Bersani F Saverio, Mellon Synthia H, Lindqvist Daniel, Kang Jee In, Rampersaud Ryan, Somvanshi Pramod Rajaram, Doyle Francis J, Hammamieh Rasha, Jett Marti, Yehuda Rachel, Marmar Charles R, Wolkowitz Owen M
Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy.
Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, 401 Parnassus Ave, San Francisco, CA 94143.
Mil Med. 2020 Jan 7;185(Suppl 1):311-318. doi: 10.1093/milmed/usz260.
Current pharmacological treatments of post-traumatic stress disorder (PTSD) have limited efficacy. Although the diagnosis is based on psychopathological criteria, it is frequently accompanied by somatic comorbidities and perhaps "accelerated biological aging," suggesting widespread physical concomitants. Such physiological comorbidities may affect core PTSD symptoms but are rarely the focus of therapeutic trials.
To elucidate the potential involvement of metabolism, inflammation, and mitochondrial function in PTSD, we integrate findings and mechanistic models from the DOD-sponsored "Systems Biology of PTSD Study" with previous data on these topics.
Data implicate inter-linked dysregulations in metabolism, inflammation, mitochondrial function, and perhaps the gut microbiome in PTSD. Several inadequately tested targets of pharmacological intervention are proposed, including insulin sensitizers, lipid regulators, anti-inflammatories, and mitochondrial biogenesis modulators.
Systemic pathologies that are intricately involved in brain functioning and behavior may not only contribute to somatic comorbidities in PTSD, but may represent novel targets for treating core psychiatric symptoms.
创伤后应激障碍(PTSD)目前的药物治疗效果有限。尽管该诊断基于精神病理学标准,但它常伴有躯体合并症,或许还有“加速生物衰老”,提示存在广泛的身体伴随症状。此类生理合并症可能会影响PTSD的核心症状,但很少成为治疗试验的重点。
为阐明代谢、炎症和线粒体功能在PTSD中的潜在作用,我们将美国国防部资助的“PTSD系统生物学研究”的研究结果和机制模型与此前关于这些主题的数据进行了整合。
数据表明,PTSD存在代谢、炎症、线粒体功能以及可能的肠道微生物群的相互关联的失调。提出了几个未经充分测试的药物干预靶点,包括胰岛素增敏剂、脂质调节剂、抗炎药和线粒体生物发生调节剂。
与大脑功能和行为复杂相关的全身性病理状况不仅可能导致PTSD的躯体合并症,还可能代表治疗核心精神症状的新靶点。