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Cooper RK, Mahoney MC, Tiffany ST, Colder CR, Tyndale RF, Hawk LW. Relationships Between the Nicotine Metabolite Ratio and Laboratory Assessments of Smoking Reinforcement and Craving Among Adults in a Smoking Cessation Trial. Nicotine Tob Res 2024; 26:604-611. [PMID: 37996099 PMCID: PMC11033563 DOI: 10.1093/ntr/ntad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/10/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION People who metabolize nicotine more quickly are generally less successful at quitting smoking. However, the mechanisms that link individual differences in the nicotine metabolite ratio (NMR), a phenotypic biomarker of the rate of nicotine clearance, to smoking outcomes are unclear. We tested the hypotheses that higher NMR is associated with greater smoking reinforcement, general craving, and cue-induced cigarette craving in a treatment-seeking sample. METHODS Participants were 252 adults who smoke cigarettes enrolled in a randomized controlled smoking cessation trial (NCT03262662) conducted in Buffalo, New York, USA. Participants completed the Choice Behavior Under Cued Conditions (CBUCC) paradigm, a laboratory choice procedure, ~1 week before the first cessation treatment visit, at which time a saliva sample was collected for NMR assessment. On each CBUCC trial, participants reported cigarette craving during cue presentation (cigarette, water) and spent $0.01-$0.25 for a chance (5%-95%) to sample the cue (one puff, sip), providing measures of smoking reinforcement (spending for cigarettes vs. water), general cigarette craving (averaged across cigarette and water cues), and cue-specific craving (cigarette craving during cigarette vs. water cues). RESULTS As observed in prior work, the NMR was significantly higher among White and female participants. As expected, both spending and cigarette craving were significantly greater on cigarette compared to water trials. However, contrary to our hypotheses, higher NMR was not associated with greater smoking reinforcement, general craving, or cue-specific craving. CONCLUSIONS The present data do not support that smoking reinforcement or craving is related to nicotine metabolism among individuals seeking to quit smoking. IMPLICATIONS Though greater smoking reinforcement, general craving, and cue-specific craving are hypothesized to be linked to faster nicotine metabolism, there was no evidence of such relationships in the present sample of adults seeking to quit smoking. Further research, including replication and consideration of alternate hypotheses, is warranted to elucidate the mechanisms by which the NMR is related to smoking cessation.
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Affiliation(s)
- Robert K Cooper
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | | | | | - Craig R Colder
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
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Luo M, Gan Q, Fu Y, Chen Z. Cue-reactivity targeted smoking cessation intervention in individuals with tobacco use disorder: a scoping review. Front Psychiatry 2023; 14:1167283. [PMID: 37743997 PMCID: PMC10512743 DOI: 10.3389/fpsyt.2023.1167283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Cue-reactivity is a critical step leading to the emergence of addictive psychology and the triggering of addictive behaviors within the framework of addiction theory and is considered a significant risk factor for addiction-related behaviors. However, the effect of cue-reactivity targeted smoking cessation intervention and the cue-reactivity paradigms used in the randomized controlled trials varies, which introduces more heterogeneity and makes a side-by-side comparison of cessation responses difficult. Therefore, the scoping review aims to integrate existing research and identify evidence gaps. Methods We searched databases in English (PubMed and Embase) and Chinese (CNKI and Wanfang) using terms synonymous with 'cue' and 'tobacco use disorder (TUD)' to April 2023, and via hand-searching and reference screening of included studies. Studies were included if they were randomized controlled trials taking cue-reactivity as an indicator for tobacco use disorder (TUD) defined by different kinds of criteria. Results Data were extracted on each study's country, population, methods, timeframes, outcomes, cue-reactivity paradigms, and so on. Of the 2,944 literature were retrieved, 201 studies met the criteria and were selected for full-text screening. Finally, 67 pieces of literature were selected for inclusion and data extraction. The results mainly revealed that non-invasive brain stimulation and exercise therapy showed a trend of greater possibility in reducing subjective craving compared to the remaining therapies, despite variations in the number of research studies conducted in each category. And cue-reactivity paradigms vary in materials and mainly fall into two main categories: behaviorally induced craving paradigm or visually induced craving paradigm. Conclusion The current studies are still inadequate in terms of comparability due to their heterogeneity, cue-reactivity can be conducted in the future by constructing a standard library of smoking cue materials. Causal analysis is suggested in order to adequately screen for causes of addiction persistence, and further explore the specific objective cue-reactivity-related indicators of TUD.
