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Williams JC, Tubiolo PN, Zheng ZJ, Silver-Frankel EB, Pham DT, Haubold NK, Abeykoon SK, Abi-Dargham A, Horga G, Van Snellenberg JX. Functional Localization of the Human Auditory and Visual Thalamus Using a Thalamic Localizer Functional Magnetic Resonance Imaging Task. bioRxiv 2024:2024.04.28.591516. [PMID: 38746171 PMCID: PMC11092475 DOI: 10.1101/2024.04.28.591516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Functional magnetic resonance imaging (fMRI) of the auditory and visual sensory systems of the human brain is an active area of investigation in the study of human health and disease. The medial geniculate nucleus (MGN) and lateral geniculate nucleus (LGN) are key thalamic nuclei involved in the processing and relay of auditory and visual information, respectively, and are the subject of blood-oxygen-level-dependent (BOLD) fMRI studies of neural activation and functional connectivity in human participants. However, localization of BOLD fMRI signal originating from neural activity in MGN and LGN remains a technical challenge, due in part to the poor definition of boundaries of these thalamic nuclei in standard T1-weighted and T2-weighted magnetic resonance imaging sequences. Here, we report the development and evaluation of an auditory and visual sensory thalamic localizer (TL) fMRI task that produces participant-specific functionally-defined regions of interest (fROIs) of both MGN and LGN, using 3 Tesla multiband fMRI and a clustered-sparse temporal acquisition sequence, in less than 16 minutes of scan time. We demonstrate the use of MGN and LGN fROIs obtained from the TL fMRI task in standard resting-state functional connectivity (RSFC) fMRI analyses in the same participants. In RSFC analyses, we validated the specificity of MGN and LGN fROIs for signals obtained from primary auditory and visual cortex, respectively, and benchmark their performance against alternative atlas- and segmentation-based localization methods. The TL fMRI task and analysis code (written in Presentation and MATLAB, respectively) have been made freely available to the wider research community.
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Weinstein JJ, Moeller SJ, Perlman G, Gil R, Van Snellenberg JX, Wengler K, Meng J, Slifstein M, Abi-Dargham A. Imaging the Vesicular Acetylcholine Transporter in Schizophrenia: A Positron Emission Tomography Study Using [ 18F]-VAT. Biol Psychiatry 2024:S0006-3223(24)00062-3. [PMID: 38309322 DOI: 10.1016/j.biopsych.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Despite longstanding interest in the central cholinergic system in schizophrenia (SCZ), cholinergic imaging studies with patients have been limited to receptors. Here, we conducted a proof-of-concept positron emission tomography study using [18F]-VAT, a new radiotracer that targets the vesicular acetylcholine transporter as a proxy measure of acetylcholine transmission capacity, in patients with SCZ and explored relationships of vesicular acetylcholine transporter with clinical symptoms and cognition. METHODS A total of 18 adult patients with SCZ or schizoaffective disorder (the SCZ group) and 14 healthy control participants underwent a positron emission tomography scan with [18F]-VAT. Distribution volume (VT) for [18F]-VAT was derived for each region of interest, and group differences in VT were assessed with 2-sample t tests. Functional significance was explored through correlations between VT and scores on the Positive and Negative Syndrome Scale and a computerized neurocognitive battery (PennCNB). RESULTS No group differences in [18F]-VAT VT were observed. However, within the SCZ group, psychosis symptom severity was positively associated with VT in multiple regions of interest, with the strongest effects in the hippocampus, thalamus, midbrain, cerebellum, and cortex. In addition, in the SCZ group, working memory performance was negatively associated with VT in the substantia innominata and several cortical regions of interest including the dorsolateral prefrontal cortex. CONCLUSIONS In this initial study, the severity of 2 important features of SCZ-psychosis and working memory deficit-was strongly associated with [18F]-VAT VT in several cortical and subcortical regions. These correlations provide preliminary evidence of cholinergic activity involvement in SCZ and, if replicated in larger samples, could lead to a more complete mechanistic understanding of psychosis and cognitive deficits in SCZ and the development of therapeutic targets.
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Affiliation(s)
- Jodi J Weinstein
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, New York; Department of Psychiatry, Columbia University Vagelos School of Medicine and New York State Psychiatric Institute, New York, New York.
| | - Scott J Moeller
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Roberto Gil
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Jared X Van Snellenberg
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, New York; Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York; Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Kenneth Wengler
- Department of Psychiatry, Columbia University Vagelos School of Medicine and New York State Psychiatric Institute, New York, New York; Department of Radiology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Jiayan Meng
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Mark Slifstein
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, New York; Department of Psychiatry, Columbia University Vagelos School of Medicine and New York State Psychiatric Institute, New York, New York
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3
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Williams JC, Zheng ZJ, Tubiolo PN, Luceno JR, Gil RB, Girgis RR, Slifstein M, Abi-Dargham A, Van Snellenberg JX. Medial Prefrontal Cortex Dysfunction Mediates Working Memory Deficits in Patients With Schizophrenia. Biol Psychiatry Glob Open Sci 2023; 3:990-1002. [PMID: 37881571 PMCID: PMC10593895 DOI: 10.1016/j.bpsgos.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 02/18/2023] Open
Abstract
Background Schizophrenia (SCZ) is marked by working memory (WM) deficits, which predict poor functional outcome. While most functional magnetic resonance imaging studies of WM in SCZ have focused on the dorsolateral prefrontal cortex (PFC), some recent work suggests that the medial PFC (mPFC) may play a role. We investigated whether task-evoked mPFC deactivation is associated with WM performance and whether it mediates deficits in SCZ. In addition, we investigated associations between mPFC deactivation and cortical dopamine release. Methods Patients with SCZ (n = 41) and healthy control participants (HCs) (n = 40) performed a visual object n-back task during functional magnetic resonance imaging. Dopamine release capacity in mPFC was quantified with [11C]FLB457 in a subset of participants (9 SCZ, 14 HCs) using an amphetamine challenge. Correlations between task-evoked deactivation and performance were assessed in mPFC and dorsolateral PFC masks and were further examined for relationships with diagnosis and dopamine release. Results mPFC deactivation was associated with WM task performance, but dorsolateral PFC activation was not. Deactivation in the mPFC was reduced in patients with SCZ relative to HCs and mediated the relationship between diagnosis and WM performance. In addition, mPFC deactivation was significantly and inversely associated with dopamine release capacity across groups and in HCs alone, but not in patients. Conclusions Reduced WM task-evoked mPFC deactivation is a mediator of, and potential substrate for, WM impairment in SCZ, although our study design does not rule out the possibility that these findings could relate to cognition in general rather than WM specifically. We further present preliminary evidence of an inverse association between deactivation during WM tasks and dopamine release capacity in the mPFC.
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Affiliation(s)
- John C. Williams
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Zu Jie Zheng
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Philip N. Tubiolo
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Jacob R. Luceno
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Roberto B. Gil
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, Presbyterian/Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Ragy R. Girgis
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, Presbyterian/Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Mark Slifstein
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, Presbyterian/Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, Presbyterian/Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Jared X. Van Snellenberg
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, Presbyterian/Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
- Department of Psychology, Stony Brook University, Stony Brook, New York
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Kohler CG, Wolf DH, Abi-Dargham A, Anticevic A, Cho YT, Fonteneau C, Gil R, Girgis RR, Gray DL, Grinband J, Javitch JA, Kantrowitz JT, Krystal JH, Lieberman JA, Murray JD, Ranganathan M, Santamauro N, Van Snellenberg JX, Tamayo Z, Gur RC, Gur RE, Calkins ME. Illness Phase as a Key Assessment and Intervention Window for Psychosis. Biol Psychiatry Glob Open Sci 2023; 3:340-350. [PMID: 37519466 PMCID: PMC10382701 DOI: 10.1016/j.bpsgos.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
The phenotype of schizophrenia, regardless of etiology, represents the most studied psychotic disorder with respect to neurobiology and distinct phases of illness. The early phase of illness represents a unique opportunity to provide effective and individualized interventions that can alter illness trajectories. Developmental age and illness stage, including temporal variation in neurobiology, can be targeted to develop phase-specific clinical assessment, biomarkers, and interventions. We review an earlier model whereby an initial glutamate signaling deficit progresses through different phases of allostatic adaptation, moving from potentially reversible functional abnormalities associated with early psychosis and working memory dysfunction, and ending with difficult-to-reverse structural changes after chronic illness. We integrate this model with evidence of dopaminergic abnormalities, including cortical D1 dysfunction, which develop during adolescence. We discuss how this model and a focus on a potential critical window of intervention in the early stages of schizophrenia impact the approach to research design and clinical care. This impact includes stage-specific considerations for symptom assessment as well as genetic, cognitive, and neurophysiological biomarkers. We examine how phase-specific biomarkers of illness phase and brain development can be incorporated into current strategies for large-scale research and clinical programs implementing coordinated specialty care. We highlight working memory and D1 dysfunction as early treatment targets that can substantially affect functional outcome.
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Affiliation(s)
- Christian G. Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel H. Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Alan Anticevic
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Youngsun T. Cho
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Clara Fonteneau
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Roberto Gil
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Ragy R. Girgis
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - David L. Gray
- Cerevel Therapeutics Research and Development, East Cambridge, Massachusetts
| | - Jack Grinband
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Jonathan A. Javitch
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Molecular Pharmacology and Therapeutics, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Division of Molecular Therapeutics, New York State Psychiatric Institute, New York
| | - Joshua T. Kantrowitz
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- New York State Psychiatric Institute, New York
- Nathan Kline Institute, Orangeburg, New York
| | - John H. Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey A. Lieberman
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - John D. Murray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mohini Ranganathan
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Nicole Santamauro
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jared X. Van Snellenberg
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Zailyn Tamayo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monica E. Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Slifstein M, Abi-Dargham A. Detecting Pharmacologically Induced Serotonin Release in Depression With Positron Emission Tomography Imaging: A New Approach. Biol Psychiatry 2023; 93:1056-1058. [PMID: 37257982 DOI: 10.1016/j.biopsych.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Mark Slifstein
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York.
| | - Anissa Abi-Dargham
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
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6
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Abi-Dargham A, Moeller SJ, Ali F, DeLorenzo C, Domschke K, Horga G, Jutla A, Kotov R, Paulus MP, Rubio JM, Sanacora G, Veenstra-VanderWeele J, Krystal JH. Candidate biomarkers in psychiatric disorders: state of the field. World Psychiatry 2023; 22:236-262. [PMID: 37159365 PMCID: PMC10168176 DOI: 10.1002/wps.21078] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 05/11/2023] Open
Abstract
The field of psychiatry is hampered by a lack of robust, reliable and valid biomarkers that can aid in objectively diagnosing patients and providing individualized treatment recommendations. Here we review and critically evaluate the evidence for the most promising biomarkers in the psychiatric neuroscience literature for autism spectrum disorder, schizophrenia, anxiety disorders and post-traumatic stress disorder, major depression and bipolar disorder, and substance use disorders. Candidate biomarkers reviewed include various neuroimaging, genetic, molecular and peripheral assays, for the purposes of determining susceptibility or presence of illness, and predicting treatment response or safety. This review highlights a critical gap in the biomarker validation process. An enormous societal investment over the past 50 years has identified numerous candidate biomarkers. However, to date, the overwhelming majority of these measures have not been proven sufficiently reliable, valid and useful to be adopted clinically. It is time to consider whether strategic investments might break this impasse, focusing on a limited number of promising candidates to advance through a process of definitive testing for a specific indication. Some promising candidates for definitive testing include the N170 signal, an event-related brain potential measured using electroencephalography, for subgroup identification within autism spectrum disorder; striatal resting-state functional magnetic resonance imaging (fMRI) measures, such as the striatal connectivity index (SCI) and the functional striatal abnormalities (FSA) index, for prediction of treatment response in schizophrenia; error-related negativity (ERN), an electrophysiological index, for prediction of first onset of generalized anxiety disorder, and resting-state and structural brain connectomic measures for prediction of treatment response in social anxiety disorder. Alternate forms of classification may be useful for conceptualizing and testing potential biomarkers. Collaborative efforts allowing the inclusion of biosystems beyond genetics and neuroimaging are needed, and online remote acquisition of selected measures in a naturalistic setting using mobile health tools may significantly advance the field. Setting specific benchmarks for well-defined target application, along with development of appropriate funding and partnership mechanisms, would also be crucial. Finally, it should never be forgotten that, for a biomarker to be actionable, it will need to be clinically predictive at the individual level and viable in clinical settings.
