Treatment biomarkers for ADHD: Taking stock and moving forward.
Treatment biomarkers for ADHD: Taking stock and moving forward.
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DOI：
10.1038/s41398-022-02207-2
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发表时间：
2022-10-12
影响因子：
6.8
通讯作者：
Loo, Sandra K.
中科院分区：
文献类型：
--
作者：
Michelini, Giorgia;Norman, Luke J.;Shaw, Philip;Loo, Sandra K.
针对精神疾病的治疗生物标志物的发展一直具有挑战性，特别是对于异质性神经发育状况，例如注意力缺陷/多动症（ADHD）。有希望的发现也很少转化为临床实践，尤其是在治疗决策和新型治疗方面的发展方面。尽管进展缓慢，但可用的神经影像学，电生理学（EEG）和遗传文献为生物标志物发现奠定了坚实的基础。本文对多动症的有前途的治疗生物标志物进行了更新的综述，这可能会增强个性化医学和新颖的治疗开发。可用的文献指出了有希望的预处理概况，可预测各种药理和非药物治疗多动症的功效。这些候选预测性生物标志物，特别是基于低成本和非侵入性脑电图评估的生物标志物，显示出对患者将来对特定治疗的未来分层的希望。对重复生物标志物评估的研究进一步表明，不同的治疗方法在脑谱上会发生明显的变化，这些治疗方法跟踪了与治疗相关的临床改善。这些候选者监测/反应生物标志物可能有助于将来监测治疗效果的监测，并指出新型治疗（例如神经疗法）的机理靶标。然而，现有的研究不支持ADHD治疗生物标志物的任何临床应用。关键障碍是复制和外部验证的匮乏，主要是白人儿童的小型和同质样本以及实际限制，包括生物标志物评估的成本和技术要求及其对ADHD患者的不知情的可行性和可接受性。最后，我们讨论了未来的方向和方法学变化，以促进临床翻译并增强多动症患者各组的个性化治疗决策。
The development of treatment biomarkers for psychiatric disorders has been challenging, particularly for heterogeneous neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD). Promising findings are also rarely translated into clinical practice, especially with regard to treatment decisions and development of novel treatments. Despite this slow progress, the available neuroimaging, electrophysiological (EEG) and genetic literature provides a solid foundation for biomarker discovery. This article gives an updated review of promising treatment biomarkers for ADHD which may enhance personalized medicine and novel treatment development. The available literature points to promising pre-treatment profiles predicting efficacy of various pharmacological and non-pharmacological treatments for ADHD. These candidate predictive biomarkers, particularly those based on low-cost and non-invasive EEG assessments, show promise for the future stratification of patients to specific treatments. Studies with repeated biomarker assessments further show that different treatments produce distinct changes in brain profiles, which track treatment-related clinical improvements. These candidate monitoring/response biomarkers may aid future monitoring of treatment effects and point to mechanistic targets for novel treatments, such as neurotherapies. Nevertheless, existing research does not support any immediate clinical applications of treatment biomarkers for ADHD. Key barriers are the paucity of replications and external validations, the use of small and homogeneous samples of predominantly White children, and practical limitations, including the cost and technical requirements of biomarker assessments and their unknown feasibility and acceptability for people with ADHD. We conclude with a discussion of future directions and methodological changes to promote clinical translation and enhance personalized treatment decisions for diverse groups of individuals with ADHD.
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