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Affiliation(s)
- Miaoling Luo
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
| | - Quan Gan
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Yu Fu
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
| | - Zhuangfei Chen
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
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3
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Lee SS, Chang Y, Rigotti NA, Singer DE, Levy DE, Tyndale RF, Davis EM, Freiberg MS, King S, Wells QS, Tindle HA. Can Treatment Support Mitigate Nicotine Metabolism-Based Disparities in Smoking Abstinence? Secondary Analysis of the Helping HAND 4 Trial. Nicotine Tob Res 2023; 25:1575-1584. [PMID: 37209421 PMCID: PMC10439488 DOI: 10.1093/ntr/ntad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION The nicotine metabolite ratio (NMR), a biomarker of CYP2A6-mediated nicotine metabolism, predicts the efficacy of nicotine replacement therapy (NRT), with fast metabolizers benefiting less than slow metabolizers. Whether treatment support to optimize NRT use (henceforth "treatment support") modifies this pharmacogenetic relationship is unknown. METHODS Hospitalized adult daily smokers were assigned to one of two post-discharge smoking cessation interventions offering NRT and counseling: (1) Transitional Tobacco Care Management, which delivered enhanced treatment support via free combination NRT at discharge and automated counseling, and (2) a quitline-based approach representing usual care (UC). The primary outcome was biochemically verified 7-day point prevalence abstinence 6 months after discharge. Secondary outcomes were the use of NRT and counseling during the 3-month intervention period. Logistic regression models tested for interactions between NMR and intervention, controlling for sex, race, alcohol use, and BMI. RESULTS Participants (N = 321) were classified as slow (n = 80) or fast (n = 241) metabolizers relative to the first quartile of NMR (0.012-0.219 vs. 0.221-3.455, respectively). Under UC, fast (vs. slow) metabolizers had lower odds of abstinence at 6 months (aOR 0.35, 95% CI 0.13-0.95) and similar odds of NRT and counseling use. Compared to UC, enhanced treatment support increased abstinence (aOR 2.13, 95% CI 0.98-4.64) and use of combination NRT (aOR 4.62, 95% CI 2.57-8.31) in fast metabolizers, while reducing abstinence in slow metabolizers (aOR 0.21, 95% CI 0.05-0.87; NMR-by-intervention interaction p = .004). CONCLUSIONS Treatment support increased abstinence and optimal use of NRT among fast nicotine metabolizers, thereby mitigating the gap in abstinence between fast and slow metabolizers. IMPLICATIONS In this secondary analysis of two smoking cessation interventions for recently hospitalized smokers, fast nicotine metabolizers quit at lower rates than slow metabolizers, but providing fast metabolizers with enhanced treatment support doubled the odds of quitting in this group and mitigated the disparity in abstinence between fast and slow metabolizers. If validated, these findings could lead to personalized approaches to smoking cessation treatment that improve outcomes by targeting treatment support to those who need it most.
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Affiliation(s)
- Scott S Lee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuchiao Chang
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy A Rigotti
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel E Singer
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Douglas E Levy
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rachel F Tyndale
- Departments of Psychiatry, and Pharmacology and Toxicology, University of Toronto and Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Esa M Davis
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen King
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn S Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Zakiniaeiz Y, Liu H, Gao H, Najafzadeh S, Ropchan J, Nabulsi N, Huang Y, Matuskey D, Chen MK, Cosgrove KP, Morris ED. Nicotine Patch Alters Patterns of Cigarette Smoking-Induced Dopamine Release: Patterns Relate to Biomarkers Associated With Treatment Response. Nicotine Tob Res 2022; 24:1597-1606. [PMID: 35100429 PMCID: PMC9575980 DOI: 10.1093/ntr/ntac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/04/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Tobacco smoking is a major public health burden. The first-line pharmacological treatment for tobacco smoking is nicotine replacement therapy (eg, the nicotine patch (NIC)). Nicotine acts on nicotinic-acetylcholine receptors on dopamine terminals to release dopamine in the ventral and dorsal striatum encoding reward and habit formation, respectively. AIMS AND METHODS To better understand treatment efficacy, a naturalistic experimental design combined with a kinetic model designed to characterize smoking-induced dopamine release in vivo was used. Thirty-five tobacco smokers (16 female) wore a NIC (21 mg, daily) for 1-week and a placebo patch (PBO) for 1-week in a randomized, counter-balanced order. Following 1-week under NIC and then overnight abstinence, smokers participated in a 90-minute [11C]raclopride positron emission tomography scan and smoked a cigarette while in the scanner. Identical procedures were followed for the PBO scan. A time-varying kinetic model was used at the voxel level to model transient dopamine release peaking instantaneously at the start of the stimulus and decaying exponentially. Magnitude and spatial extent of dopamine release were estimated. Smokers were subcategorized by nicotine dependence level and nicotine metabolism rate. RESULTS Dopamine release magnitude was enhanced by NIC in ventral striatum and diminished by NIC in dorsal striatum. More-dependent smokers activated more voxels than the less-dependent smokers under both conditions. Under PBO, fast metabolizers activated more voxels in ventral striatum and fewer voxels in dorsal striatum compared to slow metabolizers. CONCLUSIONS These findings demonstrate that the model captured a pattern of transient dopamine responses to cigarette smoking which may be different across smoker subgroup categorizations. IMPLICATIONS This is the first study to show that NIC alters highly localized patterns of cigarette smoking-induced dopamine release and that levels of nicotine dependence and nicotine clearance rate contribute to these alterations. This current work included a homogeneous subject sample with regards to demographic and smoking variables, as well as a highly sensitive model capable of detecting significant acute dopamine transients. The findings of this study add support to the recent identification of biomarkers for predicting the effect of nicotine replacement therapies on dopamine function which could help refine clinical practice for smoking cessation.
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Affiliation(s)
- Yasmin Zakiniaeiz
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
| | - Heather Liu
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Hong Gao
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Soheila Najafzadeh
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Jim Ropchan
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Nabeel Nabulsi
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Yiyun Huang
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - David Matuskey
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Ming-Kai Chen
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Kelly P Cosgrove
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
| | - Evan D Morris
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale Positron Emission Tomography (PET) Center, Yale University, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
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Nicotine acutely alters temporal properties of resting brain states. Drug Alcohol Depend 2021; 226:108846. [PMID: 34198131 PMCID: PMC8355138 DOI: 10.1016/j.drugalcdep.2021.108846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/16/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nicotine-dependent individuals have altered activity in neurocognitive networks such as the default mode (DMN), salience (SN) and central executive networks (CEN). One theory suggests that, among chronic tobacco smokers, nicotine abstinence drives more DMN-related internal processing while nicotine replacement suppresses DMN and enhances SN and CEN. Whether acute nicotine impacts network dynamics in non-smokers is, however, unknown. METHODS In a randomized double-blind crossover study, 17 healthy non-smokers (8 females) were administered placebo and nicotine (2-mg lozenge) on two different days prior to collecting resting-state functional magnetic resonance imaging (fMRI). Previously defined brain states in 462 individuals that spatially overlap with well-characterized resting-state networks including the DMN, SN, and CEN were applied to compute state-specific dynamics at rest: total time spent in state, persistence in each state after entry, and frequency of state transitions. We examined whether nicotine acutely alters these resting-state dynamics. RESULTS A significant drug-by-state interaction emerged; post-hoc analyses clarified that, relative to placebo, nicotine suppressed time spent in a frontoinsular-DMN state (posterior cingulate cortex, medial prefrontal cortex, anterior insula, striatum and orbitofrontal cortex) and enhanced time spent in a SN state (anterior cingulate cortex and insula). No significant findings were observed for persistence and frequency. CONCLUSIONS In non-smokers, nicotine biases resting-state brain function away from the frontoinsular-DMN and toward the SN, which may reduce internally focused cognition and enhance salience processing. While past work suggests nicotine impacts DMN activity, the current work shows nicotinic influences on a specific DMN-like network that has been linked with rumination and depression.