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Affiliation(s)
- Anissa Abi-Dargham
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Scott J Moeller
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Farzana Ali
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Christine DeLorenzo
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Centre for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Guillermo Horga
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Amandeep Jutla
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Roman Kotov
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | | | - Jose M Rubio
- Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
- Feinstein Institute for Medical Research - Northwell, Manhasset, NY, USA
- Zucker Hillside Hospital - Northwell Health, Glen Oaks, NY, USA
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jeremy Veenstra-VanderWeele
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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7
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Rutherford BR, Choi J, Slifstein M, O'Boyle K, Abi-Dargham A, Brown PJ, Wall MW, Vanegas-Arroyave N, Sakhardande J, Stern Y, Roose SP. Retraction notice to "Neuroanatomical predictors of L-DOPA response in older adults with psychomotor slowing and depression: A pilot study" [J. Affect. Disord. 265 (2020) 439-444]. J Affect Disord 2023; 330:369. [PMID: 36966032 PMCID: PMC10830147 DOI: 10.1016/j.jad.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Affiliation(s)
- Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Jongwoo Choi
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Mark Slifstein
- Stony Brook University College of Medicine, New York, NY, United States
| | - Kaleigh O'Boyle
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Melanie W Wall
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Jayant Sakhardande
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Yaakov Stern
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
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8
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Wolf ME, Abi-Dargham A. Synaptic plasticity as a therapeutic target to modulate circuits in psychiatric disorders. Neuropsychopharmacology 2023; 48:1-2. [PMID: 36168046 PMCID: PMC9700855 DOI: 10.1038/s41386-022-01458-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Marina E Wolf
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA.
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9
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Abstract
Although antipsychotics have been available for almost 70 years and greatly improved outcomes for individuals with schizophrenia, all currently available options derive their efficacy from blockade of dopaminergic receptors. However, this mechanism of action leaves many symptoms unresolved and is associated with a significant side effect burden. The mechanisms underlying schizophrenia, which were initially thought to be related to excessive presynaptic dopamine in specific areas of the brain, are now understood to be much more complex and involve structural and molecular changes throughout brain circuits. Consequently, drug discovery efforts have sought new targets in the search for safer and more effective medications that can improve symptoms of schizophrenia and psychosis, including trace amine-associated receptors (TAARs), muscarinic receptors, and serotonergic receptors. Positive phase 2 trial results indicating efficacy and safety of the TAAR1 agonist ulotaront (SEP-363856) and of the muscarinic M1/M4 agonist KarXT (xanomeline plus trospium) for total, positive, and negative symptoms in patients with acute exacerbation of schizophrenia, and of the serotonin 5-HT2A agonist/antagonist pimavanserin in patients with schizophrenia and predominant negative symptoms for negative symptom control are encouraging. Taken together, these data indicate in the context of ongoing phase 3 trial programs that patients with schizophrenia may soon have access to the first non-D2 blocking medication, which could drastically change the treatment landscape and improve outcomes for many of the individuals with schizophrenia who do not fully respond to or cannot tolerate currently available antipsychotic agents that currently all act via postsynaptic dopamine D2 receptor blockade.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Anissa Abi-Dargham
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook University, New York
| | - Oliver Howes
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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10
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Citrome L, Abi-Dargham A, Bilder RM, Duffy RA, Dunlop BW, Harvey PD, Pizzagalli DA, Tamminga CA, McIntyre RS, Kane JM. Making Sense of the Matrix: A Qualitative Assessment and Commentary on Connecting Psychiatric Symptom Scale Items to the Research Domain Criteria (RDoC). Innov Clin Neurosci 2022; 19:26-32. [PMID: 35382070 PMCID: PMC8970242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The Research Domain Criteria (RDoC) initiative aims to organize research according to domains of brain function. Dysfunction within these domains leads to psychopathology that is classically measured with rating scales. Examining the correspondence between the specific measures assessed within rating scales and RDoC domains is necessary to assess the needs for new RDoC-focused scales. Such RDoC-focused scales have the potential of allowing translation of this work into the clinical domain of measuring psychopathology and designing treatment. Here, we describe an initial qualitative assessment by a group of 10 clinician-scientists of the alignment between RDoC domains and the items within five commonly used rating scales. In this commentary, we report limited correspondence and make recommendations for future work needed to address these limitations.
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Affiliation(s)
- Leslie Citrome
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Anissa Abi-Dargham
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Robert M Bilder
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Ruth A Duffy
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Boadie W Dunlop
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Philip D Harvey
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Diego A Pizzagalli
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Carol A Tamminga
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - Roger S McIntyre
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
| | - John M Kane
- Dr. Citrome is with New York Medical College in Valhalla, New York
- Dr. Abi-Dargham is with Stony Brook University in Stony Brook, New York
- Dr. Bilder is with the University of California in Los Angeles, California
- Dr. Duffy is with Otsuka Pharmaceutical Development and Commercialization in Princeton, New Jersey
- Dr. Dunlop is with Emory University in Atlanta, Georgia
- Dr. Harvey is with the Miller School of Medicine, University of Miami in Miami, Florida
- Dr. Pizzagalli is with Harvard Medical School in Boston, Massachusetts
- Dr. Tamminga is with the University of Texas Southwestern in Dallas, Texas
- Dr. McIntyre is with the University of Toronto in Toronto, Canada
- Dr. Kane is with the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York
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11
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Affiliation(s)
- Katherine Jonas
- Department of Psychiatry & Behavioral Health, Stony Brook University
| | | | - Roman Kotov
- Department of Psychiatry & Behavioral Health, Stony Brook University
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12
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Reinen JM, Whitton AE, Pizzagalli DA, Slifstein M, Abi-Dargham A, McGrath PJ, Iosifescu DV, Schneier FR. Differential reinforcement learning responses to positive and negative information in unmedicated individuals with depression. Eur Neuropsychopharmacol 2021; 53:89-100. [PMID: 34517334 PMCID: PMC8633147 DOI: 10.1016/j.euroneuro.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Major depressive disorder (MDD) is characterized by behavioral and neural abnormalities in processing both rewarding and aversive stimuli, which may impact motivational and affective symptoms. Learning paradigms have been used to assess reinforcement encoding abnormalities in MDD and their association with dysfunctional incentive-based behavior, but how the valence and context of information modulate this learning is not well understood. To address these gaps, we examined responses to positive and negative reinforcement across multiple temporal phases of information processing. While undergoing functional magnetic resonance imaging (fMRI), 47 participants (23 unmedicated, predominantly medication-naïve participants with MDD and 24 demographically-matched HC participants) completed a probabilistic, feedback-based reinforcement learning task that allowed us to separate neural activation during motor response (choice) from reinforcement feedback and monetary outcome across two independent conditions: pursuing gains and avoiding losses. In the gain condition, MDD participants showed overall blunted learning responses (prediction error) in the dorsal striatum when receiving monetary outcome, and reduced responses in ventral striatum for positive, but not negative, prediction error. The MDD group showed enhanced sensitivity to negative information, and symptom severity was associated with better behavioral performance in the loss condition. These findings suggest that striatal responses during learning are abnormal in individuals with MDD but vary with the valence of information.
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Affiliation(s)
- Jenna M Reinen
- IBM Thomas J. Watson Research Center, Computational Biology Center, Yorktown Heights, NY, United States
| | - Alexis E Whitton
- McLean Hospital and Department of Psychiatry, Harvard Medical School, Belmont, MA, United States; Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Diego A Pizzagalli
- McLean Hospital and Department of Psychiatry, Harvard Medical School, Belmont, MA, United States
| | - Mark Slifstein
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY 10032, United States; Department of Psychiatry, State University of New York at Stony Brook, Stony Brook, NY, United States
| | - Anissa Abi-Dargham
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY 10032, United States; Department of Psychiatry, State University of New York at Stony Brook, Stony Brook, NY, United States
| | - Patrick J McGrath
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Dan V Iosifescu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Psychiatry, New York University School of Medicine, New York, NY, United States; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Franklin R Schneier
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY 10032, United States; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.
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13
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Abi-Dargham A, Javitch JA, Slifstein M, Anticevic A, Calkins ME, Cho YT, Fonteneau C, Gil R, Girgis R, Gur RE, Gur RC, Grinband J, Kantrowitz J, Kohler C, Krystal J, Murray J, Ranganathan M, Santamauro N, Van Snellenberg J, Tamayo Z, Wolf D, Gray D, Lieberman J. Dopamine D1R Receptor Stimulation as a Mechanistic Pro-cognitive Target for Schizophrenia. Schizophr Bull 2021; 48:199-210. [PMID: 34423843 PMCID: PMC8781338 DOI: 10.1093/schbul/sbab095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Decades of research have highlighted the importance of optimal stimulation of cortical dopaminergic receptors, particularly the D1R receptor (D1R), for prefrontal-mediated cognition. This mechanism is particularly relevant to the cognitive deficits in schizophrenia, given the abnormalities in cortical dopamine (DA) neurotransmission and in the expression of D1R. Despite the critical need for D1R-based therapeutics, many factors have complicated their development and prevented this important therapeutic target from being adequately interrogated. Challenges include determination of the optimal level of D1R stimulation needed to improve cognitive performance, especially when D1R expression levels, affinity states, DA levels, and the resulting D1R occupancy by DA, are not clearly known in schizophrenia, and may display great interindividual and intraindividual variability related to cognitive states and other physiological variables. These directly affect the selection of the level of stimulation necessary to correct the underlying neurobiology. The optimal mechanism for stimulation is also unknown and could include partial or full agonism, biased agonism, or positive allosteric modulation. Furthermore, the development of D1R targeting drugs has been complicated by complexities in extrapolating from in vitro affinity determinations to in vivo use. Prior D1R-targeted drugs have been unsuccessful due to poor bioavailability, pharmacokinetics, and insufficient target engagement at tolerable doses. Newer drugs have recently become available, and these must be tested in the context of carefully designed paradigms that address methodological challenges. In this paper, we discuss how a better understanding of these challenges has shaped our proposed experimental design for testing a new D1R/D5R partial agonist, PF-06412562, renamed CVL-562.
