Dynamics of Inflammation and its Blockade on Motivational Circuitry in Depression

抑郁症中炎症的动态及其对动机回路的封锁

• 批准号: 9917858
• 负责人: Michael Tilghman Treadway
• 金额: $ 41.4万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-20 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9917858
• 关键词: Address; Adult; Affect; Anhedonia; Anti-Inflammatory Agents; Basal Ganglia; Behavior assessment; Behavioral; Biological; C-reactive protein; Clinical; Clinical assessments; Corpus striatum structure; Data; Decision Making; Development; Disease; Dopamine; Double-Blind Method; Enrollment; Ensure; Exhibits; Fatigue; Functional Magnetic Resonance Imaging; Functional disorder; Future; Gene Expression; Genetic Markers; Goals; Hour; Human; Immune system; Impairment; Individual Differences; Inflammation; Inflammatory; Infusion procedures; Interleukin-6; Laboratory Animals; Learning; Link; Major Depressive Disorder; Measures; Mediating; Mediation; Mental Depression; Mental disorders; Metabolism; Modeling; Molecular; Monoclonal Antibodies; Motivation; Nature; Pathway interactions; Patients; Pattern; Peripheral; Pharmaceutical Preparations; Pharmacology; Placebos; Plasma; Prevention strategy; Procedures; Psychological reinforcement; Research; Rewards; Role; Sampling; Schizophrenia; Signal Pathway; Signal Transduction; Symptoms; TNF gene; Testing; Time; Validation; Ventral Striatum; base; behavior measurement; clinically relevant; cytokine; depressed patient; depressive symptoms; hedonic; inflammatory marker; infliximab; learned behavior; neural circuit; neurobiological mechanism; neuroimaging; novel; patient subsets; personalized medicine; protein biomarkers; protein expression; recruit; reduce symptoms; relating to nervous system; response; response biomarker; reward anticipation; reward circuitry; targeted biomarker; therapeutic target; treatment strategy

Project Summary Motivational anhedonia–a subset of anhedonic symptoms involving dopamine-linked impairments in effort- based decision-making, reward anticipation and reinforcement learning–are common in psychiatric disorders such as major depression, and are notoriously difficult to treat. In recent years, these symptoms have been associated with alterations in dopaminergic corticostriatal circuitry, yet the underlying causes of this circuit dysfunction remain unknown. One candidate mechanism is inflammation; increased inflammatory cytokines have been reliably found in depressed patients, and administration of inflammatory cytokines or cytokine inducers has been shown to foment depressive symptoms of apathy, anhedonia and fatigue. In addition, inflammatory cytokines have been found to disrupt dopamine synthesis, alter basal-ganglia metabolism, and blunt striatal responsivity during reward anticipation. To date, however, the majority of data supporting the relationship between cytokines and symptoms in patients with major depression and other disorders is correlational in nature, and thus alternative experimental strategies are required to elucidate causal relationships. One strategy is to block inflammatory cytokines in a sample of depressed patients with high inflammation so as to determine which symptom domains are most affected and through which molecular pathways. Previously, we found that the TNF antagonist infliximab (a “biologic” monoclonal antibody that selectively inhibits TNF) selectively reduced symptoms of motivational anhedonia, but only in depressed patients with high inflammation as reflected by plasma c-reactive protein (CRP) of at least >3mg/L. Unfortunately, not all patients in this sample exhibited high inflammation, and these associations must therefore be considered preliminary, albeit promising. More critically, this study was unable to address target engagement at the level of neural circuitry. Building off of these initial data, the current study will assess neuroimaging measures of corticostriatal circuitry before and after a placebo-controlled pharmacologic blockade of inflammation in 80 depressed patients (n = 40 per group) recruited to ensure high levels of peripheral inflammation (CRP > 3mg/L). Primary aims are to evaluate whether 1) corticostriatal function during reward motivation and anticipation are associated with change in peripheral inflammation following pharmacologic blockade relative to placebo 2) the temporal dynamics of change in inflammation, gene- expression, reward motivation and reinforcement learning behavior and motivational symptoms assessed at baseline, and 24 hours, 3 days, 1 week and two weeks post infliximab infusion, and 3) test an integrative multi- level path model to determine whether change in corticostriatal circuitry following inflammation blockade mediates the relationship between change in inflammation and change in motivational anhedonia symptoms. These data will provide further validation of inflammatory cytokines as therapeutic targets for motivational symptoms in depression and will define symptom targets and biomarkers of response for future studies.

项目概要 动机性快感缺乏——快感缺乏症状的一个子集，涉及多巴胺相关的努力障碍—— 基于决策、奖励预期和强化学习——在精神疾病中很常见 近年来，这些症状一直难以治疗。 与多巴胺能皮质纹状体回路的改变有关，但该回路的根本原因 一种可能的机制是炎症细胞因子的增加。 已在抑郁症患者中可靠地发现，并给予炎症细胞因子或细胞因子 诱导剂已被证明会引发冷漠、快感缺乏和疲劳等抑郁症状。 研究发现炎症细胞因子会破坏多巴胺合成，改变基底神经节代谢， 然而，迄今为止，大多数数据都支持这一点。 细胞因子与重度抑郁症和其他疾病患者的症状之间的关系是 本质上是相关的，因此需要替代的实验策略来阐明因果关系 一种策略是阻断抑郁症患者样本中的炎症细胞因子。 炎症，以确定哪些症状域受影响最大以及通过哪些分子 此前，我们发现 TNF 拮抗剂英夫利昔单抗（一种“生物”单克隆抗体） 选择性抑制 TNF）选择性减少动机性快感缺失的症状，但仅限于抑郁症 血浆C反应蛋白（CRP）至少>3mg/L反映的高度炎症的患者。 不幸的是，并非该样本中的所有患者都表现出高度炎症，并且这些关联必须 因此被认为是初步的、有潜力的。更关键的是，这项研究无法解决目标。 当前的研究将在这些初始数据的基础上评估神经回路层面的参与度。 安慰剂对照药理学前后皮质纹状体回路的神经影像学测量 对 80 名抑郁症患者（每组 40 名）进行炎症阻断，以确保高水平的 周围炎症（CRP > 3mg/L）的主要目的是评估 1) 皮质纹状体功能是否存在。 奖励动机和预期与周围炎症的变化相关 相对于安慰剂的药理学阻断 2) 炎症、基因变化的时间动态 表达、奖励动机和强化学习行为以及动机症状评估 基线，以及英夫利昔单抗输注后 24 小时、3 天、1 周和两周，以及 3) 测试综合多 水平路径模型以确定炎症阻断后皮质纹状体回路是否发生变化 介导炎症变化与动机性快感缺乏症状变化之间的关系。 这些数据将进一步验证炎症细胞因子作为激励治疗靶点 抑郁症的症状，并将确定未来研究的症状目标和反应生物标志物。