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Bach P, Weil G, Pompili E, Hoffmann S, Hermann D, Vollstädt-Klein S, Kiefer F, Mann K, Sommer WH. FMRI-based prediction of naltrexone response in alcohol use disorder: a replication study. Eur Arch Psychiatry Clin Neurosci 2021; 271:915-927. [PMID: 33884495 PMCID: PMC8236024 DOI: 10.1007/s00406-021-01259-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/30/2021] [Indexed: 12/20/2022]
Abstract
Pharmacological treatment in alcohol use disorder suffers from modest effect sizes. Efforts have been undertaken to identify patient characteristics that help to select individuals that benefit from pharmacological treatment. Previous studies indicated that neural alcohol cue-reactivity (CR) might provide a marker that identifies patients, which benefit from naltrexone treatment.We investigated the reproducibility of the association between ventral striatum (VS) activation and naltrexone (NTX) treatment response by analyzing data from a recent longitudinal clinical trial in N = 44 abstinent treatment-seeking alcohol-dependent patients. A follow-up was conducted over 3 months. We computed the percentage of significant voxels in VS and tested main effects and interactions with NTX treatment on relapse risk using Cox Regression models.We found a significant interaction effect between pre-treatment cue reactivity in the VS and NTX treatment on time to first heavy relapse (Hazard Ratio = 7.406, 95% CI 1.17-46.56, p = 0.033), such that the patient group with high VS activation (defined by a mean split) showed a significant medication effect (Hazard Ratio = 0.140, 95% CI 0.02-0.75, p = 0.022) with a number needed to treat of 3.4 [95% CI 2.413.5], while there was no significant effect in the group with low VS activation (Hazard Ratio = 0.726, p = 0.454).Thus, using an independent sample we replicated the previously described positive association between VS activation and NTX efficacy. Although our results should be considered cautiously in light of the small sample size, our results support the potential of neural alcohol CR as a tool for precision medicine approaches in alcohol dependence.
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Affiliation(s)
- Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany.
- Feuerlein Center On Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany.
| | - Georg Weil
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
| | - Enrico Pompili
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
- Feuerlein Center On Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Derik Hermann
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
- Feuerlein Center On Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
- Feuerlein Center On Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
| | - Wolfgang H Sommer
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
- Bethanien Hospital for Psychiatry, Greifswald, Germany
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Wang Z, Feng K. WITHDRAWN: Medical assurance system under reliability theory and countermeasures to public health risks. Work 2021:WOR205375. [PMID: 34308890 DOI: 10.3233/wor-205375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Ahead of Print article withdrawn by publisher.
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Affiliation(s)
- Zhu Wang
- School of Law, Sichuan University, Chengdu, China
| | - Ke Feng
- School of Law, Sichuan University, Chengdu, China
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8
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Butler K, Chenoweth MJ, El-Boraie A, Giratallah H, Kowalczyk WJ, Heishman SJ, Tyndale RF, Le Foll B. Impact of CYP2A6 Activity on Nicotine Reinforcement and Cue-Reactivity in Daily Smokers. Nicotine Tob Res 2021; 23:1735-1743. [PMID: 33823003 DOI: 10.1093/ntr/ntab064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/02/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Variation in CYP2A6, the primary enzyme responsible for nicotine metabolism, is associated with nicotine dependence, cigarette consumption, and abstinence outcomes in smokers. The impact of CYP2A6 activity on nicotine reinforcement and tobacco cue-reactivity, mechanisms that may contribute to these previous associations, has not been fully evaluated. AIMS AND METHODS CYP2A6 activity was indexed using 3 genetic approaches in 104 daily smokers completing forced-choice and cue-induced craving tasks assessing nicotine reinforcement and tobacco cue-reactivity, respectively. First, smokers were stratified by the presence or absence of reduced/loss-of-function CYP2A6 gene variants (normal vs. reduced metabolizers). As nicotine metabolite ratio (NMR) is a reliable biomarker of CYP2A6 activity, our second and third approaches used additional genetic variants identified in genome-wide association studies of NMR to create a weighted genetic risk score (wGRS) to stratify smokers (fast vs. slow metabolizers) and calculate a wGRS-derived NMR. RESULTS Controlling for race and sex, normal metabolizers (vs. reduced) selected a greater proportion of puffs from nicotine-containing cigarettes (vs. denicotinized) on the forced-choice task (p = .031). In confirmatory analyses, wGRS-based stratification (fast vs. slow metabolizers) produced similar findings. Additionally, wGRS-derived NMR, which correlated with actual NMR assessed in a subset of participants (n = 55), was positively associated with the proportion of puffs from nicotine-containing cigarettes controlling for race and sex (p = .015). None of the CYP2A6 indices were associated with tobacco cue-reactivity in minimally deprived smokers. CONCLUSIONS Findings suggest increased nicotine reinforcement is exhibited by smokers with high CYP2A6 activity, which may contribute to heavier smoking and poorer cessation outcomes previously reported in faster metabolizers. IMPLICATIONS CYP2A6 activity is a key determinant of smoking behavior and outcomes. Therefore, these findings support the targeting of CYP2A6 activity, either therapeutically or as a clinically relevant biomarker in a precision medicine approach, for tobacco use disorder treatment.