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Affiliation(s)
- Anissa Abi-Dargham
- Department of Psychiatry, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA,Department of Psychiatry, New York State Psychaitric Institute, Columbia University, New York, NY, USA,Department of Psychiatry, Yale University, New Haven, CT, USA,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Cerevel Therapeutics Research and Development, Boston, MA, USA,To whom correspondence should be addressed; Tel: +(631) 885-0814; e-mail:
| | - Jonathan A Javitch
- Department of Psychiatry, New York State Psychaitric Institute, Columbia University, New York, NY, USA
| | - Mark Slifstein
- Department of Psychiatry, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Alan Anticevic
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Youngsun T Cho
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Clara Fonteneau
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Roberto Gil
- Department of Psychiatry, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Ragy Girgis
- Department of Psychiatry, New York State Psychaitric Institute, Columbia University, New York, NY, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jack Grinband
- Department of Psychiatry, New York State Psychaitric Institute, Columbia University, New York, NY, USA
| | - Joshua Kantrowitz
- Department of Psychiatry, New York State Psychaitric Institute, Columbia University, New York, NY, USA
| | - Christian Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John Krystal
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - John Murray
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | | | | | - Jared Van Snellenberg
- Department of Psychiatry, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Zailyn Tamayo
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Daniel Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - David Gray
- Cerevel Therapeutics Research and Development, Boston, MA, USA
| | - Jeffrey Lieberman
- Department of Psychiatry, New York State Psychaitric Institute, Columbia University, New York, NY, USA
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14
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Serrano-Sosa M, Van Snellenberg JX, Meng J, Luceno JR, Spuhler K, Weinstein JJ, Abi-Dargham A, Slifstein M, Huang C. Multitask Learning Based Three-Dimensional Striatal Segmentation of MRI: fMRI and PET Objective Assessments. J Magn Reson Imaging 2021; 54:1623-1635. [PMID: 33970510 DOI: 10.1002/jmri.27682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Recent studies have established a clear topographical and functional organization of projections to and from complex subdivisions of the striatum. Manual segmentation of these functional subdivisions is labor-intensive and time-consuming, and automated methods are not as reliable as manual segmentation. PURPOSE To utilize multitask learning (MTL) as a method to segment subregions of the striatum consisting of pre-commissural putamen (prePU), pre-commissural caudate (preCA), post-commissural putamen (postPU), post-commissural caudate (postCA), and ventral striatum (VST). STUDY TYPE Retrospective. POPULATION Eighty-seven total data sets from patients with schizophrenia and matched controls. FIELD STRENGTH/SEQUENCE 1.5 T and 3.0 T, T1 -weighted (SPGR SENSE, 3D BRAVO). ASSESSMENT MTL-generated segmentations were compared to the Imperial College London Clinical Imaging Center (CIC) atlas. Dice similarity coefficient (DSC) was used to compare the automated methods to manual segmentations. Positron emission tomography (PET) imaging: 60 minutes of emission data were acquired using [11 C]raclopride. Data were reconstructed by filtered back projection (FBP) with computed tomography (CT) used for attenuation correction. Binding potential values, BPND , and region of interest (ROI) time series and whole-brain connectivity using functional magnetic resonance imaging (fMRI) images were compared between manual and both automated segmentations. STATISTICAL TESTS Pearson correlation and paired t-test. RESULTS MTL-generated segmentations showed excellent spatial agreement with manual (DSC ≥0.72 across all striatal subregions). BPND values from MTL-generated segmentations were shown to correlate well with manual segmentations with R2 ≥ 0.91 in all caudate and putamen subregions, and R2 = 0.69 in VST. Mean Pearson correlation coefficients of the fMRI data between MTL-generated and manual segmentations were also high in time series (≥0.86) and whole-brain connectivity (≥0.89) across all subregions. DATA CONCLUSION Across both PET and fMRI task-based assessments, results from MTL-generated segmentations more closely corresponded to results from manually drawn ROIs than CIC-generated segmentations did. Therefore, the proposed MTL approach is a fast and reliable method for three-dimensional striatal subregion segmentation with results comparable to manually segmented ROIs. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Mario Serrano-Sosa
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Jared X Van Snellenberg
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA.,Department of Psychiatry and Behavioral Health, Stony Brook Medicine, Stony Brook, New York, USA.,Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Jiayan Meng
- Department of Psychiatry and Behavioral Health, Stony Brook Medicine, Stony Brook, New York, USA
| | - Jacob R Luceno
- Department of Psychiatry and Behavioral Health, Stony Brook Medicine, Stony Brook, New York, USA
| | - Karl Spuhler
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Jodi J Weinstein
- Department of Psychiatry and Behavioral Health, Stony Brook Medicine, Stony Brook, New York, USA
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Stony Brook Medicine, Stony Brook, New York, USA
| | - Mark Slifstein
- Department of Psychiatry and Behavioral Health, Stony Brook Medicine, Stony Brook, New York, USA
| | - Chuan Huang
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA.,Department of Psychiatry and Behavioral Health, Stony Brook Medicine, Stony Brook, New York, USA.,Department of Radiology, Stony Brook Medicine, Stony Brook, New York, USA
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15
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Wengler K, Cassidy C, van der Pluijm M, Weinstein JJ, Abi-Dargham A, van de Giessen E, Horga G. Cross-Scanner Harmonization of Neuromelanin-Sensitive MRI for Multisite Studies. J Magn Reson Imaging 2021; 54:1189-1199. [PMID: 33960063 DOI: 10.1002/jmri.27679] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Neuromelanin-sensitive magnetic resonance imaging (NM-MRI) is a validated measure of neuromelanin concentration in the substantia nigra-ventral tegmental area (SN-VTA) complex and is a proxy measure of dopaminergic function with potential as a noninvasive biomarker. The development of generalizable biomarkers requires large-scale samples necessitating harmonization approaches to combine data collected across sites. PURPOSE To develop a method to harmonize NM-MRI across scanners and sites. STUDY TYPE Prospective. POPULATION A total of 128 healthy subjects (18-73 years old; 45% female) from three sites and five MRI scanners. FIELD STRENGTH/SEQUENCE 3.0 T; NM-MRI two-dimensional gradient-recalled echo with magnetization-transfer pulse and three-dimensional T1-weighted images. ASSESSMENT NM-MRI contrast (contrast-to-noise ratio [CNR]) maps were calculated and CNR values within the SN-VTA (defined previously by manual tracing on a standardized NM-MRI template) were determined before harmonization (raw CNR) and after ComBat harmonization (harmonized CNR). Scanner differences were assessed by calculating the classification accuracy of a support vector machine (SVM). To assess the effect of harmonization on biological variability, support vector regression (SVR) was used to predict age and the difference in goodness-of-fit (Δr) was calculated as the correlation (between actual and predicted ages) for the harmonized CNR minus the correlation for the raw CNR. STATISTICAL TESTS Permutation tests were used to determine if SVM classification accuracy was above chance level and if SVR Δr was significant. A P-value <0.05 was considered significant. RESULTS In the raw CNR, SVM MRI scanner classification was above chance level (accuracy = 86.5%). In the harmonized CNR, the accuracy of the SVM was at chance level (accuracy = 29.5%; P = 0.8542). There was no significant difference in age prediction using the raw or harmonized CNR (Δr = -0.06; P = 0.7304). DATA CONCLUSION ComBat harmonization removes differences in SN-VTA CNR across scanners while preserving biologically meaningful variability associated with age. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: 1.
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Affiliation(s)
- Kenneth Wengler
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Clifford Cassidy
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa, Ontario, Canada
| | - Marieke van der Pluijm
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jodi J Weinstein
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA.,Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
| | - Anissa Abi-Dargham
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Guillermo Horga
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
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16
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Cassidy CM, Konova AB, Abi-Dargham A, Martinez D, Horga G. Ubiquitous Dopamine Deficit Hypotheses in Cocaine Use Disorder Lack Support: Response to Leyton. Am J Psychiatry 2021; 178:469-470. [PMID: 33979543 DOI: 10.1176/appi.ajp.2020.20111581r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Clifford M Cassidy
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
| | - Anna B Konova
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
| | - Anissa Abi-Dargham
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
| | - Diana Martinez
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
| | - Guillermo Horga
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
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17
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Cumming P, Abi-Dargham A, Gründer G. Molecular imaging of schizophrenia: Neurochemical findings in a heterogeneous and evolving disorder. Behav Brain Res 2020; 398:113004. [PMID: 33197459 DOI: 10.1016/j.bbr.2020.113004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/22/2020] [Accepted: 10/31/2020] [Indexed: 02/07/2023]
Abstract
The past four decades have seen enormous efforts placed on a search for molecular markers of schizophrenia using positron emission tomography (PET) and single photon emission computed tomography (SPECT). In this narrative review, we cast a broad net to define and summarize what researchers have learned about schizophrenia from molecular imaging studies. Some PET studies of brain energy metabolism with the glucose analogue FDGhave have shown a hypofrontality defect in patients with schizophrenia, but more generally indicate a loss of metabolic coherence between different brain regions. An early finding of significantly increased striatal trapping of the dopamine synthesis tracer FDOPA has survived a meta-analysis of many replications, but the increase is not pathognomonic of the disorder, since one half of patients have entirely normal dopamine synthesis capacity. Similarly, competition SPECT studies show greater basal and amphetamine-evoked dopamine occupancy at post-synaptic dopamine D2/3 receptors in patients with schizophrenia, but the difference is likewise not pathognomonic. We thus propose that molecular imaging studies of brain dopamine indicate neurochemical heterogeneity within the diagnostic entity of schizophrenia. Occupancy studies have established the relevant target engagement by antipsychotic medications at dopamine D2/3 receptors in living brain. There is evidence for elevated frontal cortical dopamine D1 receptors, especially in relation to cognitive deficits in schizophrenia. There is a general lack of consistent findings of abnormalities in serotonin markers, but some evidence for decreased levels of nicotinic receptors in patients. There are sparse and somewhat inconsistent findings of reduced binding of muscarinic, glutamate, and opioid receptors ligands, inconsistent findings of microglial activation, and very recently, evidence of globally reduced levels of synaptic proteins in brain of patients. One study reports a decline in histone acetylase binding that is confined to the dorsolateral prefrontal cortex. In most contexts, the phase of the disease and effects of past or present medication can obscure or confound PET and SPECT findings in schizophrenia.
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Affiliation(s)
- Paul Cumming
- Department of Nuclear Medicine, Inselspital, Bern University, Bern, Switzerland; School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia.
| | - Anissa Abi-Dargham
- Stony Brook University, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Gerhard Gründer
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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18
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Cassidy CM, Carpenter KM, Konova AB, Cheung V, Grassetti A, Zecca L, Abi-Dargham A, Martinez D, Horga G. Evidence for Dopamine Abnormalities in the Substantia Nigra in Cocaine Addiction Revealed by Neuromelanin-Sensitive MRI. Am J Psychiatry 2020; 177:1038-1047. [PMID: 32854531 PMCID: PMC9108998 DOI: 10.1176/appi.ajp.2020.20010090] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent evidence supports the use of neuromelanin-sensitive MRI (NM-MRI) as a novel tool to investigate dopamine function in the human brain. The authors investigated the NM-MRI signal in individuals with cocaine use disorder, compared with age- and sex-matched control subjects, based on previous imaging studies showing that this disorder is associated with blunted presynaptic striatal dopamine. METHODS NM-MRI and T1-weighted images were acquired from 20 participants with cocaine use disorder and 35 control subjects. Diagnostic group effects in NM-MRI signal were determined using a voxelwise analysis within the substantia nigra. A subset of 20 cocaine users and 17 control subjects also underwent functional MRI imaging using the monetary incentive delay task, in order to investigate whether NM-MRI signal was associated with alterations in reward processing. RESULTS Compared with control subjects, cocaine users showed significantly increased NM-MRI signal in ventrolateral regions of the substantia nigra (area under the receiver operating characteristic curve=0.83). Exploratory analyses did not find a significant correlation of NM-MRI signal to activation of the ventral striatum during anticipation of monetary reward. CONCLUSIONS Given that previous imaging studies show decreased dopamine signaling in the striatum, the finding of increased NM-MRI signal in the substantia nigra provides additional insight into the pathophysiology of cocaine use disorder. One interpretation is that cocaine use disorder is associated with a redistribution of dopamine between cytosolic and vesicular pools, leading to increased accumulation of neuromelanin. The study findings thus suggest that NM-MRI can serve as a practical imaging tool for interrogating the dopamine system in addiction.
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Affiliation(s)
- Clifford M Cassidy
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa, ON,Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY,Corresponding author: Clifford Cassidy, 1145 Carling Ave, Ottawa ON, K1Z 7K4, Canada.
| | - Kenneth M Carpenter
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Anna B Konova
- Department of Psychiatry, Rutgers University, Newark, NJ
| | - Victoria Cheung
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa, ON
| | - Alexander Grassetti
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Luigi Zecca
- Institute of Biomedical Technologies, National Research Council of Italy, Milan, Italy
| | - Anissa Abi-Dargham
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | - Diana Martinez
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Guillermo Horga
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
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Clark SD, Van Snellenberg JX, Lawson JM, Abi-Dargham A. Opioid antagonists are associated with a reduction in the symptoms of schizophrenia: a meta-analysis of controlled trials. Neuropsychopharmacology 2020; 45:1860-1869. [PMID: 32516800 PMCID: PMC7608351 DOI: 10.1038/s41386-020-0730-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/10/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
Current treatments for the symptoms of schizophrenia are only effective for positive symptoms in some individuals, and have considerable side effects that impact compliance. Thus, there is a need to investigate the efficacy of other compounds in treating both positive and negative symptoms. We conducted a meta-analysis of English language placebo-controlled clinical trials of naloxone, naltrexone, nalmefene, and buprenorphine in patients with schizophrenia to determine whether opioid antagonists have therapeutic efficacy on positive, negative, total, or general symptoms. We searched online databases Ovid Medline and PsychINFO, PubMed, EMBASE, Scopus, Cochrane library/CENTRAL, Web of Science, and Google Scholar from 1970 through February 2019. Following PRISMA guidelines, Hedges g was calculated for each study. Primary study outcomes were the within-subject change on any symptom assessment scale for positive, negative, total, or general symptoms of schizophrenia between active drug and placebo conditions. Thirty studies were included with 434 total patients. We found a significant effect of all drugs on all scales combined with both a standard random effects model: (g = 0.26; P = 0.02; k = 22; CI = 0.03-0.49) and a more inclusive bootstrap model: (g = 0.26; P = 0.0002; k = 30; CI = 0.11-0.51) and a significant effect on total scales with the bootstrap model (g = 0.25288; P = 0.015; k = 19; CI = 0.04-0.35). We also observed a significant effect of all drugs on all positive scales combined with both the random effects (g = 0.33; P = 0.015; k = 17; CI = 0.07-0.60) and bootstrap models (g = 0.32; P < 0.0001; k = 21; CI = 0.13-1.38). This evidence provides support for further testing in randomized clinical trials of a new class of non-D2-receptor drugs, based on opioid mechanisms, for the treatment of positive and negative symptoms of schizophrenia.
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Affiliation(s)
- Samuel D Clark
- Columbia University Medical Center, New York, NY, USA.
