Molecular mechanisms of placebo responses in humans.
Molecular mechanisms of placebo responses in humans.
复制标题
DOI：
10.1038/mp.2014.164
复制
发表时间：
2015-04
影响因子：
11
通讯作者：
Zubieta, J-K
中科院分区：
文献类型：
--
作者：
Pecina, M.;Zubieta, J-K
内源性阿片类和非阿片类机制[如多巴胺（DA）、内源性大麻素（eCB）]与安慰剂镇痛作用的形成有关，最初的报告可追溯到三十年前。除了安慰剂效应混淆随机临床试验（RCT）的观点外，迄今为止获得的信息指向神经生物学系统，当被积极期望激活并通过条件反射和奖励学习保持时，能够诱导生理变化，导致镇痛体验和情绪状态的改善。正电子发射断层扫描（PET）和选择性μ-阿片类和D2/3放射性示踪剂[11 C]卡芬太尼和[11 C]雷氯必利的分子神经成像技术显著有助于我们理解安慰剂效应形成中涉及的神经生物学系统。这一系列研究描述了与安慰剂反应有关的神经和神经递质网络，并提供了技术工具来检查安慰剂反应机制功能的个体间差异，以及潜在的替代物（生物标志物）。因此，生物安慰剂效应的形成现在与弹性机制的概念有关，部分由遗传因素决定，并通过治疗环境及其通过学习机制的维持所产生的期望的认知情感整合来揭示。进一步的工作需要将这项研究扩展到安慰剂反应率高且其神经生物学机制基本未被探索的临床条件（例如情绪和焦虑症，持续性疼痛综合征，甚至帕金森病和多发性硬化症）。在疾病内部和疾病之间描绘这些过程将指向传统药物开发中没有考虑的生物靶点。
Endogenous opioid and non-opioid mechanisms [e.g. dopamine (DA), endocannabinoids (eCB)] have been implicated in the formation of placebo analgesic effects, with initial reports dating back three-decades. Besides the perspective that placebo effects confound randomized clinical trials (RCTs), the information so far acquired points to neurobiological systems that when activated by positive expectations and maintained through conditioning and reward learning are capable of inducing physiological changes that lead to the experience of analgesia and improvements in emotional state. Molecular neuroimaging techniques with positron emission tomography (PET) and the selective μ-opioid and D2/3 radiotracers [11C]carfentanil and [11C]raclopride have significantly contributed to our understanding of the neurobiological systems involved in the formation of placebo effects. This line of research has described neural and neurotransmitter networks implicated in placebo responses and provided the technical tools to examine inter-individual differences in the function of placebo responsive mechanisms, and potential surrogates (biomarkers). As a consequence, the formation of biological placebo effects is now being linked to the concept of resiliency mechanisms, partially determined by genetic factors, and uncovered by the cognitive emotional integration of the expectations created by the therapeutic environment and its maintenance through learning mechanisms. Further work needs to extend this research into clinical conditions where the rates of placebo responses are high and its neurobiological mechanisms have been largely unexplored (e.g. mood and anxiety disorders, persistent pain syndromes, or even Parkinson Disease and multiple sclerosis). The delineation of these processes within and across diseases would point to biological targets that have not been contemplated in traditional drug development.
登录
查看更多内容
影响因子：
56.9
作者：
Ledent, C;Valverde, O;Parmentier, M
通讯作者：
Parmentier, M
影响因子：
82.9
作者：
Benedetti, Fabrizio;Amanzio, Martina;Blanchard, Catherine
通讯作者：
Blanchard, Catherine
影响因子：
16.2
作者：
Knutson, B;Bjork, JM;Weinberger, DR
通讯作者：
Weinberger, DR
影响因子：
3.4
作者：
Hohmann, AG
通讯作者：
Hohmann, AG
影响因子：
25
作者：
Benedetti, F;Colloca, L;Lopiano, L
通讯作者：
Lopiano, L