not only comprise consummatory actions; a key component is represented by the anticipatory phase directed at procuring the reward. This phase is highly influenced by environmental food-associated stimuli, which can robustly enhance the desire to eat even in the absence of physiological needs. The opioid system (endogenous peptides and their receptors) has been strongly linked to the rewarding aspects of palatable food intake, and perhaps represents the key system involved in hedonic overeating. Here we review evidence suggesting that the opioid system can also be regarded as one of the systems that regulates the anticipatory incentive processes preceding binge eating hedonic episodes.
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14
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Abstract
Biobehavioral features associated with binge-eating disorder (BED) have been investigated; however, few systematic reviews to date have described neuroimaging findings from studies of BED. Emerging functional and structural studies support BED as having unique and overlapping neural features as compared with other disorders. Neuroimaging studies provide evidence linking heightened responses to palatable food cues with prefrontal areas, particularly the orbitofrontal cortex (OFC), with specific relationships to hunger and reward-sensitivity measures. While few studies to date have investigated non-food-cue responses; these suggest a generalized hypofunctioning in frontostriatal areas during reward and inhibitory control processes. Early studies applying neuroimaging to treatment efforts suggest that targeting neural function underlying motivational processes may prove important in the treatment of BED.
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Shank LM, Tanofsky-Kraff M, Nelson EE, Shomaker LB, Ranzenhofer LM, Hannallah LM, Field SE, Vannucci A, Bongiorno DM, Brady SM, Condarco T, Demidowich A, Kelly NR, Cassidy O, Simmons WK, Engel SG, Pine DS, Yanovski JA. Attentional bias to food cues in youth with loss of control eating. Appetite 2015; 87:68-75. [PMID: 25435490 PMCID: PMC4333006 DOI: 10.1016/j.appet.2014.11.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 11/12/2014] [Accepted: 11/25/2014] [Indexed: 12/14/2022]
Abstract
Emerging data indicate that adults with binge eating may exhibit an attentional bias toward highly palatable foods, which may promote obesogenic eating patterns and excess weight gain. However, it is unknown to what extent youth with loss of control (LOC) eating display a similar bias. We therefore studied 76 youth (14.5 ± 2.3 years; 86.8% female; BMI-z 1.7 ± .73) with (n = 47) and without (n = 29) reported LOC eating. Following a breakfast to reduce hunger, youth participated in a computerized visual probe task of sustained attention that assessed reaction time to pairs of pictures consisting of high palatable foods, low palatable foods, and neutral household objects. Although sustained attentional bias did not differ by LOC eating presence and was unrelated to body weight, a two-way interaction between BMI-z and LOC eating was observed (p = .01), such that only among youth with LOC eating, attentional bias toward high palatable foods versus neutral objects was positively associated with BMI-z. These findings suggest that LOC eating and body weight interact in their association with attentional bias to highly palatable foods cues, and may partially explain the mixed literature linking attentional bias to food cues with excess body weight.
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Affiliation(s)
- Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA.
| | - Eric E Nelson
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, NIH, DHHS, 15K North Drive, Bethesda, MD 20892, USA
| | - Lauren B Shomaker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA; Colorado State University, 303 Behavioral Sciences Building, Campus Delivery 1570, 410 Pitkin Street, Fort Collins, CO 80523, USA
| | - Lisa M Ranzenhofer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Louise M Hannallah
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Sara E Field
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Anna Vannucci
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Diana M Bongiorno
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, NIH, DHHS, 15K North Drive, Bethesda, MD 20892, USA
| | - Sheila M Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Tania Condarco
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Andrew Demidowich
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Nichole R Kelly
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Omni Cassidy
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - W Kyle Simmons
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136, USA; Faculty of Community Medicine, The University of Tulsa, 4502 E. 41st Street, Tulsa, OK 74135, USA
| | - Scott G Engel
- Neuropsychiatric Research Institute, 700 1st Ave S, Fargo, ND 58103, USA
| | - Daniel S Pine
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, NIH, DHHS, 15K North Drive, Bethesda, MD 20892, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
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Abstract
This paper is the thirty-fifth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2012 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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17
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Schreiber LRN, Odlaug BL, Grant JE. The overlap between binge eating disorder and substance use disorders: Diagnosis and neurobiology. J Behav Addict 2013; 2:191-8. [PMID: 25215200 PMCID: PMC4154572 DOI: 10.1556/jba.2.2013.015] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/19/2013] [Accepted: 08/20/2013] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND AIMS Binge eating disorder (BED) is a relatively common condition, especially in young adult females, and is characterized by chronic over-consumption of food resulting in embarrassment, distress, and potential health problems. It is formally included as a disorder in DSM-5 for the first time, an acknowledgement to its debilitating nature. This article explores the overlap between binge eating disorder and substance use disorders (SUD). METHODS The bibliographic search was a computerized screen of PubMed databases from January 1990 to the present. Binge eating disorder, substance use disorder, binging, obesity, food addiction, comorbidity, dopamine, opioid, serotonin, glutamate, and pharmacological treatment were the keywords used in searching. RESULTS BED shares similar phenomenology to SUD, including significant urges to engage in binging episodes, resulting in distress and impairment. Similar neurobiological pathways are found in both BED and SUD and medications based on similar neurobiology have been examined for both disorders. A subset of individuals with BED may have a "food addiction", but there is no clinical agreement on the meaning of "food addiction". Exploring the relationship between BED and obesity may also shed light on the extent to which BED can be viewed as an addiction. CONCLUSIONS Overall, nascent research regarding BED and SUD suggests an overlap between these disorders, but there are discrepancies between these two disorders that need further exploration.