- Terran Biosciences, New York, NY, USA.
| | - Jared X Van Snellenberg
- Department of Psychiatry and Behavioral Health, Stony Brook University Medical Center, New York, NY, USA
- Department of Psychology, Stony Brook University, New York, NY, USA
- Department of Biomedical Engineering, Stony Brook University, New York, NY, USA
| | | | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Stony Brook University Medical Center, New York, NY, USA
- Department of Biomedical Engineering, Stony Brook University, New York, NY, USA
- Department of Radiology, Stony Brook University Medical Center, New York, NY, USA
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20
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Whitton AE, Reinen JM, Slifstein M, Ang YS, McGrath PJ, Iosifescu DV, Abi-Dargham A, Pizzagalli DA, Schneier FR. Baseline reward processing and ventrostriatal dopamine function are associated with pramipexole response in depression. Brain 2020; 143:701-710. [PMID: 32040562 DOI: 10.1093/brain/awaa002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/13/2019] [Accepted: 11/27/2019] [Indexed: 01/05/2023] Open
Abstract
The efficacy of dopamine agonists in treating major depressive disorder has been hypothesized to stem from effects on ventrostriatal dopamine and reward function. However, an important question is whether dopamine agonists are most beneficial for patients with reward-based deficits. This study evaluated whether measures of reward processing and ventrostriatal dopamine function predicted response to the dopamine agonist, pramipexole (ClinicalTrials.gov Identifier: NCT02033369). Individuals with major depressive disorder (n = 26) and healthy controls (n = 26) (mean ± SD age = 26.5 ± 5.9; 50% female) first underwent assessments of reward learning behaviour and ventrostriatal prediction error signalling (measured using functional MRI). 11C-(+)-PHNO PET before and after oral amphetamine was used to assess ventrostriatal dopamine release. The depressed group then received open-label pramipexole treatment for 6 weeks (0.5 mg/day titrated to a maximum daily dose of 2.5 mg). Symptoms were assessed weekly, and reward learning was reassessed post-treatment. At baseline, relative to controls, the depressed group showed lower reward learning (P = 0.02), a trend towards blunted reward-related prediction error signals (P = 0.07), and a trend towards increased amphetamine-induced dopamine release (P = 0.07). Despite symptom improvements following pramipexole (Cohen's d ranging from 0.51 to 2.16 across symptom subscales), reward learning did not change after treatment. At a group level, baseline reward learning (P = 0.001) and prediction error signalling (P = 0.004) were both associated with symptom improvement, albeit in a direction opposite to initial predictions: patients with stronger pretreatment reward learning and reward-related prediction error signalling improved most. Baseline D2/3 receptor availability (P = 0.02) and dopamine release (P = 0.05) also predicted improvements in clinical functioning, with lower D2/3 receptor availability and lower dopamine release predicting greater improvements. Although these findings await replication, they suggest that measures of reward-related mesolimbic dopamine function may hold promise for identifying depressed individuals likely to respond favourably to dopaminergic pharmacotherapy.
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Affiliation(s)
- Alexis E Whitton
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Jenna M Reinen
- IBM TJ Watson Research Center, Computational Biology Center, Yorktown Heights, NY, USA
- Department of Psychology, Yale University, New Haven CT, USA
| | - Mark Slifstein
- Division of Translational Imaging, New York State Psychiatric Institute, New York NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Yuen-Siang Ang
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Patrick J McGrath
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
| | - Dan V Iosifescu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anissa Abi-Dargham
- Division of Translational Imaging, New York State Psychiatric Institute, New York NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Franklin R Schneier
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
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Abstract
Functional neuroimaging using techniques such as positron emission tomography (PET) and single photon emission computerised tomography (SPECT) provide a direct in vivo assessment of the expression and function of neuroreceptors, transporters and enzymes. This article examines the technical aspects of molecular imaging and the application of those techniques in drug development.
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22
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Girgis RR, Forbes A, Abi-Dargham A, Slifstein M. A positron emission tomography occupancy study of brexpiprazole at dopamine D 2 and D 3 and serotonin 5-HT 1A and 5-HT 2A receptors, and serotonin reuptake transporters in subjects with schizophrenia. Neuropsychopharmacology 2020; 45:786-792. [PMID: 31847007 PMCID: PMC7075883 DOI: 10.1038/s41386-019-0590-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/09/2022]
Abstract
The objective of this study (NCT01854944) was to assess D2/D3, 5-HT1A, 5-HT2A and serotonin transporter (SERT) occupancies of brexpiprazole in adult subjects with schizophrenia in order to identify the in vivo pharmacologic profile that may be relevant to the antipsychotic, antidepressant, and side effect profiles of the drug. Subjects were grouped into three independent cohorts of four subjects each. All subjects underwent positron emission tomography (PET) scans with two different radiotracers at baseline prior to brexpiprazole administration, and again on Day 10 after daily doses of either 4 mg (Cohorts 1 and 2), or 1 mg (Cohort 3). Cohort 1 received scans with [11C]-(+)-PHNO to measure D2 and D3 receptor occupancy and [11C]CUMI101 to measure 5-HT1A occupancy; Cohort 2 received [11C]MDL100907 for 5-HT2A occupancy and [11C]DASB for SERT occupancy; Cohort 3 underwent scanning with [11C]-(+)-PHNO and [11C]MDL100907. Five female and seven male subjects, aged 42 ± 8 years (range, 28-55 years), participated in this study. Dose dependency was observed at D2 receptors, with occupancies reaching 64 ± 8% (mean +/- SD) following 1 mg/day and 80 ± 12% following 4 mg/day. D3 receptor availability increased following 1 mg brexpiprazole treatment and did not change with 4 mg. Robust and dose-related occupancy was also observed at 5-HT2A receptors. Negligible occupancy (<5%) was observed at 5-HT1A and SERT at 4 mg/day. In summary, brexpiprazole demonstrated in vivo binding to D2 receptors and 5-HT2A receptors at steady state after 10 days of daily administration in a dose dependent manner, while binding to D3, 5-HT1A receptors and SERT was not detectable with the radiotracers used for these targets. This pharmacologic profile is consistent with the observed antipsychotic and antidepressant effects.
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Affiliation(s)
- Ragy R Girgis
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA.
| | - Andy Forbes
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
| | - Anissa Abi-Dargham
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Mark Slifstein
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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23
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Rutherford BR, Choi J, Slifstein M, O'Boyle K, Abi-Dargham A, Brown PJ, Wall MW, Vanegas-Arroyave N, Sakhardande J, Stern Y, Roose SP. Neuroanatomical predictors of L-DOPA response in older adults with psychomotor slowing and depression: A pilot study. J Affect Disord 2020; 265:439-444. [PMID: 32090770 PMCID: PMC7042346 DOI: 10.1016/j.jad.2020.01.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Declining function in dopamine circuits is implicated in normal aging and late-life depression (LLD). Dopamine augmentation recently has shown therapeutic promise, but predictors of response are unknown. METHODS Depressed elders with slowed gait underwent baseline magnetic resonance imaging (MRI) and [11C]raclopride positron emission tomography (PET). Subjects then received open treatment with carbidopa/levodopa (L-DOPA) for three weeks. Linear regressions examined relationships between baseline MRI measures, [11C]raclopride binding, and behavioral outcomes. RESULTS Among N = 16 participants aged 72.5 ± 6.8 years, higher left superior temporal gyrus volume was associated with higher processing speed at baseline, while cortical thinning in a processing speed network was associated with greater improvement following L-DOPA. Greater volume and cortical thickness in brain regions associated with mobility were associated with higher baseline gait speed. Higher baseline white matter hyperintensity volume predicted less post-L-DOPA improvement on dual task gait speed and IDS-SR scores. Higher [11C]raclopride binding in the associative striatum was associated with cortical thickness in some, but not all, processing speed brain regions, while higher binding in sensorimotor striatum was significantly associated with left caudate volume. LIMITATIONS Limiting the conclusions drawn from this pilot study are the small sample size and open administration of L-DOPA. CONCLUSIONS Greater baseline brain volumes and cortical thickness in regions supporting cognition and gait were associated with higher behavioral performance, while lower structural integrity was associated with increased responsivity to L-DOPA. If substantiated in larger studies, these findings could facilitate the targeting of dopaminergic treatments to those LLD patients most likely to respond.
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Affiliation(s)
- Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States.
| | - Jongwoo Choi
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Mark Slifstein
- Stony Brook University College of Medicine, New York, NY, United States
| | - Kaleigh O'Boyle
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Melanie W Wall
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Jayant Sakhardande
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Yaakov Stern
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
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24
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Slifstein M, Abi-Dargham A, Girgis RR, Suckow RF, Cooper TB, Divgi CR, Sokoloff P, Leriche L, Carberry P, Oya S, Joseph SK, Guiraud M, Montagne A, Brunner V, Gaudoux F, Tonner F. Binding of the D3-preferring antipsychotic candidate F17464 to dopamine D3 and D2 receptors: a PET study in healthy subjects with [ 11C]-(+)-PHNO. Psychopharmacology (Berl) 2020; 237:519-527. [PMID: 31773210 DOI: 10.1007/s00213-019-05387-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
RATIONALE F17464, a dopamine D3 receptor antagonist with relatively high D3 selectivity (70 fold vs D2 in vitro), exhibits an antipsychotic profile in preclinical studies, and therapeutic efficacy was demonstrated in a randomized placebo-controlled clinical trial in patients with schizophrenia (Bitter et al. Neuropsychopharmacology 44(11):1917-1924, 2019). OBJECTIVE This open-label study in healthy male subjects aimed at characterizing F17464 binding to D3/D2 receptors and the time course of receptor occupancy using positron emission tomography (PET) imaging with a D3-preferring tracer, [11C]-(+)-PHNO. METHODS PET scans were performed at baseline and following a single 30 mg or 15 mg dose of F17464 (3 subjects/dose), and blood samples were collected for pharmacokinetic analysis. Receptor occupancy was calculated based upon reduction in binding potential of the tracer following F17464 administration. The relationship between plasma F17464 concentration and D3/D2 receptor occupancy was modeled and the plasma concentration corresponding to 50% receptor occupancy (EC50) calculated. RESULTS Both doses of F17464 robustly blocked [11C]-(+)-PHNO D3 receptor binding, with substantial occupancy from 1 h post-administration, which increased at 6-9 h (89-98% and 79-87% for the 30 mg and 15 mg groups, respectively) and remained detectable at 22 h. In contrast, D2 binding was only modestly blocked at all time points (< 18%). F17464 exhibited a combination of rapid peripheral kinetics and hysteresis (persistence of binding 22 h post-dose despite low plasma concentration). The best estimate of the EC50 was 19 ng ml-1 (~ 40 nM). CONCLUSION Overall, F17464 was strongly D3-selective in healthy volunteers, a unique profile for an antipsychotic candidate drug.
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Affiliation(s)
- Mark Slifstein
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, 11794, USA. .,Department of Psychiatry, Renaissance School of Medicine, Stony Brook University, HSC T-10-087I Stony Brook, New York, 11794, USA.
| | - Anissa Abi-Dargham
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, 11794, USA
| | - Ragy R Girgis
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.,Columbia University College of Physicians & Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Raymond F Suckow
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Thomas B Cooper
- Nathan Kline Research Institute, 140 Old Orangeburg Road, Orangeburg, New York, NY, 10962, USA
| | - Chaitanya R Divgi
- Columbia University Medical Center Kreitchman PET Center, 772 W 168 Street, R-114, New York, NY, 10032, USA
| | | | - Ludovic Leriche
- Institut de Recherche Pierre Fabre (IRPF), 3 avenue Hubert Curien, 31100, Toulouse, France
| | - Patrick Carberry
- Columbia University Medical Center Kreitchman PET Center, 772 W 168 Street, R-114, New York, NY, 10032, USA
| | - Shunichi Oya
- Columbia University Medical Center Kreitchman PET Center, 772 W 168 Street, R-114, New York, NY, 10032, USA
| | - Simon K Joseph
- Columbia University Medical Center Kreitchman PET Center, 772 W 168 Street, R-114, New York, NY, 10032, USA
| | - Marlène Guiraud
- Institut de Recherche Pierre Fabre (IRPF), 3 avenue Hubert Curien, 31100, Toulouse, France
| | - Agnès Montagne
- Institut de Recherche Pierre Fabre (IRPF), 3 avenue Hubert Curien, 31100, Toulouse, France
| | | | - Florence Gaudoux
- Institut de Recherche Pierre Fabre (IRPF), 3 avenue Hubert Curien, 31100, Toulouse, France
| | - Françoise Tonner
- Institut de Recherche Pierre Fabre (IRPF), 3 avenue Hubert Curien, 31100, Toulouse, France
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25
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Wengler K, He X, Abi-Dargham A, Horga G. Reproducibility assessment of neuromelanin-sensitive magnetic resonance imaging protocols for region-of-interest and voxelwise analyses. Neuroimage 2019; 208:116457. [PMID: 31841683 PMCID: PMC7118586 DOI: 10.1016/j.neuroimage.2019.116457] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 01/02/2023] Open
Abstract
Neuromelanin-sensitive MRI (NM-MRI) provides a noninvasive measure of the content of neuromelanin (NM), a product of dopamine metabolism that accumulates with age in dopamine neurons of the substantia nigra (SN). NM-MRI has been validated as a measure of both dopamine neuron loss, with applications in neurodegenerative disease, and dopamine function, with applications in psychiatric disease. Furthermore, a voxelwise-analysis approach has been validated to resolve substructures, such as the ventral tegmental area (VTA), within midbrain dopaminergic nuclei thought to have distinct anatomical targets and functional roles. NM-MRI is thus a promising tool that could have diverse research and clinical applications to noninvasively interrogate in vivo the dopamine system in neuropsychiatric illness. Although a test-retest reliability study by Langley et al. using the standard NM-MRI protocol recently reported high reliability, a systematic and comprehensive investigation of the performance of the method for various acquisition parameters and preprocessing methods has not been conducted. In particular, most previous studies used relatively thick MRI slices (~3 mm), compared to the typical in-plane resolution (~0.5 mm) and to the height of the SN (~15 mm), to overcome technical limitations such as specific absorption rate and signal-to-noise ratio, at the cost of partial-volume effects. Here, we evaluated the effect of various acquisition and preprocessing parameters on the strength and test-retest reliability of the NM-MRI signal to determine optimized protocols for both region-of-interest (including whole SN-VTA complex and atlas-defined dopaminergic nuclei) and voxelwise measures. Namely, we determined a combination of parameters that optimizes the strength and reliability of the NM-MRI signal, including acquisition time, slice-thickness, spatial-normalization software, and degree of spatial smoothing. Using a newly developed, detailed acquisition protocol, across two scans separated by 13 days on average, we obtained intra-class correlation values indicating excellent reliability and high contrast, which could be achieved with a different set of parameters depending on the measures of interest and experimental constraints such as acquisition time. Based on this, we provide detailed guidelines covering acquisition through analysis and recommendations for performing NM-MRI experiments with high quality and reproducibility. This work provides a foundation for the optimization and standardization of NM-MRI, a promising MRI approach with growing applications throughout clinical and basic neuroscience.
