Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
Transl Psychiatry. 2022 Oct 12;12(1):444. doi: 10.1038/s41398-022-02207-2.
The development of treatment biomarkers for psychiatric disorders has been challenging, particularly for heterogeneous neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD). Promising findings are also rarely translated into clinical practice, especially with regard to treatment decisions and development of novel treatments. Despite this slow progress, the available neuroimaging, electrophysiological (EEG) and genetic literature provides a solid foundation for biomarker discovery. This article gives an updated review of promising treatment biomarkers for ADHD which may enhance personalized medicine and novel treatment development. The available literature points to promising pre-treatment profiles predicting efficacy of various pharmacological and non-pharmacological treatments for ADHD. These candidate predictive biomarkers, particularly those based on low-cost and non-invasive EEG assessments, show promise for the future stratification of patients to specific treatments. Studies with repeated biomarker assessments further show that different treatments produce distinct changes in brain profiles, which track treatment-related clinical improvements. These candidate monitoring/response biomarkers may aid future monitoring of treatment effects and point to mechanistic targets for novel treatments, such as neurotherapies. Nevertheless, existing research does not support any immediate clinical applications of treatment biomarkers for ADHD. Key barriers are the paucity of replications and external validations, the use of small and homogeneous samples of predominantly White children, and practical limitations, including the cost and technical requirements of biomarker assessments and their unknown feasibility and acceptability for people with ADHD. We conclude with a discussion of future directions and methodological changes to promote clinical translation and enhance personalized treatment decisions for diverse groups of individuals with ADHD.
精神疾病治疗生物标志物的发展一直具有挑战性，特别是对于注意力缺陷/多动障碍（ADHD）等异质神经发育障碍。有希望的发现也很少转化为临床实践，特别是在治疗决策和新治疗方法的开发方面。尽管进展缓慢，但现有的神经影像学、电生理学（EEG）和遗传学文献为生物标志物的发现提供了坚实的基础。本文对有希望的 ADHD 治疗生物标志物进行了更新综述，这些标志物可能增强个性化医疗和新治疗方法的发展。现有文献指出了有希望的治疗前预测因子，可预测 ADHD 患者接受各种药物和非药物治疗的疗效。这些候选预测生物标志物，特别是基于成本低且非侵入性 EEG 评估的预测生物标志物，为未来将患者分层为特定治疗方法提供了希望。具有重复生物标志物评估的研究进一步表明，不同的治疗方法会导致大脑特征产生不同的变化，这些变化与治疗相关的临床改善相关。这些候选监测/反应生物标志物可能有助于未来监测治疗效果，并为神经治疗等新治疗方法提供机制目标。然而，现有的研究并不支持 ADHD 治疗生物标志物的任何即时临床应用。主要障碍是缺乏复制和外部验证，使用的是白人儿童为主的小型和同质样本，以及实际限制，包括生物标志物评估的成本和技术要求，以及它们对 ADHD 患者的可行性和可接受性尚不清楚。我们最后讨论了未来的方向和方法学改变，以促进 ADHD 患者的临床转化，并增强个性化治疗决策。
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