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Affiliation(s)
- Kevin Butler
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Meghan J Chenoweth
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Ahmed El-Boraie
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Haidy Giratallah
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - William J Kowalczyk
- National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA.,Department of Psychology, Hartwick College, Oneonta, NY, USA
| | - Stephen J Heishman
- National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Perez-Paramo YX, Lazarus P. Pharmacogenetics factors influencing smoking cessation success; the importance of nicotine metabolism. Expert Opin Drug Metab Toxicol 2021; 17:333-349. [PMID: 33322962 PMCID: PMC8049967 DOI: 10.1080/17425255.2021.1863948] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/10/2020] [Indexed: 01/12/2023]
Abstract
Introduction: Smoking remains a worldwide epidemic, and despite an increase in public acceptance of the harms of tobacco use, it remains the leading cause of preventable death. It is estimated that up to 70% of all smokers express a desire to quit, but only 3-5% of them are successful.Areas covered: The goal of this review was to evaluate the current status of smoking cessation treatments and the feasibility of implementing personalized-medicine approaches to these pharmacotherapies. We evaluated the genetics associated with higher levels of nicotine addiction and follow with an analysis of the genetic variants that affect the nicotine metabolic ratio (NMR) and the FDA approved treatments for smoking cessation. We also highlighted the gaps in the process of translating current laboratory understanding into clinical practice, and the benefits of personalized treatment approaches for a successful smoking cessation strategy.Expert opinion: Evidence supports the use of tailored therapies to ensure that the most efficient treatments are utilized in an individual's smoking cessation efforts. An understanding of the genetic effects on the efficacy of individualized smoking cessation pharmacotherapies is key to smoking cessation, ideally utilizing a polygenetic risk score that considers all genetic variation.
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Affiliation(s)
- Yadira X. Perez-Paramo
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Philip Lazarus
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
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Allenby C, Falcone M, Ashare RL, Cao W, Bernardo L, Wileyto EP, Pruessner J, Loughead J, Lerman C. Brain Marker Links Stress and Nicotine Abstinence. Nicotine Tob Res 2020; 22:885-891. [PMID: 31120113 DOI: 10.1093/ntr/ntz077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Subjective stress is a well-documented predictor of early smoking relapse, yet our understanding of stress and tobacco use is limited by reliance on self-reported measures of stress. We utilized a validated functional neuroimaging paradigm to examine whether stress exposure during early abstinence alters objective measures of brain function. METHODS Seventy-five participants underwent blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) during the Montreal Imaging Stress Task (MIST) on two occasions: once during smoking satiety and once following biochemically confirmed 24-hour abstinence (order counterbalanced). The primary outcome measure was brain response during stress (vs. control) blocks of the MIST, assessed using whole-brain analysis corrected for multiple comparisons using clusters determined by Z ≥ 3.1. RESULTS Abstinence (vs. satiety) was associated with significantly increased activation in the left inferior frontal gyrus, a brain region associated with inhibitory control. Abstinence-induced change in brain response to stress was positively associated with change in self-reported stress. CONCLUSIONS This study provides objective evidence that the brain response to stress is altered during the first 24 hours of a quit attempt compared to smoking satiety. IMPLICATIONS These results point to the potential value of inoculating smokers with stress management training prior to a quit attempt.
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Affiliation(s)
- Cheyenne Allenby
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Mary Falcone
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Wen Cao
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Leah Bernardo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Jens Pruessner
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - James Loughead
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Caryn Lerman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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11
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Jao NC, Tan MM, Matthews PA, Simon MA, Schnoll R, Hitsman B. Menthol Cigarettes, Tobacco Dependence, and Smoking Persistence: The Need to Examine Enhanced Cognitive Functioning as a Neuropsychological Mechanism. Nicotine Tob Res 2020; 22:466-472. [PMID: 30551213 DOI: 10.1093/ntr/nty264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Despite the overall decline in the prevalence of cigarette use in the United States, menthol cigarette use among smokers is rising, and evidence shows that it may lead to more detrimental effects on public health than regular cigarette use. One of the mechanisms by which nicotine sustains tobacco use and dependence is due to its cognitive enhancing properties, and basic science literature suggests that menthol may also enhance nicotine's acute effect on cognition. AIMS AND METHODS The purpose of this review is to suggest that the cognitive enhancing effects of menthol may be a potentially important neuropsychological mechanism that has yet to be examined. In this narrative review, we provide an overview of basic science studies examining neurobiological and cognitive effects of menthol and menthol cigarette smoking. We also review studies examining menthol essential oils among humans that indicate menthol alone has acute cognitive enhancing properties. Finally, we present factors influencing the rising prevalence of menthol cigarette use among smokers and the importance of this gap in the literature to improve public health and smoking cessation treatment. CONCLUSIONS Despite the compelling evidence for menthol's acute cognitive enhancing and reinforcing effects, this mechanism for sustaining tobacco dependence and cigarette use has yet to be examined and validated among humans. On the basis of the basic science evidence for menthol's neurobiological effects on nicotinic receptors and neurotransmitters, perhaps clarifying menthol's effect on cognitive performance can help to elucidate the complicated literature examining menthol and tobacco dependence. IMPLICATIONS Menthol cigarette use has continued to be a topic of debate among researchers and policy makers, because of its implications for understanding menthol's contribution to nicotine dependence and smoking persistence, as well as its continued use as a prevalent flavoring in tobacco and nicotine products in the United States and internationally. As international tobacco regulation policies have begun to target menthol cigarettes, research studies need to examine how flavoring additives, specifically menthol, may acutely influence neurobiological and cognitive functioning as a potential mechanism of sustained smoking behavior to develop more effective treatments.