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Affiliation(s)
- Kenneth Wengler
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY, USA; Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.
| | - Xiang He
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Anissa Abi-Dargham
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA; Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Guillermo Horga
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
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26
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Clark SD, Abi-Dargham A. The Role of Dynorphin and the Kappa Opioid Receptor in the Symptomatology of Schizophrenia: A Review of the Evidence. Biol Psychiatry 2019; 86:502-511. [PMID: 31376930 DOI: 10.1016/j.biopsych.2019.05.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/25/2019] [Accepted: 05/05/2019] [Indexed: 01/17/2023]
Abstract
Schizophrenia is a debilitating mental illness that affects approximately 1% of the world's population. Despite much research in its neurobiology to aid in developing new treatments, little progress has been made. One system that has not received adequate attention is the kappa opioid system and its potential role in the emergence of symptoms, as well as its therapeutic potential. Here we present an overview of the kappa system and review various lines of evidence derived from clinical studies for dynorphin and kappa opioid receptor involvement in the pathology of both the positive and negative symptoms of schizophrenia. This overview includes evidence for the psychotomimetic effects of kappa opioid receptor agonists in healthy volunteers and their reversal by the pan-opioid antagonists naloxone and naltrexone and evidence for a therapeutic benefit in schizophrenia for 4 pan-opioid antagonists. We describe the interactions between kappa opioid receptors and the dopaminergic pathways that are disrupted in schizophrenia and the histologic evidence suggesting abnormal kappa opioid receptor signaling in schizophrenia. We conclude by discussing future directions.
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Affiliation(s)
- Samuel David Clark
- Columbia University Medical Center, New York; Terran Biosciences Inc., New York.
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
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27
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Rutherford BR, Slifstein M, Chen C, Abi-Dargham A, Brown PJ, Wall MW, Vanegas-Arroyave N, Stern Y, Bailey V, Valente E, Roose SP. RETRACTED: Effects of L-DOPA Monotherapy on Psychomotor Speed and [ 11C]Raclopride Binding in High-Risk Older Adults With Depression. Biol Psychiatry 2019; 86:221-229. [PMID: 31178096 PMCID: PMC6641997 DOI: 10.1016/j.biopsych.2019.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/22/2019] [Accepted: 04/04/2019] [Indexed: 01/28/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of Biological Psychiatry Editor John H. Krystal, M.D., with agreement from all authors except Chen Chen and Emily Valente. These two co-authors moved and, with no forwarding information that was available or could be found, they were therefore unable to be contacted. The authors have uncovered irregularities and deviations from the approved protocol related to the work reported in this article. Treatment with antidepressant medications within the past 28 days was an exclusion criterion: “Subjects were excluded for… current treatment or treatment within the past 4 weeks with psychotropic or other medications known to affect dopamine.” Individuals taking an ineffective antidepressant medication who otherwise met study criteria were to undergo a study-supervised medication taper to discontinue their medication for the required period prior to study participation. The published article does not describe that a subgroup of participants (15 out of the 47 consented subjects) enrolled in the study while taking an ineffective antidepressant medication. Of this subgroup, 10 individuals were successfully tapered off their medication and were among the 36 subjects contributing data to the analyses described. In addition, the authors have found that 8 participants did not complete the required 28-day washout prior to beginning the study. For these 8 participants, the medication-free period ranged from 1 to 21 days, with a mean of 10.1 days. Separately, an inclusion criterion was that eligible subjects “had Center for Epidemiologic Studies—Depression Rating scale score ≤ 10.” However, the authors have found that 3 ineligible participants were included, each of whom had depressive symptom scores 1 point out of range for eligibility. Lastly, the CONSORT diagram in Figure S1 states that 11 participants were lost to follow-up. However, this is incorrect. Instead, 9 participants were lost to follow up and 2 participants were screen failures. The authors voluntarily informed the Journal of these honest errors upon discovery. Because of the extent of these issues, the editors and authors concluded that the only course of action was to retract this paper. However, the authors are revising the paper, which the Journal will consider further for publication.
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Affiliation(s)
- Bret R Rutherford
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York.
| | - Mark Slifstein
- Stony Brook University Renaissance College of Medicine, Stony Brook, New York
| | - Chen Chen
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Anissa Abi-Dargham
- Stony Brook University Renaissance College of Medicine, Stony Brook, New York
| | - Patrick J Brown
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Melanie W Wall
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | | | - Yaakov Stern
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Emily Valente
- New York State Psychiatric Institute, New York, New York
| | - Steven P Roose
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
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Moeller SJ, Abi-Dargham A. Letter to the Editor: A Novel Therapeutic for Opioid Use Disorder Targeting the Cholinergic System. Am J Addict 2019; 28:235-237. [PMID: 31165540 DOI: 10.1111/ajad.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Anissa Abi-Dargham
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
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Girgis RR, Baker S, Mao X, Gil R, Javitt DC, Kantrowitz JT, Gu M, Spielman DM, Ojeil N, Xu X, Abi-Dargham A, Shungu DC, Kegeles LS. Effects of acute N-acetylcysteine challenge on cortical glutathione and glutamate in schizophrenia: A pilot in vivo proton magnetic resonance spectroscopy study. Psychiatry Res 2019; 275:78-85. [PMID: 30884334 PMCID: PMC6515541 DOI: 10.1016/j.psychres.2019.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022]
Abstract
Findings from in vivo brain proton magnetic resonance spectroscopy (1H MRS) and preclinical studies have suggested region- and medication status-dependent increases in glutamate (Glu) levels and deficiencies in glutathione (GSH) levels in schizophrenia. N-acetylcysteine (NAC), a GSH synthesis precursor, has demonstrated modest clinical benefit in schizophrenia. The objective of this study was to examine the effects of acute administration of NAC on GSH and Glu levels measured with 1H MRS in 19 patients with schizophrenia and 20 healthy control subjects. Levels of GSH were acquired in dorsal anterior cingulate cortex (dACC), and those of Glu in dACC and medial prefrontal cortex (mPFC), at baseline and 60 min following acute oral administration of 2400 mg of NAC. No differences in the levels of GSH or Glu were found at baseline or following NAC administration between patients with schizophrenia and control subjects in either of the targeted brain regions. Future studies measuring GSH levels in brain regions previously found to exhibit glutamatergic abnormalities or using genetic polymorphisms, while controlling for the age and medication status of the cohorts, are warranted to better identify groups of patients more likely to respond to NAC and its mode of action and mechanisms.
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Affiliation(s)
- Ragy R Girgis
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA.
| | - Seth Baker
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Xiangling Mao
- Department of Radiology, Weill Cornell Medical College, New York, USA
| | - Roberto Gil
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, USA
| | - Daniel C Javitt
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Joshua T Kantrowitz
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Meng Gu
- Department of Radiology, Stanford University, Stanford, CA, USA
| | | | - Najate Ojeil
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Xiaoyan Xu
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Anissa Abi-Dargham
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, USA
| | - Dikoma C Shungu
- Department of Radiology, Weill Cornell Medical College, New York, USA
| | - Lawrence S Kegeles
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
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Cassidy CM, Zucca FA, Girgis RR, Baker SC, Weinstein JJ, Sharp ME, Bellei C, Valmadre A, Vanegas N, Kegeles LS, Brucato G, Kang UJ, Sulzer D, Zecca L, Abi-Dargham A, Horga G. Neuromelanin-sensitive MRI as a noninvasive proxy measure of dopamine function in the human brain. Proc Natl Acad Sci U S A 2019; 116:5108-5117. [PMID: 30796187 PMCID: PMC6421437 DOI: 10.1073/pnas.1807983116] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Neuromelanin-sensitive MRI (NM-MRI) purports to detect the content of neuromelanin (NM), a product of dopamine metabolism that accumulates with age in dopamine neurons of the substantia nigra (SN). Interindividual variability in dopamine function may result in varying levels of NM accumulation in the SN; however, the ability of NM-MRI to measure dopamine function in nonneurodegenerative conditions has not been established. Here, we validated that NM-MRI signal intensity in postmortem midbrain specimens correlated with regional NM concentration even in the absence of neurodegeneration, a prerequisite for its use as a proxy for dopamine function. We then validated a voxelwise NM-MRI approach with sufficient anatomical sensitivity to resolve SN subregions. Using this approach and a multimodal dataset of molecular PET and fMRI data, we further showed the NM-MRI signal was related to both dopamine release in the dorsal striatum and resting blood flow within the SN. These results suggest that NM-MRI signal in the SN is a proxy for function of dopamine neurons in the nigrostriatal pathway. As a proof of concept for its clinical utility, we show that the NM-MRI signal correlated to severity of psychosis in schizophrenia and individuals at risk for schizophrenia, consistent with the well-established dysfunction of the nigrostriatal pathway in psychosis. Our results indicate that noninvasive NM-MRI is a promising tool that could have diverse research and clinical applications to investigate in vivo the role of dopamine in neuropsychiatric illness.
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Affiliation(s)
- Clifford M Cassidy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032;
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa, ON K1Z 8N3, Canada
| | - Fabio A Zucca
- Institute of Biomedical Technologies, National Research Council of Italy, Segrate, 20090 Milan, Italy
| | - Ragy R Girgis
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
| | - Seth C Baker
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
| | - Jodi J Weinstein
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
- Department of Psychiatry, Stony Brook University, Stony Brook, NY 11794
| | - Madeleine E Sharp
- Department of Neurology, Columbia University Medical Center, New York, NY 10032
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC H3A 2B4, Canada
| | - Chiara Bellei
- Institute of Biomedical Technologies, National Research Council of Italy, Segrate, 20090 Milan, Italy
| | - Alice Valmadre
- Institute of Biomedical Technologies, National Research Council of Italy, Segrate, 20090 Milan, Italy
| | - Nora Vanegas
- Department of Neurology, Columbia University Medical Center, New York, NY 10032
| | - Lawrence S Kegeles
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
| | - Gary Brucato
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
| | - Un Jung Kang
- Department of Neurology, Columbia University Medical Center, New York, NY 10032
| | - David Sulzer
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
- Department of Neurology, Columbia University Medical Center, New York, NY 10032
| | - Luigi Zecca
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
- Institute of Biomedical Technologies, National Research Council of Italy, Segrate, 20090 Milan, Italy
| | - Anissa Abi-Dargham
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
- Department of Psychiatry, Stony Brook University, Stony Brook, NY 11794
| | - Guillermo Horga
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032;
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McCutcheon RA, Abi-Dargham A, Howes OD. Schizophrenia, Dopamine and the Striatum: From Biology to Symptoms. Trends Neurosci 2019; 42:205-220. [PMID: 30621912 PMCID: PMC6401206 DOI: 10.1016/j.tins.2018.12.004] [Citation(s) in RCA: 367] [Impact Index Per Article: 73.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/04/2018] [Accepted: 12/16/2018] [Indexed: 12/15/2022]
Abstract
The mesolimbic hypothesis has been a central dogma of schizophrenia for decades, positing that aberrant functioning of midbrain dopamine projections to limbic regions causes psychotic symptoms. Recently, however, advances in neuroimaging techniques have led to the unanticipated finding that dopaminergic dysfunction in schizophrenia is greatest within nigrostriatal pathways, implicating the dorsal striatum in the pathophysiology and calling into question the mesolimbic theory. At the same time our knowledge of striatal anatomy and function has progressed, suggesting new mechanisms via which striatal dysfunction may contribute to the symptoms of schizophrenia. This Review draws together these developments, to explore what they mean for our understanding of the pathophysiology, clinical manifestations, and treatment of the disorder. Techniques for characterising the mesostriatal dopamine system, both in humans and animal models, have advanced significantly over the past decade. In vivo imaging studies in schizophrenia patients demonstrate that dopaminergic dysfunction in schizophrenia is greatest in nigrostriatal as opposed to mesolimbic pathways. Better understanding of striatal structure and function has enhanced our insight into the neurobiological basis of psychotic symptoms. The role of other neurotransmitters in modulating striatal dopamine function merits further exploration, and modulating these neurotransmitter systems has potential to offer new therapeutic strategies.
