多巴胺系统调节回路及其在精神分裂症中的紊乱:治疗和预防的新视角。
The Circuitry of Dopamine System Regulation and its Disruption in Schizophrenia: Insights Into Treatment and Prevention.
机构信息
Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA.
出版信息
Schizophr Bull. 2019 Jan 1;45(1):148-157. doi: 10.1093/schbul/sbx199.
Despite evidence for a role of the dopamine system in the pathophysiology of schizophrenia, there has not been substantial evidence that this disorder originates from a pathological change within the dopamine system itself. Current data from human imaging studies and preclinical investigations instead point to a disruption in afferent regulation of the dopamine system, with a focus on the hippocampus. We found that the hippocampus in the methylazoxymethanol acetate (MAM) rodent developmental disruption model of schizophrenia is hyperactive and dysrhythmic, possibly due to loss of parvalbumin interneurons, leading to a hyperresponsive dopamine system. Whereas current therapeutic approaches target dopamine receptor blockade, treatment at the site of pathology may be a more effective therapeutic avenue. This model also provided insights into potential means for prevention of schizophrenia. Specifically, given that stress is a risk factor in schizophrenia, and that stress can damage hippocampal parvalbumin interneurons, we tested whether alleviating stress early in life can effectively circumvent transition to schizophrenia-like states. Administering diazepam prepubertally at an antianxiety dose in MAM rats was effective at preventing the emergence of the hyperdopaminergic state in the adult. Moreover, multiple stressors applied to normal rats at the same time point resulted in pathology similar to the MAM rat. These data suggest that a genetic predisposition leading to stress hyper-responsivity, or exposure to substantial stressors, could be a primary factor leading to the emergence of schizophrenia later in life, and furthermore treating stress at a critical period may be effective in circumventing this transition.
尽管多巴胺系统在精神分裂症的病理生理学中具有重要作用,但并没有充分的证据表明这种疾病源自多巴胺系统本身的病理性改变。目前来自人类影像学研究和临床前研究的数据表明,多巴胺系统的传入调节受到干扰,而焦点是海马体。我们发现,精神分裂症的甲基乙氧甲酰胺(MAM)啮齿动物发育中断模型中的海马体过度活跃且节律紊乱,这可能是由于 parvalbumin 中间神经元缺失,导致多巴胺系统过度反应。虽然当前的治疗方法针对多巴胺受体阻断,但在病理部位进行治疗可能是一种更有效的治疗途径。该模型还为潜在的预防精神分裂症的方法提供了思路。具体而言,鉴于压力是精神分裂症的一个风险因素,并且压力可以破坏海马 parvalbumin 中间神经元,我们测试了在生命早期缓解压力是否可以有效地避免出现类似精神分裂症的状态。在 MAM 大鼠中,在青春期前给予安定(抗焦虑剂量)可有效预防成年后出现的高多巴胺状态。此外,同时向正常大鼠施加多个应激源会导致类似于 MAM 大鼠的病理学变化。这些数据表明,导致应激过度反应的遗传倾向,或暴露于大量应激源,可能是导致晚年出现精神分裂症的一个主要因素,此外,在关键时期治疗应激可能有效避免这种转变。
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