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Affiliation(s)
- Nancy C Jao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marcia M Tan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phoenix A Matthews
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL
| | - Melissa A Simon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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12
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Wang KS, Zegel M, Molokotos E, Moran LV, Olson DP, Pizzagalli DA, Janes AC. The acute effects of nicotine on corticostriatal responses to distinct phases of reward processing. Neuropsychopharmacology 2020; 45:1207-1214. [PMID: 31931509 PMCID: PMC7235267 DOI: 10.1038/s41386-020-0611-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/09/2022]
Abstract
Nicotine enhances the reinforcement of non-drug rewards by increasing nucleus accumbens (NAcc) reactivity to anticipatory cues. This anticipatory effect is selective as no clear evidence has emerged showing that nicotine acutely changes reward receipt reactivity. However, repeated rewarding experiences shift peak brain reactivity from hedonic reward outcome to the motivational anticipatory cue yielding more habitual cue-induced behavior. Given nicotine's influence on NAcc reactivity and connectivity, it is plausible that nicotine acutely induces this shift and alters NAcc functional connectivity during reward processing. To evaluate this currently untested hypothesis, a randomized crossover design was used in which healthy non-smokers were administered placebo and nicotine (2-mg lozenge). Brain activation to monetary reward anticipation and outcome was evaluated with functional magnetic resonance imaging. Relative to placebo, nicotine induced more NAcc reactivity to reward anticipation. Greater NAcc activation during anticipation was significantly associated with lower NAcc activation to outcome. During outcome, nicotine reduced NAcc functional connectivity with cortical regions including the anterior cingulate cortex, orbitofrontal cortex, and insula. These regions showed the same negative relationship between reward anticipation and outcome as noted in the NAcc. The current findings significantly improve our understanding of how nicotine changes corticostriatal circuit function and communication during distinct phases of reward processing and critically show that these alterations happen acutely following a single dose. The implications of this work explain nicotinic modulation of general reward function, which offer insights into the initial drive to smoke and the subsequent difficulty in cessation.
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Affiliation(s)
- Kainan S. Wang
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
| | - Maya Zegel
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA
| | - Elena Molokotos
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,0000 0001 0684 8852grid.264352.4Department of Psychology, Suffolk University, Boston, MA USA
| | - Lauren V. Moran
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
| | - David P. Olson
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
| | - Diego A. Pizzagalli
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
| | - Amy C. Janes
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
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13
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Allenby C, Falcone M, Wileyto EP, Cao W, Bernardo L, Ashare RL, Janes A, Loughead J, Lerman C. Neural cue reactivity during acute abstinence predicts short-term smoking relapse. Addict Biol 2020; 25:e12733. [PMID: 30806013 DOI: 10.1111/adb.12733] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
Abstract
In smokers, neural responses to smoking cues can be sensitive to acute abstinence, but the degree to which abstinence-related cue reactivity contributes to relapse is not fully understood. This study addressed this question in a sample of 75 smokers who were motivated to quit smoking. Participants underwent blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) during presentation of visual smoking cues and neutral stimuli on two occasions: once during smoking satiety and once following 24-hour abstinence (order counterbalanced). Following the imaging sessions, participants received brief smoking cessation counseling prior to a short-term (7-day) quit attempt. The primary smoking cessation outcome was biochemically confirmed 7-day relapse. The secondary smoking cessation outcome measure was total number of self-reported days of abstinence. During abstinence (vs satiety), smoking cue reactivity was significantly increased only in the anterior cingulate cortex (ACC); other regions showing a cue (vs neutral) response did not exhibit an abstinence effect in the stringent whole-brain analysis. Participants who showed greater smoking cue reactivity in the ACC during acute abstinence (compared with smoking satiety) were more likely to relapse (OR = 2.10 per standard deviation increase in percent signal change [abstinence minus smoking satiety], 95% CI: 1.05 to 4.20, P = 0.036). Greater abstinence-induced change in ACC activation also predicted fewer total days abstinent (β = -0.63, 95% CI = 0.43 to 0.66, P < 0.0001). This study provides the first evidence that changes in smoking cue reactivity in the ACC during acute abstinence predict smoking relapse, thereby improving our understanding of the neurobiology of smoking cessation.
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Affiliation(s)
- Cheyenne Allenby
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Mary Falcone
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - E. Paul Wileyto
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of Pennsylvania Philadelphia PA USA
| | - Wen Cao
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Leah Bernardo
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Rebecca L. Ashare
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Amy Janes
- McLean Hospital, and the Department of Psychiatry, Harvard Medical SchoolMcLean Imaging Center Belmont MA USA
| | - James Loughead
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Caryn Lerman
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
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14
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Siegel SD, Lerman C, Flitter A, Schnoll RA. The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions. Cancer Prev Res (Phila) 2020; 13:261-272. [PMID: 32132120 PMCID: PMC7080293 DOI: 10.1158/1940-6207.capr-19-0259] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022]
Abstract
The nicotine metabolite ratio (NMR), a genetically informed biomarker of rate of nicotine metabolism, has been validated as a tool to select the optimal treatment for individual smokers, thereby improving treatment outcomes. This review summarizes the evidence supporting the development of the NMR as a biomarker of individual differences in nicotine metabolism, the relationship between the NMR and smoking behavior, the clinical utility of using the NMR to personalize treatments for smoking cessation, and the potential mechanisms that underlie the relationship between NMR and smoking cessation. We conclude with a call for additional research necessary to determine the ultimate benefits of using the NMR to personalize treatments for smoking cessation. These future directions include measurement and other methodologic considerations, disseminating this approach to at-risk subpopulations, expanding the NMR to evaluate its efficacy in predicting treatment responses to e-cigarettes and other noncigarette forms of nicotine, and implementation science including cost-effectiveness analyses.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.