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Affiliation(s)
- Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK; South London and Maudsley NHS Foundation Trust, London, SE5 8AF, UK
| | - Anissa Abi-Dargham
- Department of Psychiatry, School of Medicine, Stony Brook University, New York, USA
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK; South London and Maudsley NHS Foundation Trust, London, SE5 8AF, UK.
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Abi-Dargham A. From "bedside" to "bench" and back: A translational approach to studying dopamine dysfunction in schizophrenia. Neurosci Biobehav Rev 2018; 110:174-179. [PMID: 30528375 DOI: 10.1016/j.neubiorev.2018.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/25/2018] [Accepted: 12/04/2018] [Indexed: 01/07/2023]
Abstract
Despite multiple lines of research, a mechanistic understanding of schizophrenia remains elusive. Neuroimaging studies have yielded observations that can be used in translational studies in animals to attempt to uncover their cellular and circuit basis and their significance for the diseased human brain. Enhanced D2 stimulation in the striatum is a well replicated and established observation in patients with schizophrenia. This "bedside" observation was reproduced "at the bench" level by creating a transgenic mouse overexpressing D2 receptors in dorsal striatum (D2R-OE mouse). The D2R-OE mouse showed multiple behavioral, molecular, electrophysiological and anatomical alterations. Some of these are consistent with findings in patients with schizophrenia, providing construct validity to the model and mechanistic insights for the observations made in humans. Other findings were novel, and provide an opportunity for a reverse translational effort back into the clinic. In this review we will summarize the process of translation and back translation from the D2R-OE mouse and describe the insights into the pathophysiology of the disease gained through this type of translational work.
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Affiliation(s)
- Anissa Abi-Dargham
- Departments of Psychiatry and Radiology, Stony Brook School of Medicine, HSC-T10-087H, 101 Nicolls Road, Stony Brook, NY, 11794-8101, United States.
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Schneier FR, Slifstein M, Whitton AE, Pizzagalli DA, Reinen J, McGrath PJ, Iosifescu DV, Abi-Dargham A. Dopamine Release in Antidepressant-Naive Major Depressive Disorder: A Multimodal [ 11C]-(+)-PHNO Positron Emission Tomography and Functional Magnetic Resonance Imaging Study. Biol Psychiatry 2018; 84:563-573. [PMID: 30041971 PMCID: PMC6347467 DOI: 10.1016/j.biopsych.2018.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/02/2018] [Accepted: 05/15/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mesolimbic dopamine system dysfunction is believed to contribute to major depressive disorder (MDD), but molecular neuroimaging of striatal dopamine neurotransmission has yielded mixed results, possibly owing to limited sensitivity of antagonist radioligands used with positron emission tomography to assess dopamine release capacity. This study used an agonist radioligand with agonist challenge to assess dopamine release capacity and D2/D3 receptor availability in MDD. METHODS Twenty-six treatment-naive adults with MDD and 26 healthy comparison participants underwent functional magnetic resonance imaging during a probabilistic reinforcement task, and positron emission tomography with the D3-preferring ligand [11C]-(+)-PHNO, before and after oral dextroamphetamine. MDD participants then received pramipexole treatment for 6 weeks. RESULTS MDD participants had trend-level greater dopamine release capacity in the ventral striatum, as measured by percent change in baseline binding potential relative to nondisplaceable compartment (ΔBPND) (-34% vs. -30%; p = .072, d = 0.58) but no difference in D2/D3 receptor availability (BPND). Striatal and extrastriatal BPND and percent change in baseline BPND were not significantly associated with blood oxygen level-dependent response to reward prediction error in the ventral striatum, severity of depression and anhedonia, or antidepressant response to pramipexole (response rate = 72.7%). CONCLUSIONS [11C]-(+)-PHNO demonstrated high sensitivity to displacement by amphetamine-induced dopamine release, but dopamine release capacity and D2/D3 availability were not associated with ventral striatal activation to reward prediction error or clinical features, in this study powered to detect large effects. While a preponderance of indirect evidence implicates dopaminergic dysfunction in MDD, these findings suggest that presynaptic dopamine dysregulation may not be a feature of MDD or a prerequisite for treatment response to dopamine agonists.
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Affiliation(s)
- Franklin R Schneier
- Division of Clinical Therapeutics, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York; Department of Psychiatry, Columbia University Medical Center, New York, New York.
| | - Mark Slifstein
- Division of Translational Imaging, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York; Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Alexis E Whitton
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont; Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont; Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts
| | - Jenna Reinen
- Department of Psychology, Columbia University Medical Center, New York, New York; Department of Psychology, Yale University, New Haven, Connecticut
| | - Patrick J McGrath
- Division of Clinical Therapeutics, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York; Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Dan V Iosifescu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anissa Abi-Dargham
- Division of Translational Imaging, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York; Department of Psychiatry, Columbia University Medical Center, New York, New York
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Weinstein JJ, van de Giessen E, Rosengard RJ, Xu X, Ojeil N, Brucato G, Gil RB, Kegeles LS, Laruelle M, Slifstein M, Abi-Dargham A. PET imaging of dopamine-D2 receptor internalization in schizophrenia. Mol Psychiatry 2018; 23:1506-1511. [PMID: 28507321 PMCID: PMC5690884 DOI: 10.1038/mp.2017.107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/22/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023]
Abstract
Recent genetic, molecular and post-mortem studies suggest impaired dopamine (DA)-D2 receptor (D2R) trafficking in patients with schizophrenia (SZ). Imaging and preclinical studies have shown agonist-induced D2R internalization can be imaged with positron emission tomography (PET) using D2R radiotracers combined with psychostimulant challenge. This is feasible if radiotracer binding is measured when postchallenge DA levels have returned to baseline, following the initial competition phase between DA and radiotracer for binding to D2R. Here we used 'late-phase' imaging after challenge to test the hypothesis that impaired D2R internalization in SZ leads to blunted late-phase displacement, or a faster return to baseline, in patients compared with healthy controls (HCs). We imaged 10 patients with SZ and 9 HCs with PET and [11C]raclopride at baseline and two times (3-5 and 6-10 h) following 0.5 mg kg-1 dextroamphetamine. We measured binding potential relative to non-displaceable compartment (BPND) and derived percent reduction from baseline (ΔBPND) for each postamphetamine scan. To test the hypothesis that time course of return of striatal BPND to baseline differed between SZ and HCs, we implemented a linear model with ΔBPND as dependent variable, time after amphetamine as repeated measure and time after amphetamine and diagnostic group as fixed effects. Neither diagnostic group nor interaction of diagnostic group-by-time after amphetamine significantly affected striatal ΔBPND (F=1.38, P=0.26; F=0.51, P=0.61). These results show similar pattern of return of BPND to baseline as a function of time in patients with SZ and HC, suggesting that striatal D2R internalization as measured by our imaging paradigm is normal in patients with SZ.
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Affiliation(s)
- Jodi J. Weinstein
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - Xiaoyan Xu
- New York State Psychiatric Institute, New York, New York
| | - Najate Ojeil
- New York State Psychiatric Institute, New York, New York
| | - Gary Brucato
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,New York State Psychiatric Institute, New York, New York
| | - Roberto B. Gil
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
| | - Lawrence S. Kegeles
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,New York State Psychiatric Institute, New York, New York
| | - Marc Laruelle
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mark Slifstein
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
| | - Anissa Abi-Dargham
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
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Kegeles LS, Horga G, Ghazzaoui R, Rosengard R, Ojeil N, Xu X, Slifstein M, Petrakis I, O'Malley SS, Krystal JH, Abi-Dargham A. Enhanced Striatal Dopamine Release to Expectation of Alcohol: A Potential Risk Factor for Alcohol Use Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2018; 3:591-598. [PMID: 29803635 DOI: 10.1016/j.bpsc.2018.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/07/2018] [Accepted: 03/26/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND We used positron emission tomography imaging with [11C]raclopride to examine the effects of consumption of alcohol or placebo beverage by participants with alcohol use disorder (AUD) compared with healthy participants with and without family history of AUD. We sought to assess dopamine release following alcohol exposure in relation to AUD risk. METHODS Three groups were enrolled: participants with AUD (n = 15) and healthy participants with family history negative (n = 34) or positive (n = 16) for AUD. Participants consumed a placebo (n = 65) or alcohol (n = 63) beverage in counterbalanced order before positron emission tomography scanning (128 scans). Binding potential (BPND) in the two drink conditions and the percent change in BPND between conditions were evaluated across striatal subregions. Subjective effects of beverage consumption were rated. Effects of group, drink order, and sex were evaluated. RESULTS Alcohol resulted in greater dopamine release than did placebo in the ventral striatum (p < .001). There were no main effects of group, drink order, or sex on ventral striatum BPND or percent change in BPND. However, there was a drink order-by-group interaction (p = .02) whereby family history-positive participants who received placebo first had both lower placebo BPND and less difference between placebo and alcohol BPND than all other groups, consistent with expectation of alcohol powerfully evoking dopamine release in this group. Subjective responses showed the same order-by-group interaction. CONCLUSIONS Hyper-responsivity of the dopaminergic system in family history-positive participants to expectation of alcohol may contribute to the expression of familial risk for AUD.
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Affiliation(s)
- Lawrence S Kegeles
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York; Department of Radiology, Columbia University College of Physicians and Surgeons, New York, New York.
| | - Guillermo Horga
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York
| | - Rassil Ghazzaoui
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York
| | - Rachel Rosengard
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York
| | - Najate Ojeil
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York
| | - Xiaoyan Xu
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York
| | - Mark Slifstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York
| | - Ismene Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Anissa Abi-Dargham
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York; Department of Radiology, Columbia University College of Physicians and Surgeons, New York, New York
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Slifstein M, Abi-Dargham A. Is it Pre- or Postsynaptic? Imaging Striatal Dopamine Excess in Schizophrenia. Biol Psychiatry 2018; 83:635-637. [PMID: 29559095 DOI: 10.1016/j.biopsych.2018.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Mark Slifstein
- Department of Psychiatry, Stony Brook University, Stony Brook, New York.
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Cassidy CM, Balsam PD, Weinstein JJ, Rosengard RJ, Slifstein M, Daw ND, Abi-Dargham A, Horga G. A Perceptual Inference Mechanism for Hallucinations Linked to Striatal Dopamine. Curr Biol 2018; 28:503-514.e4. [PMID: 29398218 PMCID: PMC5820222 DOI: 10.1016/j.cub.2017.12.059] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/23/2017] [Accepted: 12/29/2017] [Indexed: 12/14/2022]
Abstract
Hallucinations, a cardinal feature of psychotic disorders such as schizophrenia, are known to depend on excessive striatal dopamine. However, an underlying cognitive mechanism linking dopamine dysregulation and the experience of hallucinatory percepts remains elusive. Bayesian models explain perception as an optimal combination of prior expectations and new sensory evidence, where perceptual distortions such as illusions and hallucinations may occur if prior expectations are afforded excessive weight. Such excessive weight of prior expectations, in turn, could stem from a gain-control process controlled by neuromodulators such as dopamine. To test for such a dopamine-dependent gain-control mechanism of hallucinations, we studied unmedicated patients with schizophrenia with varying degrees of hallucination severity and healthy individuals using molecular imaging with a pharmacological manipulation of dopamine, structural imaging, and a novel task designed to measure illusory changes in the perceived duration of auditory stimuli under different levels of uncertainty. Hallucinations correlated with a perceptual bias, reflecting disproportional gain on expectations under uncertainty. This bias could be pharmacologically induced by amphetamine, strongly correlated with striatal dopamine release, and related to cortical volume of the dorsal anterior cingulate, a brain region involved in tracking environmental uncertainty. These findings outline a novel dopamine-dependent mechanism for perceptual modulation in physiological conditions and further suggest that this mechanism may confer vulnerability to hallucinations in hyper-dopaminergic states underlying psychosis.
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Affiliation(s)
- Clifford M Cassidy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; The Royal's Institute of Mental Health Research, University of Ottawa, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada
| | - Peter D Balsam
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; Department of Psychology, Columbia University, 3009 Broadway, New York, NY 10027, USA
| | - Jodi J Weinstein
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; Department of Psychiatry, Stony Brook University, 100 Nicholls Road, Stony Brook, NY 11794, USA
| | - Rachel J Rosengard
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Mark Slifstein
- Department of Psychiatry, Stony Brook University, 100 Nicholls Road, Stony Brook, NY 11794, USA
| | - Nathaniel D Daw
- Department of Psychology, Princeton University, South Drive, Princeton, NJ 08540, USA
| | - Anissa Abi-Dargham
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; Department of Psychiatry, Stony Brook University, 100 Nicholls Road, Stony Brook, NY 11794, USA
| | - Guillermo Horga
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA.
