Felger J C, Li Z, Haroon E, Woolwine B J, Jung M Y, Hu X, Miller A H
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
Mol Psychiatry. 2016 Oct;21(10):1358-65. doi: 10.1038/mp.2015.168. Epub 2015 Nov 10.
Depression is associated with alterations in corticostriatal reward circuitry. One pathophysiological pathway that may drive these changes is inflammation. Biomarkers of inflammation (for example, cytokines and C-reactive protein (CRP)) are reliably elevated in depressed patients. Moreover, administration of inflammatory stimuli reduces neural activity and dopamine release in reward-related brain regions in association with reduced motivation and anhedonia. Accordingly, we examined whether increased inflammation in depression affects corticostriatal reward circuitry to lead to deficits in motivation and goal-directed motor behavior. Resting-state functional magnetic resonance imaging was conducted on 48 medically stable, unmedicated outpatients with major depression. Whole-brain, voxel-wise functional connectivity was examined as a function of CRP using seeds for subdivisions of the ventral and dorsal striatum associated with motivation and motor control. Increased CRP was associated with decreased connectivity between ventral striatum and ventromedial prefrontal cortex (vmPFC) (corrected P<0.05), which in turn correlated with increased anhedonia (R=-0.47, P=0.001). Increased CRP similarly predicted decreased dorsal striatal to vmPFC and presupplementary motor area connectivity, which correlated with decreased motor speed (R=0.31 to 0.45, P<0.05) and increased psychomotor slowing (R=-0.35, P=0.015). Of note, mediation analyses revealed that these effects of CRP on connectivity mediated significant relationships between CRP and anhedonia and motor slowing. Finally, connectivity between striatum and vmPFC was associated with increased plasma interleukin (IL)-6, IL-1beta and IL-1 receptor antagonist (R=-0.33 to -0.36, P<0.05). These findings suggest that decreased corticostriatal connectivity may serve as a target for anti-inflammatory or pro-dopaminergic treatment strategies to improve motivational and motor deficits in patients with increased inflammation, including depression.
抑郁症与皮质纹状体奖赏回路的改变有关。炎症可能是驱动这些变化的一种病理生理途径。炎症生物标志物(如细胞因子和C反应蛋白(CRP))在抑郁症患者中确实会升高。此外,给予炎症刺激会降低奖赏相关脑区的神经活动和多巴胺释放,同时伴有动机降低和快感缺失。因此,我们研究了抑郁症中炎症增加是否会影响皮质纹状体奖赏回路,从而导致动机和目标导向运动行为的缺陷。对48名病情稳定、未服药的重度抑郁症门诊患者进行了静息态功能磁共振成像检查。使用与动机和运动控制相关的腹侧和背侧纹状体细分区域的种子点,以CRP为函数检查全脑体素水平的功能连接性。CRP升高与腹侧纹状体和腹内侧前额叶皮质(vmPFC)之间的连接性降低相关(校正P<0.05),而这又与快感缺失增加相关(R=-0.47,P=0.001)。CRP升高同样预示着背侧纹状体与vmPFC和补充运动前区之间的连接性降低,这与运动速度降低相关(R=0.31至0.45,P<0.05)以及精神运动迟缓增加相关(R=-0.35,P=0.015)。值得注意的是,中介分析表明,CRP对连接性的这些影响介导了CRP与快感缺失和运动迟缓之间的显著关系。最后,纹状体与vmPFC之间的连接性与血浆白细胞介素(IL)-6、IL-1β和IL-1受体拮抗剂增加相关(R=-0.33至-0.36,P<0.05)。这些发现表明,皮质纹状体连接性降低可能成为抗炎或促多巴胺能治疗策略的靶点,以改善炎症增加患者(包括抑郁症患者)的动机和运动缺陷。
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