Designing Neuroimaging Studies to Help Inform the Clinical Treatment of Addiction.
Designing Neuroimaging Studies to Help Inform the Clinical Treatment of Addiction.
复制标题
设计神经影像学研究以帮助为成瘾的临床治疗提供信息。
DOI：
10.1016/j.biopsych.2020.08.011
复制
发表时间：
2020
影响因子：
10.6
通讯作者：
Cosgrove,KellyP
中科院分区：
文献类型：
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作者：
Zakiniaeiz,Yasmin;Cosgrove,KellyP
正电子发射断层扫描（PET）提供了一个独特的窗口神经化学潜在的成瘾。利用PET，我们已经能够在多巴胺（DA）支配的大脑区域研究药物使用障碍患者的神经递质-受体相互作用。特别是，PET研究一致地确定了药物和酒精使用障碍患者纹状体中的DA功能障碍。与不使用可卡因、酒精、烟草、大麻、兴奋剂和海洛因的人相比，使用可卡因、酒精、烟草、大麻和海洛因的人纹状体D2/3Rs水平较低。此外，在可卡因、酒精和烟草使用障碍中，da对安非他命的“钝化”反应已被记录；而且，重要的是，反应越迟钝，治疗结果就越差（见(1)综述）。这些发现表明，大脑奖励系统存在严重缺陷，可能会干扰恢复。了解纹状体DA缺陷与不良治疗结果有关，有助于为成瘾的临床治疗提供信息，并影响未来的研究。重要的是要考虑收集到的认知和行为指标，就像我们考虑神经成像成分一样仔细。大多数对DA系统的PET研究仅限于纹状体。这在一定程度上是由于广泛使用的放射性示踪剂的局限性，例如[11C] raclopride，它最适合测量DA受体高密度存在的大脑区域（即纹状体）中的D2/3Rs。放射性示踪剂开发的最新进展使我们能够检测低密度纹状体外区域（如前额皮质）的D2/3Rs水平和DA的波动，从而检查与高阶神经认知功能相关的DA相关损伤，这些损伤在加法的启动、维持和恢复中起着关键作用。
Positron emission tomography (PET) provides a unique window into the neurochemistry underlying addiction. Using PET, we have been able to study neurotransmitter-receptor interactions in living individuals with drug use disorders in brain regions innervated by dopamine (DA). In particular, PET studies have consistently identified DA dysfunction in the striatum in drug and alcohol use disorders. There are lower levels of striatal D2/3Rs in individuals with cocaine, alcohol, tobacco, cannabis, stimulant, and heroin use disorder compared to non-using counterparts. In addition, a ‘blunted’DA response to an amphetamine challenge has been documented in cocaine, alcohol, and tobacco use disorder; and, importantly, the more blunted the response, the worse the treatment outcome (see (1) for review). These findings demonstrate critical deficits in the brains’ reward system that likely interfere with recovery. Knowing that striatal DA deficits are linked to poor treatment outcomes helps inform the clinical treatment of addiction, and shapes future research studies. It’s important to consider the cognitive and behavioral measures that are collected just as carefully as we consider the neuroimaging components.Most PET investigations of the DA system have been limited to the striatum. This is due, in part, to the limitations of widely available radiotracers, such as [11C] raclopride, which are best for measuring D2/3Rs in brain regions where DA receptors are present at high density, ie, the striatum. Recent advancements in radiotracer development have enabled us to detect levels of D2/3Rs and fluctuations in DA in lower density extra-striatal areas, such as the prefrontal cortex, allowing for examination of DA-related impairments in relation to higher-order neurocognitive functions, that play a key role in the initiation, maintenance, and recovery from addition.