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Weinstein JJ, van de Giessen E, Rosengard RJ, Xu X, Ojeil N, Brucato G, Gil RB, Kegeles LS, Laruelle M, Slifstein M, Abi-Dargham A. PET imaging of dopamine-D2 receptor internalization in schizophrenia. Mol Psychiatry 2017:mp2017157. [PMID: 29155803 DOI: 10.1038/mp.2017.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This corrects the article DOI: 10.1038/mp.2017.107.
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Murray RM, Englund A, Abi-Dargham A, Lewis DA, Di Forti M, Davies C, Sherif M, McGuire P, D'Souza DC. Cannabis-associated psychosis: Neural substrate and clinical impact. Neuropharmacology 2017. [PMID: 28634109 DOI: 10.1016/j.neuropharm.2017.06.018] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Prospective epidemiological studies have consistently demonstrated that cannabis use is associated with an increased subsequent risk of both psychotic symptoms and schizophrenia-like psychoses. Early onset of use, daily use of high-potency cannabis, and synthetic cannabinoids carry the greatest risk. The risk-increasing effects are not explained by shared genetic predisposition between schizophrenia and cannabis use. Experimental studies in healthy humans show that cannabis and its active ingredient, delta-9-tetrahydrocannabinol (THC), can produce transient, dose-dependent, psychotic symptoms, as well as an array of psychosis-relevant behavioral, cognitive and psychophysiological effects; the psychotogenic effects can be ameliorated by cannabidiol (CBD). Findings from structural imaging studies in cannabis users have been inconsistent but functional MRI studies have linked the psychotomimetic and cognitive effects of THC to activation in brain regions implicated in psychosis. Human PET studies have shown that acute administration of THC weakly releases dopamine in the striatum but that chronic users are characterised by low striatal dopamine. We are beginning to understand how cannabis use impacts on the endocannabinoid system but there is much still to learn about the biological mechanisms underlying how cannabis increases risk of psychosis. This article is part of the Special Issue entitled "A New Dawn in Cannabinoid Neurobiology".
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Affiliation(s)
- R M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.
| | - A Englund
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - A Abi-Dargham
- Department of Psychiatry, School of Medicine, Stony Brook University, New York, USA
| | - D A Lewis
- Department of Psychiatry, University of Pittsburg, PA, USA
| | - M Di Forti
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - C Davies
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - M Sherif
- Department of Psychiatry, Yale University School of Medicine, CT, USA
| | - P McGuire
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - D C D'Souza
- Department of Psychiatry, Yale University School of Medicine, CT, USA
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Affiliation(s)
- Anissa Abi-Dargham
- Department of Psychiatry, Stony Brook University, Stony Brook, New York.
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Lehembre-Shiah E, Leong W, Brucato G, Abi-Dargham A, Lieberman JA, Horga G, Girgis RR. Distinct Relationships Between Visual and Auditory Perceptual Abnormalities and Conversion to Psychosis in a Clinical High-Risk Population. JAMA Psychiatry 2017; 74:104-106. [PMID: 27851840 PMCID: PMC5337304 DOI: 10.1001/jamapsychiatry.2016.3055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Eugénie Lehembre-Shiah
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York
| | - Wei Leong
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York
| | - Gary Brucato
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York
| | - Anissa Abi-Dargham
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York
| | - Jeffrey A. Lieberman
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York
| | - Guillermo Horga
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York
| | - Ragy R. Girgis
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York
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Weinstein JJ, Chohan MO, Slifstein M, Kegeles LS, Moore H, Abi-Dargham A. Pathway-Specific Dopamine Abnormalities in Schizophrenia. Biol Psychiatry 2017; 81:31-42. [PMID: 27206569 PMCID: PMC5177794 DOI: 10.1016/j.biopsych.2016.03.2104] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/21/2016] [Accepted: 03/25/2016] [Indexed: 02/08/2023]
Abstract
In light of the clinical evidence implicating dopamine in schizophrenia and the prominent hypotheses put forth regarding alterations in dopaminergic transmission in this disease, molecular imaging has been used to examine multiple aspects of the dopaminergic system. We review the imaging methods used and compare the findings across the different molecular targets. Findings have converged to suggest early dysregulation in the striatum, especially in the rostral caudate, manifesting as excess synthesis and release. Recent data showed deficit extending to most cortical regions and even to other extrastriatal subcortical regions not previously considered to be "hypodopaminergic" in schizophrenia. These findings yield a new topography for the dopaminergic dysregulation in schizophrenia. We discuss the dopaminergic innervation within the individual projection fields to provide a topographical map of this dual dysregulation and explore potential cellular and circuit-based mechanisms for brain region-dependent alterations in dopaminergic parameters. This refined knowledge is essential to better guide translational studies and efforts in early drug development.
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Affiliation(s)
- Jodi J. Weinstein
- Columbia University Department of Psychiatry, New York, NY,New York State Psychiatric Institute Division of Translational Imaging,Corresponding author: Jodi Weinstein, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, New York 10032, +1-646-774-8123,
| | - Muhammad O. Chohan
- New York State Psychiatric Institute Division of Integrative Neuroscience
| | - Mark Slifstein
- Columbia University Department of Psychiatry, New York, NY,New York State Psychiatric Institute Division of Translational Imaging
| | - Lawrence S. Kegeles
- Columbia University Department of Psychiatry, New York, NY,New York State Psychiatric Institute Division of Translational Imaging
| | - Holly Moore
- Columbia University Department of Psychiatry, New York, NY,New York State Psychiatric Institute Division of Integrative Neuroscience
| | - Anissa Abi-Dargham
- Columbia University Department of Psychiatry, New York, NY,New York State Psychiatric Institute Division of Translational Imaging
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Delevich K, Abi-Dargham A, Hall J, Sawa A. Studying schizophrenia in the post-genomic era: perspectives from the 2016 summer Banbury Workshop at Cold Spring Harbor Laboratory. Mol Psychiatry 2017; 22:2-3. [PMID: 27777417 DOI: 10.1038/mp.2016.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- K Delevich
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - A Abi-Dargham
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - J Hall
- Neuroscience & Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - A Sawa
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
BACKGROUND Recent findings demonstrate that patients with schizophrenia are worse at learning to predict rewards than losses, suggesting that motivational context modulates learning in this disease. However, these findings derive from studies in patients treated with antipsychotic medications, D2 receptor antagonists that may interfere with the neural systems that underlie motivation and learning. Thus, it remains unknown how motivational context affects learning in schizophrenia, separate from the effects of medication. METHODS To examine the impact of motivational context on learning in schizophrenia, we tested 16 unmedicated patients with schizophrenia and 23 matched controls on a probabilistic learning task while they underwent functional magnetic resonance imaging (fMRI) under 2 conditions: one in which they pursued rewards, and one in which they avoided losses. Computational models were used to derive trial-by-trial prediction error responses to feedback. RESULTS Patients performed worse than controls on the learning task overall, but there were no behavioral effects of condition. FMRI revealed an attenuated prediction error response in patients in the medial prefrontal cortex, striatum, and medial temporal lobe when learning to predict rewards, but not when learning to avoid losses. CONCLUSIONS Patients with schizophrenia showed differences in learning-related brain activity when learning to predict rewards, but not when learning to avoid losses. Together with prior work, these results suggest that motivational deficits related to learning in schizophrenia are characteristic of the disease and not solely a result of antipsychotic treatment.
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Affiliation(s)
- Jenna M. Reinen
- Department of Psychology, Columbia University, New York, NY;,Department of Psychology, Yale University, New Haven, CT;,*To whom correspondence should be addressed; Department of Psychology, Yale University, 1 Prospect Street, New Haven, CT 06511, US; tel: 203-436-9449, fax: 203-432-7172, e-mail:
| | - Jared X. Van Snellenberg
- Department of Psychiatry, Columbia University Medical Center, New York, NY;,Division of Translational Imaging, New York State Psychiatric Institute, New York, NY
| | - Guillermo Horga
- Department of Psychiatry, Columbia University Medical Center, New York, NY;,Division of Translational Imaging, New York State Psychiatric Institute, New York, NY
| | - Anissa Abi-Dargham
- Department of Psychiatry, Columbia University Medical Center, New York, NY;,Division of Translational Imaging, New York State Psychiatric Institute, New York, NY
| | - Nathaniel D. Daw
- Princeton Neuroscience Institute and Department of Psychology, Princeton University, Princeton, NJ;,These authors contributed equally to this work
| | - Daphna Shohamy
- Department of Psychology, Columbia University, New York, NY;,Zuckerman Mind, Brain, Behavior Institute and Kavli Center for Brain Science, Columbia University, New York, NY.,These authors contributed equally to this work
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45
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Van Snellenberg JX, Girgis RR, Horga G, van de Giessen E, Slifstein M, Ojeil N, Weinstein JJ, Moore H, Lieberman JA, Shohamy D, Smith EE, Abi-Dargham A. Mechanisms of Working Memory Impairment in Schizophrenia. Biol Psychiatry 2016; 80:617-26. [PMID: 27056754 PMCID: PMC4995154 DOI: 10.1016/j.biopsych.2016.02.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The neural correlates of working memory (WM) impairment in schizophrenia remain a key puzzle in understanding the cognitive deficits and dysfunction of dorsolateral prefrontal cortex observed in this disorder. We sought to determine whether patients with schizophrenia exhibit an alteration in the inverted-U relationship between WM load and activation that we recently observed in healthy individuals and whether this could account for WM deficits in this population. METHODS Medicated (n = 30) and unmedicated (n = 21) patients with schizophrenia and healthy control subjects (n = 45) performed the self-ordered WM task during functional magnetic resonance imaging. We identified regions exhibiting an altered fit to an inverted-U relationship between WM load and activation that were also predictive of WM performance. RESULTS A blunted inverted-U response was observed in left dorsolateral prefrontal cortex in patients and was associated with behavioral deficits in WM capacity. In addition, suppression of medial prefrontal cortex during WM was reduced in patients and was associated with poorer WM capacity in patients. Finally, activation of visual cortex in the cuneus was elevated in patients and associated with improved WM capacity. Together, these findings explained 55% of the interindividual variance in WM capacity when combined with diagnostic and medication status, which alone accounted for only 22% of the variance in WM capacity. CONCLUSIONS These findings identify a novel biomarker and putative mechanism of WM deficits in patients with schizophrenia, a reduction or flattening of the inverted-U relationship between activation and WM load observed in healthy individuals in left dorsolateral prefrontal cortex.
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Affiliation(s)
- Jared X Van Snellenberg
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Divisions of Translational Imaging, New York, New York; Cognitive Neuroscience, New York, New York.
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Divisions of Translational Imaging, New York, New York
| | - Guillermo Horga
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Divisions of Translational Imaging, New York, New York
| | - Elsmarieke van de Giessen
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Divisions of Translational Imaging, New York, New York; Department of Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Slifstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Divisions of Translational Imaging, New York, New York
| | - Najate Ojeil
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Divisions of Translational Imaging, New York, New York
| | - Jodi J Weinstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Divisions of Translational Imaging, New York, New York
| | - Holly Moore
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Integrative Neuroscience, New York, New York
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Daphna Shohamy
- Department of Psychology, Columbia University, New York, New York
| | - Edward E Smith
- Cognitive Neuroscience, New York, New York; Department of Psychology, Columbia University, New York, New York
| | - Anissa Abi-Dargham
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Divisions of Translational Imaging, New York, New York
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Abstract
Molecular imaging with PET or SPECT has been an important research tool in psychiatry for as long as these modalities have been available. Here, we discuss two areas of neuroimaging relevant to current psychiatry research. The first is the use of imaging to study neurotransmission. We discuss the use of pharmacologic probes to induce changes in levels of neurotransmitters that can be inferred through their effects on outcome measures of imaging experiments, from their historical origins focusing on dopamine transmission through recent developments involving serotonin, GABA, and glutamate. Next, we examine imaging of neuroinflammation in the context of psychiatry. Imaging markers of neuroinflammation have been studied extensively in other areas of brain research, but they have more recently attracted interest in psychiatry research, based on accumulating evidence that there may be an inflammatory component to some psychiatric conditions. Furthermore, new probes are under development that would allow unprecedented insights into cellular processes. In summary, molecular imaging would continue to offer great potential as a unique tool to further our understanding of brain function in health and disease.
