Pontificia Universidad Javeriana, PhD program of Neuroscience, Bogotá, Colombia; Hospital Universitario San Ignacio, Centro de Memoria y Cognición Intellectus, Bogotá, Colombia.
Global Brain Health Institute, University California of San Francisco, San Francisco, California; Global Brain Health Institute, Trinity College of Dublin, Dublin, Ireland; Latin American Brain Health Institute, Universidad Adolfo Ibanez, Santiago, Chile.
Biol Psychiatry. 2025 Jan 1;97(1):28-40. doi: 10.1016/j.biopsych.2024.06.024. Epub 2024 Jul 2.
Emerging theories emphasize the crucial role of allostasis (anticipatory and adaptive regulation of the body's biological processes) and interoception (integration, anticipation, and regulation of internal bodily states) in adjusting physiological responses to environmental and bodily demands. In this review, we explore the disruptions in integrated allostatic interoceptive mechanisms in psychiatric and neurological disorders, including anxiety, depression, Alzheimer's disease, and frontotemporal dementia. We assess the biological mechanisms associated with allostatic interoception, including whole-body cascades, brain structure and function of the allostatic interoceptive network, heart-brain interactions, respiratory-brain interactions, the gut-brain-microbiota axis, peripheral biological processes (inflammatory, immune), and epigenetic pathways. These processes span psychiatric and neurological conditions and call for developing dimensional and transnosological frameworks. We synthesize new pathways to understand how allostatic interoceptive processes modulate interactions between environmental demands and biological functions in brain disorders. We discuss current limitations of the framework and future transdisciplinary developments. This review opens a new research agenda for understanding how allostatic interoception involves brain predictive coding in psychiatry and neurology, allowing for better clinical application and the development of new therapeutic interventions.
新兴理论强调了全身适应(对身体生物过程的预期和适应性调节)和内脏感知(内部身体状态的整合、预期和调节)在调节对环境和身体需求的生理反应方面的关键作用。在这篇综述中,我们探讨了在精神和神经障碍中,包括焦虑、抑郁、阿尔茨海默病和额颞叶痴呆,整合的全身适应内脏感知机制的破坏。我们评估了与全身适应内脏感知相关的生物学机制,包括全身级联、全身适应内脏感知网络的大脑结构和功能、心脏-大脑相互作用、呼吸-大脑相互作用、肠道-大脑-微生物群轴、外周生物过程(炎症、免疫)和表观遗传途径。这些过程跨越了精神和神经疾病的范围,需要开发维度和跨学科框架。我们综合了新的途径来了解全身适应内脏感知过程如何调节大脑疾病中环境需求和生物功能之间的相互作用。我们讨论了该框架的当前局限性和未来的跨学科发展。这篇综述为理解全身适应内脏感知如何涉及精神病学和神经病学中的大脑预测编码开辟了一个新的研究议程,从而能够更好地进行临床应用和开发新的治疗干预措施。
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