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在男性精神兴奋剂和多药滥用者长期戒断期间克服 qEEG 异常和奖励基因缺陷:第 2 部分。

Overcoming qEEG abnormalities and reward gene deficits during protracted abstinence in male psychostimulant and polydrug abusers utilizing putative dopamine D₂ agonist therapy: part 2.

机构信息

Department of Psychiatry and McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.

出版信息

Postgrad Med. 2010 Nov;122(6):214-26. doi: 10.3810/pgm.2010.11.2237.

DOI:10.3810/pgm.2010.11.2237
PMID:21084796
Abstract

BACKGROUND

It is well established that in both food- and drug-addicted individuals there is "dopamine resistance" associated with the DRD2 gene A1 allele. Based on earlier studies, evidence is emerging wherein the potential of utilizing a natural, nonaddicting, safe, putative D2 agonist may play a significant role in the recovery of individuals with reward deficiency syndrome, including those addicted to psychoactive chemicals.

FINDINGS

Positive outcomes demonstrated by quantitative electroencephalographic (qEEG) imaging in a randomized, triple-blind, placebo-controlled, crossover study involving oral Synaptose Complex KB220Z™ showed an increase of alpha waves and low beta wave activity in the parietal brain region. Using t statistics, significant differences observed between placebo and Synaptose Complex KB220Z™ consistently occurred in the frontal regions after week 1 and then again after week 2 of analyses (P = 0.03). This is the first report to demonstrate involvement of the prefrontal cortex in the qEEG response to a natural putative D2 agonist (Synaptose Complex KB220Z™), especially evident in dopamine D2 A1 allele subjects. Independently, we have further supported this finding with an additional study of 3 serious polydrug abusers undergoing protracted abstinence who carried the DRD2 A1 allele. Significant qEEG differences were found between those who received 1 dose of placebo compared with those who were administered Synaptose Complex KB220Z™. Synaptose Complex KB220Z™ induced positive regulation of the dysregulated electrical activity of the brain in these addicts. The results are indicative of a phase change from low amplitude or low power in the brain to a more regulated state by increasing an average of 6.169 mV(2) across the prefrontal cortical region. In the first experiment we found that while 50% of the subjects carried the DRD2 A1 allele, 100% carried ≥ 1 risk allele. Specifically, based on the proposed addiction risk score for these 14 subjects, 72% had moderate-to-severe addiction risk. Similar findings were obtained by repeating the experiment in 3 additional currently abstinent polydrug abusers carrying the DRD2 A1 allele.

CONCLUSION

This seminal work will provide important information that may ultimately lead to significant improvement in the recovery of individuals with psychostimulant and polydrug abuse problems, specifically those with genetically induced dopamine deficiency. Based on this small sample size, we are proposing that with necessary large populations supporting these initial results, and possibly even additional candidate genes and single nucleotide polymorphisms, we may eventually have the clinical ability to classify severity according to genotype and possession of risk alleles, along with offering a safe, nonaddicting, natural dopaminergic receptor agonist that potentially upregulates instead of downregulates dopaminergic receptors, preferably the D2 subtype.

摘要

背景

在食物成瘾者和药物成瘾者中,DRD2 基因 A1 等位基因与“多巴胺抵抗”有关,这一点已得到充分证实。基于早期的研究,有证据表明,利用天然、无成瘾、安全、潜在的 D2 激动剂可能在恢复奖励缺陷综合征患者(包括那些对精神活性化学物质上瘾的患者)方面发挥重要作用。

发现

一项随机、三盲、安慰剂对照、交叉研究中,对口服 Synaptose Complex KB220Z 的定量脑电图 (qEEG) 成像的阳性结果表明,顶叶脑区的 alpha 波增加,低 beta 波活动减少。使用 t 统计,在第 1 周和第 2 周的分析中,在额叶区域观察到安慰剂和 Synaptose Complex KB220Z 之间的显著差异(P = 0.03)。这是第一项报告,证明了天然潜在 D2 激动剂(Synaptose Complex KB220Z)对 qEEG 反应涉及前额叶皮层,特别是在多巴胺 D2 A1 等位基因受试者中更为明显。独立地,我们通过对 3 名携带 DRD2 A1 等位基因的严重多药滥用者进行的另一项延长禁欲研究进一步支持了这一发现。与接受 Synaptose Complex KB220Z 治疗的患者相比,接受 1 剂安慰剂的患者之间存在显著的 qEEG 差异。Synaptose Complex KB220Z 诱导了这些成瘾者大脑失调电活动的正向调节。结果表明,从大脑的低幅度或低功率到更规则的状态发生了阶段变化,前额皮质区域的平均增加了 6.169 mV(2)。在第一个实验中,我们发现,虽然 50%的受试者携带 DRD2 A1 等位基因,但 100%的受试者携带≥1个风险等位基因。具体来说,根据这 14 名受试者的拟议成瘾风险评分,72%的人具有中重度成瘾风险。在另外 3 名携带 DRD2 A1 等位基因且目前禁欲的多药滥用者中重复该实验,得到了类似的发现。

结论

这项开创性的工作将提供重要信息,最终可能会显著改善患有精神兴奋剂和多药滥用问题的个体的康复,特别是那些因遗传引起多巴胺缺乏的个体。基于这个小样本量,我们提出,随着必要的大人群支持这些初步结果,甚至可能还有其他候选基因和单核苷酸多态性,我们最终可能具有根据基因型和风险等位基因进行分类严重程度的临床能力,并提供一种安全、无成瘾、天然的多巴胺能受体激动剂,它可能上调而不是下调多巴胺能受体,最好是 D2 亚型。

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