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Wengler K, Trujillo P, Cassidy CM, Horga G. Neuromelanin-sensitive MRI for mechanistic research and biomarker development in psychiatry. Neuropsychopharmacology 2024:10.1038/s41386-024-01934-y. [PMID: 39160355 DOI: 10.1038/s41386-024-01934-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/21/2024] [Accepted: 07/15/2024] [Indexed: 08/21/2024]
Abstract
Neuromelanin-sensitive MRI is a burgeoning non-invasive neuroimaging method with an increasing number of applications in psychiatric research. This MRI modality is sensitive to the concentration of neuromelanin, which is synthesized from intracellular catecholamines and accumulates in catecholaminergic nuclei including the dopaminergic substantia nigra and the noradrenergic locus coeruleus. Emerging data suggest the utility of neuromelanin-sensitive MRI as a proxy measure for variability in catecholamine metabolism and function, even in the absence of catecholaminergic cell loss. Given the importance of catecholamine function to several psychiatric disorders and their treatments, neuromelanin-sensitive MRI is ideally positioned as an informative and easy-to-acquire catecholaminergic index. In this review paper, we examine basic aspects of neuromelanin and neuromelanin-sensitive MRI and focus on its psychiatric applications in the contexts of mechanistic research and biomarker development. We discuss ongoing debates and state-of-the-art research into the mechanisms of the neuromelanin-sensitive MRI contrast, standardized protocols and optimized analytic approaches, and application of cutting-edge methods such as machine learning and artificial intelligence to enhance the feasibility and predictive power of neuromelanin-sensitive-MRI-based tools. We finally lay out important future directions to allow neuromelanin-sensitive-MRI to fulfill its potential as a key component of the research, and ultimately clinical, toolbox in psychiatry.
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Affiliation(s)
- Kenneth Wengler
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paula Trujillo
- Department of Neurology, Vanderbilt University Medical Center, Vanderbilt, TN, USA
| | - Clifford M Cassidy
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Guillermo Horga
- New York State Psychiatric Institute, New York, NY, USA.
- Department of Psychiatry, Columbia University, New York, NY, USA.
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Abstract
PURPOSE OF REVIEW This article reviews the history, nosology, clinical features, epidemiology, and treatment of tardive syndromes. RECENT FINDINGS The major advance in the field of tardive syndromes has been the development and US Food and Drug Administration (FDA) approval of two vesicular monoamine transporter type 2 inhibitors, valbenazine and deutetrabenazine, for treating tardive syndromes. These medications are derivatives of tetrabenazine and reduce dyskinetic movements by reducing dopamine stimulation. Treatment is not curative, and the medications reduce, or "mask," symptoms but presumably without adding to the long-term risk of increased involuntary movements believed to accrue from suppressive treatment with dopamine receptor-blocking drugs. A confounding advance has been the accumulation of data finding that second-generation antipsychotics, also known as atypical antipsychotics, may not be safer than first-generation antipsychotics in causing tardive syndromes. The public health risk of tardive syndromes may actually have increased as some second-generation antipsychotics, widely promoted to both doctors and patients, are increasingly used as antidepressants. SUMMARY Tardive syndromes remain a public health risk. Second-generation antipsychotics have not been proven to have less risk than first-generation drugs in causing tardive syndromes and are nevertheless being used more widely to treat depression, bipolar disease, and insomnia. Symptomatic treatment for tardive syndromes is available, although expensive.