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Affiliation(s)
| | | | - Jon E. Grant
- ,
Corresponding author. Jon E. Grant Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine; 5841 S. Maryland Avenue, Chicago, IL 60637, USAE-mail: E-mail:
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18
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Ziauddeen H, Fletcher PC. Central nervous system biomarkers for antiobesity drug development. Drug Discov Today 2013; 18:1282-91. [PMID: 23993917 PMCID: PMC3858811 DOI: 10.1016/j.drudis.2013.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/06/2013] [Accepted: 08/20/2013] [Indexed: 01/01/2023]
Abstract
Neuroimaging, cognitive and behavioural biomarkers can aid antiobesity drug development. These biomarkers can detect early signals of mechanistic efficacy and adverse effects. In Phase II biomarkers can provide proof-of-concept to inform the decision to advance to Phase III. Potential biomarker candidates that have been used with antiobesity drugs are discussed. These candidate biomarkers need further exploration, standardisation and validation.
With antiobesity agents, weight loss can emerge from an array of metabolic, cognitive and behavioural changes that translate into weight change over time. In early drug development, characterising these changes can actually be more informative than simply measuring weight loss. Biomarkers for these mechanisms can be used to determine whether potential compounds are worth developing further by providing proof of mechanistic action and detecting early signs of neuropsychiatric adverse effects. In this review, we examine potential biomarkers for effects on metabolism and satiety, hedonics and motivation, and eating behaviour. We also review biomarkers for early detection of neuropsychiatric adverse effects.
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Affiliation(s)
- Hisham Ziauddeen
- Department of Psychiatry, Behavioural & Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, UK; Wellcome Trust MRC Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, UK; Cambridgeshire & Peterborough NHS Foundation Trust (CPFT), Cambridge, UK.
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19
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Ziauddeen H, Nathan PJ, Dodds C, Maltby K, Miller SR, Waterworth D, Song K, Warren L, Hosking L, Zucchetto M, Bush M, Johnson LV, Sarai B, Mogg K, Bradley BP, Richards DB, Fletcher PC, Bullmore ET. The effects of alcohol on the pharmacokinetics and pharmacodynamics of the selective mu-opioid receptor antagonist GSK1521498 in healthy subjects. J Clin Pharmacol 2013; 53:1078-90. [PMID: 23934621 PMCID: PMC4282435 DOI: 10.1002/jcph.110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/11/2013] [Indexed: 11/27/2022]
Abstract
The mu-opioid system has a key role in hedonic and motivational processes critical to substance addiction. However, existing mu-opioid antagonists have had limited success as anti-addiction treatments. GSK1521498 is a selective and potent mu-opioid antagonist being developed for the treatment of overeating and substance addictions. In this study, 28 healthy participants were administered single doses of GSK1521498 20 mg, ethanol 0.5 g/kg body weight, or both in combination, in a double blind placebo controlled four-way crossover design. The primary objective was to determine the risk of significant adverse pharmacodynamic and pharmacokinetic (PK) interactions. The effects of GSK1521498 on hedonic and consummatory responses to alcohol and the attentional processing of alcohol-related stimuli, and their modulation by the OPRM1 A118G polymorphism were also explored. GSK1521498 20 mg was well tolerated alone and in combination with ethanol. There were mild transient effects of GSK1521498 on alertness and mood that were greater when it was combined with ethanol. These effects were not of clinical significance. There were no effects of GSK1521498 on reaction time, hedonic or consummatory responses. These findings provide encouraging safety and PK data to support continued development of GSK1521498 for the treatment of alcohol addiction.
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Affiliation(s)
- Hisham Ziauddeen
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke's Centre for Clinical Investigations, Cambridge, UK; Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK; Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK
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20
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McElroy SL, Guerdjikova AI, Blom TJ, Crow SJ, Memisoglu A, Silverman BL, Ehrich EW. A placebo-controlled pilot study of the novel opioid receptor antagonist ALKS-33 in binge eating disorder. Int J Eat Disord 2013; 46:239-45. [PMID: 23381803 DOI: 10.1002/eat.22114] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 12/25/2012] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess preliminarily the effectiveness of a novel opioid antagonist, ALKS-33, in binge eating disorder (BED). METHOD In this randomized, placebo-controlled, flexible dose, proof-of-concept trial, 62 outpatients with BED and obesity received ALKS-33 (N = 26) or placebo (N = 36) for 6 weeks. Outcome measures of binge eating, body weight, and eating pathology were assessed. RESULTS A large decrease in binge eating episode frequency was observed following both ALKS-33 and placebo treatment. There was no significant difference between treatment groups in binge eating episode frequency or any other measure of binge eating, body weight, or eating pathology. DISCUSSION In this preliminary proof-of-concept study in BED, ALKS-33 did not separate from placebo. Although a failed trial cannot be excluded, the finding is consistent with earlier observations in bulimia nervosa with other opioid antagonists and suggests ALKS-33, at least when administered daily for 6 weeks, may not be efficacious for BED.
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Affiliation(s)
- Susan L McElroy
- Lindner Center of HOPE, Research Institute, Mason, OH 45040, USA.
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