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Affiliation(s)
- Mark Slifstein
- Department of Psychiatry, Columbia University Medical Center, New York, NY; New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Stony Brook University, New York, NY.
| | - Anissa Abi-Dargham
- Department of Psychiatry, Columbia University Medical Center, New York, NY; Department of Radiology, Columbia University Medical Center, New York, NY; New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Stony Brook University, New York, NY
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Girgis RR, Slifstein M, D'Souza D, Lee Y, Periclou A, Ghahramani P, Laszlovszky I, Durgam S, Adham N, Nabulsi N, Huang Y, Carson RE, Kiss B, Kapás M, Abi-Dargham A, Rakhit A. Preferential binding to dopamine D3 over D2 receptors by cariprazine in patients with schizophrenia using PET with the D3/D2 receptor ligand [(11)C]-(+)-PHNO. Psychopharmacology (Berl) 2016; 233:3503-12. [PMID: 27525990 PMCID: PMC5035321 DOI: 10.1007/s00213-016-4382-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 07/10/2016] [Indexed: 01/01/2023]
Abstract
RATIONALE Second-generation antipsychotics occupy dopamine D2 receptors and act as antagonists or partial agonists at these receptors. While these drugs alleviate positive symptoms in patients with schizophrenia, they are less effective for treating cognitive deficits and negative symptoms. Dopamine D3 receptors are highly expressed in areas of the brain thought to play a role in the regulation of motivation and reward-related behavior. Consequently, the dopamine D3 receptor has become a target for treating negative symptoms in combination with D2 antagonism to treat positive symptoms in patients with schizophrenia. OBJECTIVE The purpose of this study was to determine the cariprazine receptor occupancies in brain for D2 and D3 receptors in patients with schizophrenia. METHODS Using [(11)C]-(+)-PHNO as a radioligand, positron emission tomography (PET) scans were performed in eight patients at baseline and postdose on days 1, 4, and 15. Plasma and cerebrospinal fluid (CSF) samples were analyzed for cariprazine concentrations. RESULTS A monotonic dose-occupancy relationship was observed for both receptor types. After 2 weeks of treatment, near complete (∼100 %) occupancies were observed for both receptors at a dose of 12 mg/day. At the lowest cariprazine dose (1 mg/day), mean D3 and D2 receptor occupancies were 76 and 45 %, respectively, suggesting selectivity for D3 over D2 receptors at low doses. An exposure-response analysis found a ∼3-fold difference in EC50 (D3 = 3.84 nM and D2 = 13.03 nM) in plasma after 2 weeks of dosing. CONCLUSION This PET imaging study in patients with schizophrenia demonstrated that cariprazine is a D3-preferring dual D3/D2 receptor partial agonist.
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Affiliation(s)
- Ragy R Girgis
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive Unit 31, New York, NY, 10032, USA.
- New York State Psychiatric Institute (NYSPI), Columbia University Medical Center, New York, NY, USA.
| | - Mark Slifstein
- New York State Psychiatric Institute (NYSPI), Columbia University Medical Center, New York, NY, USA
| | - Deepak D'Souza
- Clinical Neuroscience Research Unit (CNRU), Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, Yale PET Center, New Haven, CT, USA
| | - Yih Lee
- Forest Research Institute, Jersey City, NJ, USA
- Pharmaceutical Product Development, LLC, Richmond, VA, 23230, USA
| | | | | | | | | | - Nika Adham
- Forest Research Institute, Jersey City, NJ, USA
| | - Nabeel Nabulsi
- Department of Psychiatry, Yale University School of Medicine, Yale PET Center, New Haven, CT, USA
| | - Yiyun Huang
- Department of Psychiatry, Yale University School of Medicine, Yale PET Center, New Haven, CT, USA
| | - Richard E Carson
- Department of Psychiatry, Yale University School of Medicine, Yale PET Center, New Haven, CT, USA
| | - Béla Kiss
- Gedeon Richter Plc., Budapest, Hungary
| | | | - Anissa Abi-Dargham
- New York State Psychiatric Institute (NYSPI), Columbia University Medical Center, New York, NY, USA
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Wiers CE, Shokri-Kojori E, Wong CT, Abi-Dargham A, Demiral ŞB, Tomasi D, Wang GJ, Volkow ND. Cannabis Abusers Show Hypofrontality and Blunted Brain Responses to a Stimulant Challenge in Females but not in Males. Neuropsychopharmacology 2016; 41:2596-605. [PMID: 27156854 PMCID: PMC4987858 DOI: 10.1038/npp.2016.67] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 12/14/2022]
Abstract
The extent to which cannabis is deleterious to the human brain is not well understood. Here, we test whether cannabis abusers (CA) have impaired frontal function and reactivity to dopaminergic signaling, which are fundamental to relapse in addiction. We measured brain glucose metabolism using PET and [(18)F]FDG both at baseline (placebo) and after challenge with methylphenidate (MP), a dopamine-enhancing drug, in 24 active CA (50% female) and 24 controls (HC; 50% female). Results show that (i) CA had lower baseline glucose metabolism than HC in frontal cortex including anterior cingulate, which was associated with negative emotionality. (ii) MP increased whole-brain glucose metabolism in HC but not in CA; and group by challenge effects were most profound in putamen, caudate, midbrain, thalamus, and cerebellum. In CA, MP-induced metabolic increases in putamen correlated negatively with addiction severity. (iii) There were significant gender effects, such that both the group differences at baseline in frontal metabolism and the attenuated regional brain metabolic responses to MP were observed in female CA but not in male CA. As for other drug addictions, reduced baseline frontal metabolism is likely to contribute to relapse in CA. The attenuated responses to MP in midbrain and striatum are consistent with decreased brain reactivity to dopamine stimulation and might contribute to addictive behaviors in CA. The gender differences suggest that females are more sensitive than males to the adverse effects of cannabis in brain.
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Affiliation(s)
- Corinde E Wiers
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA,National Institute on Alcohol Abuse and Alcoholism, Laboratory of Neuroimaging, National Institutes of Health, 10 Center Drive, Room B2L124, Bethesda, MD 20892, USA, Tel: +1 301 451 3021 or +1 301 402 0868, Fax: +1 301 496 5568, E-mail: or
| | - Ehsan Shokri-Kojori
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Christopher T Wong
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Anissa Abi-Dargham
- Division of Translational Imaging, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Şükrü B Demiral
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Dardo Tomasi
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Nora D Volkow
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA,National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA,National Institute on Alcohol Abuse and Alcoholism, Laboratory of Neuroimaging, National Institutes of Health, 10 Center Drive, Room B2L124, Bethesda, MD 20892, USA, Tel: +1 301 451 3021 or +1 301 402 0868, Fax: +1 301 496 5568, E-mail: or
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49
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Horga G, Cassidy CM, Xu X, Moore H, Slifstein M, Van Snellenberg JX, Abi-Dargham A. Dopamine-Related Disruption of Functional Topography of Striatal Connections in Unmedicated Patients With Schizophrenia. JAMA Psychiatry 2016; 73:862-70. [PMID: 27145361 PMCID: PMC5310843 DOI: 10.1001/jamapsychiatry.2016.0178] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite the well-established role of striatal dopamine in psychosis, current views generally agree that cortical dysfunction is likely necessary for the emergence of psychotic symptoms. The topographic organization of striatal-cortical connections is central to gating and integration of higher-order information, so a disruption of such topography via dysregulated dopamine could lead to cortical dysfunction in schizophrenia. However, this hypothesis remains to be tested using multivariate methods ascertaining the global pattern of striatal connectivity and without the confounding effects of antidopaminergic medication. OBJECTIVES To examine whether the pattern of brain connectivity across striatal subregions is abnormal in unmedicated patients with schizophrenia and whether this abnormality relates to psychotic symptoms and extrastriatal dopaminergic transmission. DESIGN, SETTING, AND PARTICIPANTS In this multimodal, case-control study, we obtained resting-state functional magnetic resonance imaging data from 18 unmedicated patients with schizophrenia and 24 matched healthy controls from the New York State Psychiatric Institute. A subset of these (12 and 17, respectively) underwent positron emission tomography with the dopamine D2 receptor radiotracer carbon 11-labeled FLB457 before and after amphetamine administration. Data were acquired between June 16, 2011, and February 25, 2014. Data analysis was performed from September 1, 2014, to January 11, 2016. MAIN OUTCOMES AND MEASURES Group differences in the striatal connectivity pattern (assessed via multivariable logistic regression) across striatal subregions, the association between the multivariate striatal connectivity pattern and extrastriatal baseline D2 receptor binding potential and its change after amphetamine administration, and the association between the multivariate connectivity pattern and the severity of positive symptoms evaluated with the Positive and Negative Syndrome Scale. RESULTS Of the patients with schizophrenia (mean [SEM] age, 35.6 [11.8] years), 9 (50%) were male and 9 (50%) were female. Of the controls (mean [SEM] age, 33.7 [8.8] years), 10 (42%) were male and 14 (58%) were female. Patients had an abnormal pattern of striatal connectivity, which included abnormal caudate connections with a distributed set of associative cortex regions (χ229 = 53.55, P = .004). In patients, more deviation from the multivariate pattern of striatal connectivity found in controls correlated specifically with more severe positive symptoms (ρ = -0.77, P = .002). Striatal connectivity also correlated with baseline binding potential across cortical and extrastriatal subcortical regions (t25 = 3.01, P = .01, Bonferroni corrected) but not with its change after amphetamine administration. CONCLUSIONS AND RELEVANCE Using a multimodal, circuit-level interrogation of striatal-cortical connections, it was demonstrated that the functional topography of these connections is globally disrupted in unmedicated patients with schizophrenia. These findings suggest that striatal-cortical dysconnectivity may underlie the effects of dopamine dysregulation on the pathophysiologic mechanism of psychotic symptoms.
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Affiliation(s)
- Guillermo Horga
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York,Please address correspondence to Guillermo Horga, MD, PhD, at New York State Psychiatric Institute, Columbia University Medical Center, Unit 31, 1051 Riverside Dr., New York, NY 10032, or
| | - Clifford M. Cassidy
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
| | - Xiaoyan Xu
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
| | - Holly Moore
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Integrative Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Mark Slifstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
| | - Jared X. Van Snellenberg
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
| | - Anissa Abi-Dargham
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
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Heinz A, Voss M, Lawrie SM, Mishara A, Bauer M, Gallinat J, Juckel G, Lang U, Rapp M, Falkai P, Strik W, Krystal J, Abi-Dargham A, Galderisi S. Shall we really say goodbye to first rank symptoms? Eur Psychiatry 2016; 37:8-13. [PMID: 27429167 DOI: 10.1016/j.eurpsy.2016.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND First rank symptoms (FRS) of schizophrenia have been used for decades for diagnostic purposes. In the new version of the DSM-5, the American Psychiatric Association (APA) has abolished any further reference to FRS of schizophrenia and treats them like any other "criterion A" symptom (e.g. any kind of hallucination or delusion) with regard to their diagnostic implication. The ICD-10 is currently under revision and may follow suit. In this review, we discuss central points of criticism that are directed against the continuous use of first rank symptoms (FRS) to diagnose schizophrenia. METHODS We describe the specific circumstances in which Schneider articulated his approach to schizophrenia diagnosis and discuss the relevance of his approach today. Further, we discuss anthropological and phenomenological aspects of FRS and highlight the importance of self-disorder (as part of FRS) for the diagnosis of schizophrenia. Finally, we will conclude by suggesting that the theory and rationale behind the definition of FRS is still important for psychopathological as well as neurobiological approaches today. RESULTS Results of a pivotal meta-analysis and other studies show relatively poor sensitivity, yet relatively high specificity for FRS as diagnostic marker for schizophrenia. Several methodological issues impede a systematic assessment of the usefulness of FRS in the diagnosis of schizophrenia. However, there is good evidence that FRS may still be useful to differentiate schizophrenia from somatic causes of psychotic states. This may be particularly important in countries or situations with little access to other diagnostic tests. FRS may thus still represent a useful aid for clinicians in the diagnostic process. CONCLUSION In conclusion, we suggest to continue a tradition of careful clinical observation and fine-grained psychopathological assessment, including a focus on symptoms regarding self-disorders, which reflects a key aspect of psychosis. We suggest that the importance of FRS may indeed be scaled down to a degree that the occurrence of a single FRS alone should not suffice to diagnose schizophrenia, but, on the other hand, absence of FRS should be regarded as a warning sign that the diagnosis of schizophrenia or schizoaffective disorder is not warranted and requires specific care to rule out other causes, particularly neurological and other somatic disorders. With respect to the current stage of the development of ICD-11, we appreciate the fact that self-disorders are explicitly mentioned (and distinguished from delusions) in the list of mandatory symptoms but still feel that delusional perceptions and complex hallucinations as defined by Schneider should be distinguished from delusions or hallucinations of "any kind". Finally, we encourage future research to explore the psychopathological context and the neurobiological correlates of self-disorders as a potential phenotypic trait marker of schizophrenia.
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Affiliation(s)
- A Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Saint-Hedwig Hospital, Humboldt University, Berlin, Germany
| | - M Voss
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Saint-Hedwig Hospital, Humboldt University, Berlin, Germany.
| | - S M Lawrie
- Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
| | - A Mishara
- Department of Clinical Psychology, Chicago School of Professional Psychology, Los Angeles, USA
| | - M Bauer
- University Hospital Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J Gallinat
- University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - G Juckel
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Ruhr-University, Bochum, Germany
| | - U Lang
- Psychiatric University Clinics (UPK), Basel, Switzerland
| | - M Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany
| | - W Strik
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - J Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - A Abi-Dargham
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - S Galderisi
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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