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Affiliation(s)
- Scott D Siegel
- Value Institute and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware.
| | - Caryn Lerman
- Department of Psychiatry and Norris Cancer Center, University of Southern California, Los Angeles, California
| | - Alex Flitter
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Garcia‐Rivas V, Deroche‐Gamonet V. Not all smokers appear to seek nicotine for the same reasons: implications for preclinical research in nicotine dependence. Addict Biol 2019; 24:317-334. [PMID: 29480575 DOI: 10.1111/adb.12607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 12/11/2017] [Accepted: 01/15/2018] [Indexed: 01/08/2023]
Abstract
Tobacco use leads to 6 million deaths every year due to severe long-lasting diseases. The main component of tobacco, nicotine, is recognized as one of the most addictive drugs, making smoking cessation difficult, even when 70 percent of smokers wish to do so. Clinical and preclinical studies have demonstrated consistently that nicotine seeking is a complex behavior involving various psychopharmacological mechanisms. Evidence supports that the population of smokers is heterogeneous, particularly as regards the breadth of motives that determine the urge to smoke. Here, we review converging psychological, genetic and neurobiological data from clinical and preclinical studies supporting that the mechanisms controlling nicotine seeking may vary from individual to individual. It appears timely that basic neuroscience integrates this heterogeneity to refine our understanding of the neurobiology of nicotine seeking, as tremendous progress has been made in modeling the various psychopharmacological mechanisms driving nicotine seeking in rodents. For a better understanding of the mechanisms that drive nicotine seeking, we emphasize the need for individual-based research strategies in which nicotine seeking, and eventually treatment efficacy, are determined while taking into account individual variations in the mechanisms of nicotine seeking.
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Affiliation(s)
- Vernon Garcia‐Rivas
- Université de Bordeaux France
- INSERM U1215, Psychobiology of Drug AddictionNeuroCentre Magendie France
| | - Véronique Deroche‐Gamonet
- Université de Bordeaux France
- INSERM U1215, Psychobiology of Drug AddictionNeuroCentre Magendie France
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16
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Ashare RL, Thompson M, Leone F, Metzger D, Gross R, Mounzer K, Tyndale RF, Lerman C, Mahoney MC, Cinciripini P, George TP, Collman RG, Schnoll R. Differences in the rate of nicotine metabolism among smokers with and without HIV. AIDS 2019; 33:1083-1088. [PMID: 30946162 DOI: 10.1097/qad.0000000000002127] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE HIV-infected smokers lose more life years to tobacco use than to HIV infection. The nicotine metabolite ratio (NMR), a biomarker of CYP2A6, represents individual variation in the rate at which nicotine is metabolized and is associated with response to smoking cessation treatments. We evaluated whether HIV-infected smokers metabolize nicotine faster than HIV-uninfected smokers, which may contribute to the disproportionate smoking burden and may have important treatment implications. DESIGN We analysed baseline data from two clinical trials (NCT01710137; NCT01314001) to compare the NMR in HIV-infected smokers (N = 131) to HIV-uninfected smokers (N = 199). METHODS Propensity scores were used to match the groups 2 : 1 on characteristics that influence NMR: sex, race, BMI and smoking rate. Nicotine metabolites were assessed via liquid chromatography-tandem mass spectrometry methods and the ratio of 3-hydroxycotinine:cotinine was used to compute the NMR. RESULTS HIV-infected smokers had significantly higher NMR (mean = 0.47, SEM = 0.02) and were more likely to be in the highest NMR quartile compared with HIV-uninfected smokers (mean = 0.34, SEM = 0.02; Ps < 0.001). CONCLUSION The higher NMR observed among HIV-infected smokers may partially explain higher smoking rates and lower response to transdermal nicotine therapy. Understanding the mechanisms by which HIV and/or ART contribute to faster nicotine metabolism may guide the use of the NMR to personalize tobacco cessation strategies in this underserved population.
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17
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Schnoll RA, Thompson M, Serrano K, Leone F, Metzger D, Frank I, Gross R, Mounzer K, Tyndale RF, Weisbrot J, Meline M, Collman RG, Ashare RL. Brief Report: Rate of Nicotine Metabolism and Tobacco Use Among Persons With HIV: Implications for Treatment and Research. J Acquir Immune Defic Syndr 2019; 80:e36-e40. [PMID: 30399039 PMCID: PMC6331237 DOI: 10.1097/qai.0000000000001895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The nicotine metabolite ratio (NMR) is a biomarker that represents individual variation in the speed that nicotine is metabolized. The rate of nicotine metabolism alters smoking behavior (eg, amount) and has been validated for personalizing tobacco dependence medication selection to increase treatment efficacy and reduce treatment side effects in the general population of smokers. Although smoking rates are extremely high among those with HIV, the NMR has not been evaluated in this underserved population. METHODS We used baseline data from a smoking cessation clinical trial for smokers with HIV (N = 131) to examine associations between NMR and demographic, smoking, disease-related, and psychological characteristics. Pearson r and analysis of variance were used to identify univariate correlates of NMR, which were then entered into a multiple linear regression model. RESULTS In univariate analyses, a higher NMR (faster nicotine metabolism) was associated with being white, and more cigarettes per day, nicotine dependence, exhaled carbon monoxide, and symptoms of depression and anxiety, and using efavirenz. In a multiple regression model, a higher NMR was associated with more cigarettes per day, higher anxiety symptoms, and efavirenz use. CONCLUSIONS As in other populations, faster nicotine metabolism was associated with the use of more cigarettes and higher anxiety symptoms. Notably, efavirenz use was associated with faster metabolism, which might make it harder to quit smoking for people with HIV treated with that medication. These findings could help guide further study and the clinical use of the NMR to personalize nicotine dependence treatment in this underserved population.
