Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis.
Altered structural and effective connectivity in anorexia and bulimia nervosa in circuits that regulate energy and reward homeostasis.
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DOI：
10.1038/tp.2016.199
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发表时间：
2016-11-01
影响因子：
6.8
通讯作者：
Pryor TL
中科院分区：
文献类型：
--
作者：
Frank GK;Shott ME;Riederer J;Pryor TL
厌食症和神经性贪食症是严重的饮食失调症，它们有许多共同的行为。结构和功能性大脑回路可以提供这些疾病所共有的生物学联系。我们招募了 77 名年轻成年女性、26 名健康对照者、26 名患有厌食症的女性和 25 名患有神经性贪食症的女性。概率纤维束成像用于绘制调节大脑回路的味觉和食物摄入之间的白质连接强度。独立的多样本贪婪等价搜索算法测试了蔗糖品尝过程中这些区域之间的有效连接性。厌食症和神经性贪食症患者的岛叶、眶额皮质和腹侧纹状体之间的通路具有较高的结构连通性，但从眶额皮质和杏仁核到下丘脑的连通性较低（P<0.05，已根据合并症、药物治疗和多重比较进行校正）。从功能上来说，在对照组中，下丘脑驱动腹侧纹状体活动，但在厌食症和神经性贪食症中，有效的连接是从前扣带回通过腹侧纹状体到达下丘脑。在所有群体中，甜味感知是通过连接中眶额皮层的通路的连接强度来预测的。这项研究提供的证据表明，与对照组相比，厌食症和神经性贪食症患者的白质结构以及能量稳态和食物奖励调节回路内的有效连接有根本不同。在饮食失调中，前扣带回认知-情感自上而下的控制可能会影响食物奖励和饮食驱动，超越下丘脑对腹侧纹状体的输入，并导致长期的食物限制。
Anorexia and bulimia nervosa are severe eating disorders that share many behaviors. Structural and functional brain circuits could provide biological links that those disorders have in common. We recruited 77 young adult women, 26 healthy controls, 26 women with anorexia and 25 women with bulimia nervosa. Probabilistic tractography was used to map white matter connectivity strength across taste and food intake regulating brain circuits. An independent multisample greedy equivalence search algorithm tested effective connectivity between those regions during sucrose tasting. Anorexia and bulimia nervosa had greater structural connectivity in pathways between insula, orbitofrontal cortex and ventral striatum, but lower connectivity from orbitofrontal cortex and amygdala to the hypothalamus (P<0.05, corrected for comorbidity, medication and multiple comparisons). Functionally, in controls the hypothalamus drove ventral striatal activity, but in anorexia and bulimia nervosa effective connectivity was directed from anterior cingulate via ventral striatum to the hypothalamus. Across all groups, sweetness perception was predicted by connectivity strength in pathways connecting to the middle orbitofrontal cortex. This study provides evidence that white matter structural as well as effective connectivity within the energy-homeostasis and food reward-regulating circuitry is fundamentally different in anorexia and bulimia nervosa compared with that in controls. In eating disorders, anterior cingulate cognitive–emotional top down control could affect food reward and eating drive, override hypothalamic inputs to the ventral striatum and enable prolonged food restriction.