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Cassidy CM, Zucca FA, Girgis RR, Baker SC, Weinstein JJ, Sharp ME, Bellei C, Valmadre A, Vanegas N, Kegeles LS, Brucato G, Kang UJ, Sulzer D, Zecca L, Abi-Dargham A, Horga G. Neuromelanin-sensitive MRI as a noninvasive proxy measure of dopamine function in the human brain. Proc Natl Acad Sci U S A 2019; 116:5108-5117. [PMID: 30796187 PMCID: PMC6421437 DOI: 10.1073/pnas.1807983116] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Neuromelanin-sensitive MRI (NM-MRI) purports to detect the content of neuromelanin (NM), a product of dopamine metabolism that accumulates with age in dopamine neurons of the substantia nigra (SN). Interindividual variability in dopamine function may result in varying levels of NM accumulation in the SN; however, the ability of NM-MRI to measure dopamine function in nonneurodegenerative conditions has not been established. Here, we validated that NM-MRI signal intensity in postmortem midbrain specimens correlated with regional NM concentration even in the absence of neurodegeneration, a prerequisite for its use as a proxy for dopamine function. We then validated a voxelwise NM-MRI approach with sufficient anatomical sensitivity to resolve SN subregions. Using this approach and a multimodal dataset of molecular PET and fMRI data, we further showed the NM-MRI signal was related to both dopamine release in the dorsal striatum and resting blood flow within the SN. These results suggest that NM-MRI signal in the SN is a proxy for function of dopamine neurons in the nigrostriatal pathway. As a proof of concept for its clinical utility, we show that the NM-MRI signal correlated to severity of psychosis in schizophrenia and individuals at risk for schizophrenia, consistent with the well-established dysfunction of the nigrostriatal pathway in psychosis. Our results indicate that noninvasive NM-MRI is a promising tool that could have diverse research and clinical applications to investigate in vivo the role of dopamine in neuropsychiatric illness.
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Affiliation(s)
- Clifford M Cassidy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032;
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa, ON K1Z 8N3, Canada
| | - Fabio A Zucca
- Institute of Biomedical Technologies, National Research Council of Italy, Segrate, 20090 Milan, Italy
| | - Ragy R Girgis
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
| | - Seth C Baker
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
| | - Jodi J Weinstein
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
- Department of Psychiatry, Stony Brook University, Stony Brook, NY 11794
| | - Madeleine E Sharp
- Department of Neurology, Columbia University Medical Center, New York, NY 10032
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC H3A 2B4, Canada
| | - Chiara Bellei
- Institute of Biomedical Technologies, National Research Council of Italy, Segrate, 20090 Milan, Italy
| | - Alice Valmadre
- Institute of Biomedical Technologies, National Research Council of Italy, Segrate, 20090 Milan, Italy
| | - Nora Vanegas
- Department of Neurology, Columbia University Medical Center, New York, NY 10032
| | - Lawrence S Kegeles
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
| | - Gary Brucato
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
| | - Un Jung Kang
- Department of Neurology, Columbia University Medical Center, New York, NY 10032
| | - David Sulzer
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
- Department of Neurology, Columbia University Medical Center, New York, NY 10032
| | - Luigi Zecca
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
- Institute of Biomedical Technologies, National Research Council of Italy, Segrate, 20090 Milan, Italy
| | - Anissa Abi-Dargham
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032
- Department of Psychiatry, Stony Brook University, Stony Brook, NY 11794
| | - Guillermo Horga
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032;
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Oda Y, Kanahara N, Iyo M. Alterations of Dopamine D2 Receptors and Related Receptor-Interacting Proteins in Schizophrenia: The Pivotal Position of Dopamine Supersensitivity Psychosis in Treatment-Resistant Schizophrenia. Int J Mol Sci 2015; 16:30144-63. [PMID: 26694375 PMCID: PMC4691170 DOI: 10.3390/ijms161226228] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/01/2015] [Accepted: 12/08/2015] [Indexed: 12/22/2022] Open
Abstract
Although the dopamine D2 receptor (DRD2) has been a main target of antipsychotic pharmacotherapy for the treatment of schizophrenia, the standard treatment does not offer sufficient relief of symptoms to 20%-30% of patients suffering from this disorder. Moreover, over 80% of patients experience relapsed psychotic episodes within five years following treatment initiation. These data strongly suggest that the continuous blockade of DRD2 by antipsychotic(s) could eventually fail to control the psychosis in some point during long-term treatment, even if such treatment has successfully provided symptomatic improvement for the first-episode psychosis, or stability for the subsequent chronic stage. Dopamine supersensitivity psychosis (DSP) is historically known as a by-product of antipsychotic treatment in the manner of tardive dyskinesia or transient rebound psychosis. Numerous data in psychopharmacological studies suggest that the up-regulation of DRD2, caused by antipsychotic(s), is likely the mechanism underlying the development of the dopamine supersensitivity state. However, regardless of evolving notions of dopamine signaling, particularly dopamine release, signal transduction, and receptor recycling, most of this research has been conducted and discussed from the standpoint of disease etiology or action mechanism of the antipsychotic, not of DSP. Hence, the mechanism of the DRD2 up-regulation or mechanism evoking clinical DSP, both of which are caused by pharmacotherapy, remains unknown. Once patients experience a DSP episode, they become increasingly difficult to treat. Light was recently shed on a new aspect of DSP as a treatment-resistant factor. Clarification of the detailed mechanism of DSP is therefore crucial, and a preventive treatment strategy for DSP or treatment-resistant schizophrenia is urgently needed.