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Affiliation(s)
- Robert A. Schnoll
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Morgan Thompson
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Katrina Serrano
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Frank Leone
- Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104, USA;
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Ian Frank
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, 3610 Hamilton Walk, Philadelphia, PA 19104, USA;
| | - Robert Gross
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, 3610 Hamilton Walk, Philadelphia, PA 19104, USA;
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Karam Mounzer
- Philadelphia Fight, 1233 Locust Street, 3rd Floor, Philadelphia, PA 19107, USA;
| | - Rachel F. Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Department of Pharmacology and Toxicology, and Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto; 1 King’s College Circle, Toronto, Canada M5S 1A8;
| | - Jessica Weisbrot
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Miles Meline
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
| | - Ronald G. Collman
- Pulmonary, Allergy & Critical Care, University of Pennsylvania School of Medicine 522 Johnson Pavilion, 36th & Hamilton Walk, Philadelphia, PA 19104;
| | - Rebecca L. Ashare
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA; ; ; ; ; ; ;
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18
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Valentine GW, DeVito EE, Jatlow PI, Gueorguieva R, Sofuoglu M. Acute effects of inhaled menthol on the rewarding effects of intravenous nicotine in smokers. J Psychopharmacol 2018; 32:986-994. [PMID: 29788802 PMCID: PMC6329876 DOI: 10.1177/0269881118773972] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This double-blind, placebo controlled study examined whether menthol inhaled from an electronic cigarette (e-cigarette) would change subjective and withdrawal alleviating effects of intravenous nicotine in young adult smokers. METHODS A total of 32 menthol-preferring smokers and 25 non-menthol-preferring smokers participated in the study that consisted of a random sequence of three different inhaled menthol conditions (0.0%, 0.5%, and 3.2%) across three test sessions (a single menthol condition per session). In each test session (performed at least 24 hours apart), a random order of saline, and two different nicotine infusions of 0.25 mg and 0.5 mg/70 kg of bodyweight were administered, one hour apart, concurrent with menthol inhalation. RESULTS While menthol did not alter the positive subjective effects of nicotine, menthol significantly enhanced aversive effects of nicotine in non-menthol-preferring smokers and reduced smoking urges in menthol-preferring smokers. In addition, menthol-preferring smokers reported blunted positive subjective responses to nicotine and less severe nicotine withdrawal after overnight nicotine deprivation. Finally, compared to non-menthol-preferring smokers, menthol-preferring smokers had a significantly lower baseline nicotine metabolite ratio indicating slower nicotine metabolism within our sample of menthol-preferring smokers. CONCLUSIONS Our findings did not support an enhancement of nicotine's positive subjective effects from inhaled menthol. However, as compared to non-menthol-preferring smokers, menthol-preferring smokers had blunted positive subjective responses to nicotine and reduced overnight withdrawal severity that may be partly due to inhibition of nicotine metabolism from chronic exposure to inhaled menthol. Collectively, these results reveal a more complex and nuanced role of inhaled menthol in smokers than previously recognized.
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Affiliation(s)
- Gerald W Valentine
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Elise E DeVito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Peter I Jatlow
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT USA
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
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19
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Di Ciano P, Tyndale RF, Mansouri E, Hendershot CS, Wilson AA, Lagzdins D, Houle S, Boileau I, Le Foll B. Influence of Nicotine Metabolism Ratio on [11C]-(+)-PHNO PET Binding in Tobacco Smokers. Int J Neuropsychopharmacol 2018; 21:503-512. [PMID: 29346545 PMCID: PMC6007643 DOI: 10.1093/ijnp/pyx119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying the biological basis of smoking cessation success is of growing interest. The rate of nicotine metabolism, measured by the nicotine metabolite ratio, affects multiple aspects of nicotine dependence. Fast nicotine metabolizers tend to smoke more, experience more withdrawal and craving, and have lower cessation rates compared with slow metabolizers. The nicotine metabolite ratio predicts treatment response, and differences in brain activation between fast metabolizers and slow metabolizers have been reported in fMRI studies. As reinforcing/rewarding effects of tobacco are associated with dopamine transmission, the purpose of the present study was to study the dopaminergic system in human smokers based on their nicotine metabolite ratio. METHODS The first aim of the study was to explore if there were differences in D2 and D3 receptor binding between fast metabolizers and slow metabolizers during abstinence. The second aim was to explore smoking-induced dopamine release in both groups. Participants underwent 2 [11C]-(+)-PHNO PET scans: one scan during abstinence and the other after smoking a tobacco cigarette. Subjective measures were recorded and blood was drawn for measurement of nicotine and cotinine levels. RESULTS During abstinence, slow metabolizers (n = 13) had lower [11C]-(+)-PHNO binding potential than fast metabolizers (n = 15) restricted to the D2 regions of the associative striatum and sensorimotor striatum. After smoking a cigarette, [11C]-(+)-PHNO binding potential was decreased in the limbic striatum and ventral pallidum, suggestive of increases in dopamine, but there were no nicotine metabolite ratio differences. CONCLUSIONS Further studies are required to delineate if differences in [11C]-(+)-PHNO binding between slow metabolizers and fast metabolizers at abstinence baseline are preexisting traits or induced by prolonged tobacco use.
