Laureate Institute for Brain Research, Tulsa, OK, USA; Research Center for Child Mental Development, Chiba University, Chiba, Japan.
Laureate Institute for Brain Research, Tulsa, OK, USA.
Neuroimage Clin. 2021;29:102559. doi: 10.1016/j.nicl.2021.102559. Epub 2021 Jan 19.
Real-time fMRI neurofeedback (rtfMRI-nf) left amygdala (LA) training is a promising intervention for major depressive disorder (MDD). We have previously proposed that rtfMRI-nf LA training may reverse depression-associated regional impairments in neuroplasticity and restore information flow within emotion-regulating neural circuits. Inflammatory cytokines as well as the neuroactive metabolites of an immunoregulatory pathway, i.e. the kynurenine pathway (KP), have previously been implicated in neuroplasticity. Therefore, in this proof-of-principle study, we investigated the association between rtfMRI-nf LA training and circulating inflammatory mediators and KP metabolites. Based on our previous work, the primary variable of interest was the ratio of the NMDA-receptor antagonist, kynurenic acid to the NMDA receptor agonist, quinolinic acid (KynA/QA), a putative neuroprotective index. We tested two main hypotheses. i. Whether rtfMRI-nf acutely modulates KynA/QA, and ii. whether baseline KynA/QA predicts response to rtfMRI-nf. Twenty-nine unmedicated participants who met DSM-5 criteria for MDD based on the Mini-International Neuropsychiatric Interview and had current depressive symptoms (Montgomery-Åsberg Depression Rating Scale (MADRS) score > 6) completed two rtfMRI-nf sessions to upregulate LA activity (Visit1 and 2), as well as a follow-up (Visit3) without rtfMRI-nf. All visits occurred at two-week intervals. At all three visits, the MADRS was administered to participants and serum samples for the quantification of inflammatory cytokines and KP metabolites were obtained. First, the longitudinal changes in the MADRS score and immune markers were tested by linear mixed effect model analysis. Further, utilizing a linear regression model, we investigated the relationship between rtfMRI-nf performance and immune markers. After two sessions of rtfMRI-nf, MADRS scores were significantly reduced (t[58] = -4.07, p = 0.009, d = 0.56). Thirteen participants showed a ≥ 25% reduction in the MADRS score (the partial responder group). There was a significant effect of visit (F[2,58] = 3.17, p = 0.05) for the neuroprotective index, KynA to 3-hydroxykynurenine (3-HK), that was driven by a significant increase in KynA/3-HK between Visit1 and Visit3 (t[58] = 2.50, p = 0.03, d = 0.38). A higher baseline level of KynA/QA (β = 5.23, p = 0.06; rho = 0.49, p = 0.02) was associated with greater ability to upregulate the LA. Finally, for exploratory purposes correlation analyses were performed between the partial responder and the non-responder groups as well as in the whole sample including all KP metabolites and cytokines. In the partial responder group, greater ability to upregulate the LA was correlated with an increase in KynA/QA after rtfMRI-nf (rho = 0.75, p = 0.03). The results are consistent with the possibility that rtfMRI-nf decreases metabolism down the so-called neurotoxic branch of the KP. Nevertheless, non-specific effects cannot be ruled out due to the lack of a sham control. Future, controlled studies are needed to determine whether the increase in KynA/3HK and KynA/QA is specific to rtfMRI-nf or whether it is a non-specific correlate of the resolution of depressive symptoms. Similarly, replication studies are needed to determine whether KynA/QA has clinical utility as a treatment response biomarker.
实时功能磁共振神经反馈 (rtfMRI-nf) 左杏仁核 (LA) 训练是治疗重度抑郁症 (MDD) 的一种很有前途的干预手段。我们之前提出,rtfMRI-nf LA 训练可能会逆转与抑郁相关的神经可塑性区域损伤,并恢复情绪调节神经回路中的信息流。炎症细胞因子以及免疫调节途径的神经活性代谢物,即犬尿氨酸途径 (KP),之前与神经可塑性有关。因此,在这项原理验证研究中,我们调查了 rtfMRI-nf LA 训练与循环炎症介质和 KP 代谢物之间的关联。基于我们之前的工作,主要关注的变量是 NMDA 受体拮抗剂,犬尿氨酸与 NMDA 受体激动剂,喹啉酸 (KynA/QA) 的比值,这是一个潜在的神经保护指数。我们测试了两个主要假设。i. rtfMRI-nf 是否会急性调节 KynA/QA,ii. 基线 KynA/QA 是否可以预测 rtfMRI-nf 的反应。29 名未经药物治疗的参与者根据 Mini-International Neuropsychiatric Interview 符合 DSM-5 重度抑郁症标准,并且当前有抑郁症状 (MADRS 评分 > 6),完成了两次 rtfMRI-nf 以增加 LA 活动 (第 1 次和第 2 次就诊),以及没有 rtfMRI-nf 的后续随访 (第 3 次就诊)。所有就诊时间间隔为两周。在所有三次就诊中,都对 MADRS 评分进行了评估,并获得了用于量化炎症细胞因子和 KP 代谢物的血清样本。首先,通过线性混合效应模型分析测试了 MADRS 评分和免疫标志物的纵向变化。进一步,利用线性回归模型,我们研究了 rtfMRI-nf 表现与免疫标志物之间的关系。在两次 rtfMRI-nf 之后,MADRS 评分显著降低(t[58] = -4.07,p = 0.009,d = 0.56)。13 名参与者的 MADRS 评分降低了≥25%(部分缓解组)。神经保护指数,犬尿氨酸与 3-羟基犬尿氨酸 (3-HK) 的比值 KynA/3-HK 存在显著的就诊效应 (F[2,58] = 3.17,p = 0.05),这是由于 KynA/3-HK 在第 1 次就诊和第 3 次就诊之间显著增加(t[58] = 2.50,p = 0.03,d = 0.38)。较高的基线 KynA/QA 水平 (β = 5.23,p = 0.06;rho = 0.49,p = 0.02) 与上调 LA 的能力更强相关。最后,出于探索目的,我们在部分缓解组和非缓解组以及包括所有 KP 代谢物和细胞因子的整个样本中进行了相关性分析。在部分缓解组中,上调 LA 的能力与 rtfMRI-nf 后 KynA/QA 的增加相关 (rho = 0.75,p = 0.03)。结果与 rtfMRI-nf 降低 KP 所谓神经毒性分支的代谢的可能性一致。然而,由于缺乏假对照,不能排除非特异性影响。未来需要进行对照研究,以确定 KynA/3HK 和 KynA/QA 的增加是否是 rtfMRI-nf 特有的,还是抑郁症状缓解的非特异性相关。同样,需要进行复制研究,以确定 KynA/QA 是否可以作为治疗反应的生物标志物具有临床效用。