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Affiliation(s)
- Yasunori Oda
- Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
| | - Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
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Arrondo G, Aznárez-Sanado M, Fernández-Seara MA, Goñi J, Loayza FR, Salamon-Klobut E, Heukamp FH, Pastor MA. Dopaminergic modulation of the trade-off between probability and time in economic decision-making. Eur Neuropsychopharmacol 2015; 25:817-27. [PMID: 25840742 DOI: 10.1016/j.euroneuro.2015.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/16/2014] [Accepted: 02/25/2015] [Indexed: 11/28/2022]
Abstract
Studies on animals and humans have demonstrated the importance of dopamine in modulating decision-making processes. In this work, we have tested dopaminergic modulation of economic decision-making and its neural correlates by administering either placebo or metoclopramide, a dopamine D2-receptor antagonist, to healthy subjects, during a functional MRI study. The decision-making task combined probability and time delay with a fixed monetary reward. For individual behavioral characterization, we used the Probability Time Trade-off (PTT) economic model, which integrates the traditional trade-offs of reward magnitude-time and reward magnitude-probability into a single measurement, thereby quantifying the subjective value of a delayed and probabilistic outcome. A regression analysis between BOLD signal and the PTT model index permitted to identify the neural substrate encoding the subjective reward-value. Behaviorally, medication reduced the rate of temporal discounting over probability, reflected in medicated subjects being more prone to postpone the reward in order to increase the outcome probability. In addition, medicated subjects showed less activity during the task in the postcentral gyrus as well as frontomedian areas, whereas there were no differences in the ventromedial orbitofrontal cortex (VMOFC) between groups when coding the subjective value. The present study demonstrates by means of behavior and imaging that dopamine modulation alters the probability-time trade-off in human economic decision-making.
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Affiliation(s)
- Gonzalo Arrondo
- Functional Neuroimaging Laboratory, Division of Neurosciences, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain; Managerial Decision Sciences, IESE Business School, University of Navarra, 08034 Barcelona, Spain; Psychiatry Department, University of Cambridge, United Kingdom
| | - Maite Aznárez-Sanado
- Functional Neuroimaging Laboratory, Division of Neurosciences, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain
| | - Maria A Fernández-Seara
- Functional Neuroimaging Laboratory, Division of Neurosciences, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain
| | - Joaquín Goñi
- Functional Neuroimaging Laboratory, Division of Neurosciences, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain
| | - Francis R Loayza
- Functional Neuroimaging Laboratory, Division of Neurosciences, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain
| | - Ewa Salamon-Klobut
- Managerial Decision Sciences, IESE Business School, University of Navarra, 08034 Barcelona, Spain
| | - Franz H Heukamp
- Managerial Decision Sciences, IESE Business School, University of Navarra, 08034 Barcelona, Spain
| | - Maria A Pastor
- Functional Neuroimaging Laboratory, Division of Neurosciences, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain.
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Loss of dopamine neuron terminals in antipsychotic-treated schizophrenia; relation to tardive dyskinesia. Prog Neuropsychopharmacol Biol Psychiatry 2013; 44:178-83. [PMID: 23454261 DOI: 10.1016/j.pnpbp.2013.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 11/24/2022]
Abstract
The in vivo labeling and brain imaging of dopamine transporters measure the density of dopamine neuron terminals in the human caudate/putamen. A review of such studies shows that the long-term use of antipsychotics had no major effect on the density of the dopamine terminals in individuals who had no tardive dyskinesia, but had reduced the density in those patients with tardive dyskinesia. In addition, the normal loss of dopamine terminals in healthy individuals was approximately 5% per decade. However, this rate of cell loss was apparently increased by approximately three-fold, to about 15% per decade, in schizophrenia patients using antipsychotics on a long-term basis, as measured by the in vivo imaging of the dopamine transporters in the dopamine neuron terminals. While an apparent reduction in dopamine transporters may result from reduced expression of the transporters secondary to antipsychotic treatment, the seemingly increased loss rate is consistent with the accumulation of antipsychotics in the neuromelanin of the substantia nigra, subsequent injury to the dopamine-containing neurons, and the development of extrapyramidal motor disturbances such as tardive dyskinesia or Parkinson's disease.
