Department of Psychiatry and Behavioral Sciences and.
Center for Neurogastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
JCI Insight. 2021 Mar 22;6(6):144046. doi: 10.1172/jci.insight.144046.
Functional dyspepsia (FD) is associated with chronic gastrointestinal distress and with anxiety and depression. Here, we hypothesized that aberrant gastric signals, transmitted by the vagus nerve, may alter key brain regions modulating affective and pain behavior. Using a previously validated rat model of FD characterized by gastric hypersensitivity, depression-like behavior, and anxiety-like behavior, we found that vagal activity - in response to gastric distention - was increased in FD rats. The FD phenotype was associated with gastric mast cell hyperplasia and increased expression of corticotrophin-releasing factor (Crh) and decreased brain-derived neurotrophic factor genes in the central amygdala. Subdiaphragmatic vagotomy reversed these changes and restored affective behavior to that of controls. Vagotomy partially attenuated pain responses to gastric distention, which may be mediated by central reflexes in the periaqueductal gray, as determined by local injection of lidocaine. Ketotifen, a mast cell stabilizer, reduced vagal hypersensitivity, normalized affective behavior, and attenuated gastric hyperalgesia. In conclusion, vagal activity, partially driven by gastric mast cells, induces long-lasting changes in Crh signaling in the amygdala that may be responsible for enhanced pain and enhanced anxiety- and depression-like behaviors. Together, these results support a "bottom-up" pathway involving the gut-brain axis in the pathogenesis of both gastric pain and psychiatric comorbidity in FD.
功能性消化不良(FD)与慢性胃肠道不适以及焦虑和抑郁有关。在这里,我们假设迷走神经传递的异常胃信号可能会改变调节情感和疼痛行为的关键大脑区域。我们使用以前验证过的具有胃高敏性、抑郁样行为和焦虑样行为的 FD 大鼠模型,发现 FD 大鼠的迷走神经活动(对胃扩张的反应)增加。FD 表型与胃肥大细胞增生以及中央杏仁核中促肾上腺皮质释放因子(Crh)表达增加和脑源性神经营养因子基因减少有关。膈下迷走神经切断术逆转了这些变化,并使情感行为恢复到对照水平。迷走神经切断术部分减弱了对胃扩张的疼痛反应,这可能是通过periaqueductal gray 中的中枢反射来介导的,这是通过局部注射利多卡因来确定的。酮替芬是一种肥大细胞稳定剂,可降低迷走神经敏感性、使情感行为正常化,并减轻胃高敏性。总之,迷走神经活动部分由胃肥大细胞驱动,导致杏仁核中 Crh 信号的持久变化,这可能是导致疼痛加剧以及焦虑和抑郁样行为增强的原因。这些结果共同支持了一种涉及胃肠道-大脑轴的“自下而上”的途径,该途径在 FD 中胃疼痛和精神共病的发病机制中起作用。
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