Gauthier C, Doyen C, Amado I, Lôo H, Gaillard R
Service hospitalo-universitaire, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris cedex 14, France.
Service de psychopathologie de l'enfant et de l'adolescent, CREDAT, centre de diagnostic et de recherche pour l'autisme et les troubles apparentés, hôpital Sainte-Anne, Paris, France.
Encephale. 2016 Feb;42(1):24-31. doi: 10.1016/j.encep.2015.07.006. Epub 2016 Jan 18.
The neuropeptide oxytocin (OT) is an evolutionary highly conserved molecule that plays a part in the regulation of complex social cognition and behaviours. From a pathophysiological point of view, several studies have evidenced dysfunctions of the oxytocinergic system in autism spectrum disorders (ASD): a lowering of plasma OT and genetic or epigenetic anomalies of the OT receptor. Therefore, some authors have hypothesized that an abnormality in the OT neurotransmission may account for several features of autism and that a treatment restoring a normal OT pathway functioning could improve social abilities. OT administration has thus been used in clinical trials, especially in groups of subjects suffering from autism. Some studies found that OT decreased repetitive behaviours, enhanced emotional understanding of speech intonation, improved performance of the Reading the Mind in the Eyes Test and reinforced cooperation. Nevertheless, the findings of the OT administration studies on clinical samples show great diversity. The context, the personality and childhood experiences of the subject could be moderators influencing the effect of exogenous OT. Besides, three mechanisms could play a part in the action of OT on ASD social symptoms: anxiety reduction (with a lowering in the hypothalamic-pituitary-adrenal axis responsiveness and in the amygdale reactivity to social stimuli), increased affiliative motivation (involving the dopaminergic pathway and several regions of the social brain) and enhanced perceptual selectivity and social stimuli salience. To conclude, OT could be a promising molecule used as a treatment to promote social behaviours, helping individuals with ASD to develop new relationships. OT could be administered during a cognitive-behavioural therapy to reinforce the efficacy of such procedures. More studies are needed, on larger samples, to investigate the safety and efficacy of OT administration and to specify optimal dosages and characteristics of patients who may benefit from this treatment.
神经肽催产素(OT)是一种在进化上高度保守的分子,它在复杂的社会认知和行为调节中发挥作用。从病理生理学角度来看,多项研究已证明自闭症谱系障碍(ASD)中催产素能系统存在功能障碍:血浆OT水平降低以及OT受体的基因或表观遗传异常。因此,一些作者推测OT神经传递异常可能是自闭症多种特征的原因,恢复正常OT通路功能的治疗可能会改善社交能力。OT给药已用于临床试验,尤其是在自闭症患者群体中。一些研究发现,OT可减少重复行为、增强对语音语调的情感理解、提高“眼神读心测试”的表现并加强合作。然而,OT给药对临床样本的研究结果差异很大。受试者的背景、个性和童年经历可能是影响外源性OT效果的调节因素。此外,三种机制可能在OT对ASD社交症状的作用中发挥作用:减轻焦虑(下丘脑 - 垂体 - 肾上腺轴反应性降低以及杏仁核对社交刺激反应性降低)、增加亲和动机(涉及多巴胺能通路和社交脑的几个区域)以及增强感知选择性和社交刺激显著性。总之,OT可能是一种有前景的用于促进社交行为的治疗分子,帮助ASD患者建立新关系。OT可在认知行为治疗期间给药以增强此类治疗程序的疗效。需要对更大样本进行更多研究,以调查OT给药的安全性和有效性,并确定可能从这种治疗中受益的患者的最佳剂量和特征。