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Seeman P, Remington G. Antipsychotic Dosing: Extended, and Transient. ACTA ACUST UNITED AC 2012; 6:86-7. [DOI: 10.3371/csrp.6.2.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Crowley JJ, Kim Y, Szatkiewicz JP, Pratt AL, Quackenbush CR, Adkins DE, van den Oord E, Bogue MA, Yang H, Wang W, Threadgill DW, de Villena FPM, McLeod HL, Sullivan PF. Genome-wide association mapping of loci for antipsychotic-induced extrapyramidal symptoms in mice. Mamm Genome 2012; 23:322-35. [PMID: 22207321 PMCID: PMC3356790 DOI: 10.1007/s00335-011-9385-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 12/09/2011] [Indexed: 12/18/2022]
Abstract
Tardive dyskinesia (TD) is a debilitating, unpredictable, and often irreversible side effect resulting from chronic treatment with typical antipsychotic agents such as haloperidol. TD is characterized by repetitive, involuntary, purposeless movements primarily of the orofacial region. In order to investigate genetic susceptibility to TD, we used a validated mouse model for a systems genetics analysis geared toward detecting genetic predictors of TD in human patients. Phenotypic data from 27 inbred strains chronically treated with haloperidol and phenotyped for vacuous chewing movements were subject to a comprehensive genomic analysis involving 426,493 SNPs, 4,047 CNVs, brain gene expression, along with gene network and bioinformatic analysis. Our results identified ~50 genes that we expect to have high prior probabilities for association with haloperidol-induced TD, most of which have never been tested for association with human TD. Among our top candidates were genes regulating the development of brain motor control regions (Zic4 and Nkx6-1), glutamate receptors (Grin1 and Grin2a), and an indirect target of haloperidol (Drd1a) that has not been studied as well as the direct target, Drd2.
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Affiliation(s)
- James J Crowley
- Department of Genetics, University of North Carolina, Genomic Medicine Building, CB#7264, Chapel Hill, NC 27599-7264, USA.
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Lai TKY, Seeman P, Liu F. Cell membrane lytic action of metoclopramide and its relation to tardive dyskinesia. Synapse 2011; 66:273-6. [PMID: 22034087 DOI: 10.1002/syn.21504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 10/13/2011] [Indexed: 11/10/2022]
Abstract
The long-term use of many antipsychotic medications carries a risk of tardive dyskinesia in a small proportion of patients. Although metoclopramide is an antipsychotic at high doses, this drug is more commonly used at low daily doses to accelerate stomach movement of food. Because prolonged use of metoclopramide has also been associated with tardive dyskinesia, this drug is convenient to study to examine the possible basis of tardive dyskinesia. Previous work proposed that antipsychotics accumulated in the melanin granules of the human substantia nigra, ultimately building up to high concentrations that could disrupt cell membranes of nigral neurons. While previous work demonstrated the accumulation of metoclopramide in postmortem human nigral tissue, it remained to be tested whether high concentrations of metoclopramide would actually disrupt cell membranes. Therefore, the present work examined whether metoclopramide could disrupt cell membranes, using human erythrocytes directly exposed to various concentrations of metoclopramide in vitro. It was found that metoclopramide caused disruption of the red cells starting at a threshold of 1 mM, which would result in ~280 μmoles of metoclopramide per kilogram of dry red cell membranes. However, the nonspecific adsorption of metoclopramide to human substantia nigra is ~23 μmol/kg of dry solids (measured at the clinical spinal fluid concentration of metoclopramide). Therefore, the membrane-lytic concentration of metoclopramide is only about 12 times higher than that after a single exposure of the drug to the nigral tissue. Hence, metoclopramide accumulation in the substantia nigra over a matter of months may lead to nigral neuron damage.
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Affiliation(s)
- Terence K Y Lai
- Department of Neuroscience, Centre for Addiction and Mental Health, Clarke Division, Toronto, Ontario M5T 1R8, Canada
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