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Affiliation(s)
- Patricia Di Ciano
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute Toronto, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada,Department of Pharmacology and Toxicology,Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Christian S Hendershot
- Campbell Family Mental Health Research Institute Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Alan A Wilson
- Campbell Family Mental Health Research Institute Toronto, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada,Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Dina Lagzdins
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sylvain Houle
- Campbell Family Mental Health Research Institute Toronto, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada,Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Isabelle Boileau
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada,Addiction Imaging Research Group Toronto, Canada,Campbell Family Mental Health Research Institute Toronto, Canada,Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada,Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada,Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada,Campbell Family Mental Health Research Institute Toronto, Canada,Department of Pharmacology and Toxicology,Department of Psychiatry, University of Toronto, Toronto, Canada,Institute of Medical Sciences, University of Toronto, Toronto, Canada,Correspondence: Bernard Le Foll, MD, PhD, Centre for Addiction and Mental Health., 33 Russell Street, Toronto, Ontario, M5S 2S1 ()
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20
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Gilman JM, Radoman M, Schuster RM, Pachas G, Azzouz N, Fava M, Evins AE. Anterior insula activation during inhibition to smoking cues is associated with ability to maintain tobacco abstinence. Addict Behav Rep 2018; 7:40-46. [PMID: 29450255 PMCID: PMC5805503 DOI: 10.1016/j.abrep.2018.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 11/04/2022] Open
Abstract
Relapse to smoking after initial abstinence is a major clinical challenge with significant public health consequences. At the brain and behavioral level, those who relapse to tobacco smoking have both greater cue-reactivity and lower inhibitory control than those who remain abstinent. Little is known about neural activation during inhibitory control tasks in the presence of drug-related cues. In the current study, tobacco smokers (SMK; n = 22) and non-smoking controls (CON; n = 19) completed a Go/NoGo task involving smoking cues during a functional magnetic resonance imaging (fMRI) scan. Following the scan session, smokers were required to quit smoking, and maintenance of abstinence was evaluated as part of a 12-week smoking cessation trial. We evaluated pre-cessation brain activity during NoGo trials in smokers who were versus were not able to quit smoking. We then compared fMRI and inhibitory control measures between smokers and non-smokers. We did not find differences between SMK and CON in performance or activation to smoking or neutral cues. However, compared to SMK who relapsed, SMK who attained biochemically-validated abstinence at the end of the smoking cessation trial had greater neural activation in the anterior insula during NoGo trials specifically with smoking-related cues. Results indicate that within SMK, decreased inhibitory control activation during direct exposure to drug-related stimuli may be a marker of difficulty quitting and relapse vulnerability. Smokers and controls showed no differences in performance or activation to smoking or neutral cues. Abstinent smokers compared to relapsers had greater activation in the insula during NoGo trials with smoking-related cues. Within smokers, decreased NoGo activation during exposure to drug-related cues may be a marker of relapse vulnerability.
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Affiliation(s)
- Jodi M Gilman
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, MGH, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Milena Radoman
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA
| | - Randi M Schuster
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Gladys Pachas
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA
| | - Nour Azzouz
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA
| | - Maurizio Fava
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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21
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Faulkner P, Ghahremani DG, Tyndale RF, Cox CM, Kazanjian AS, Paterson N, Lotfipour S, Hellemann GS, Petersen N, Vigil C, London ED. Reduced-Nicotine Cigarettes in Young Smokers: Impact of Nicotine Metabolism on Nicotine Dose Effects. Neuropsychopharmacology 2017; 42:1610-1618. [PMID: 28117337 PMCID: PMC5518898 DOI: 10.1038/npp.2017.18] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/16/2016] [Accepted: 01/19/2017] [Indexed: 01/05/2023]
Abstract
The use of cigarettes delivering different nicotine doses allows evaluation of the contribution of nicotine to the smoking experience. We compared responses of 46 young adult smokers to research cigarettes, delivering 0.027, 0.110, 0.231, or 0.763 mg nicotine, and conventional cigarettes. On five separate days, craving, withdrawal, affect, and sustained attention were measured after overnight abstinence and again after smoking. Participants also rated each cigarette, and the nicotine metabolite ratio (NMR) was used to identify participants as normal or slow metabolizers. All cigarettes equally alleviated craving, withdrawal, and negative affect in the whole sample, but normal metabolizers reported greater reductions of craving and withdrawal than slow metabolizers, with dose-dependent effects. Only conventional cigarettes and, to a lesser degree, 0.763-mg nicotine research cigarettes increased sustained attention. Finally, there were no differences between ratings of lower-dose cigarettes, but the 0.763-mg cigarettes and (even more so) conventional cigarettes were rated more favorably than lower-dose cigarettes. The findings indicate that smoking-induced relief of craving and withdrawal reflects primarily non-nicotine effects in slow metabolizers, but depends on nicotine dose in normal metabolizers. By contrast, relief of withdrawal-related attentional deficits and cigarette ratings depend on nicotine dose regardless of metabolizer status. These findings have bearing on the use of reduced-nicotine cigarettes to facilitate smoking cessation and on policy regarding regulation of nicotine content in cigarettes. They suggest that normal and slow nicotine metabolizers would respond differently to nicotine reduction in cigarettes, but that irrespective of metabolizer status, reductions to <0.763 mg/cigarette may contribute to temporary attentional deficits.
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Affiliation(s)
- Paul Faulkner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Dara G Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Rachel F Tyndale
- Department of Pharmacology & Toxicology, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health (CAMH), University of Toronto, 1 King’s College Circle, Toronto, ON, Canada,Department of Psychiatry, Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health (CAMH), University of Toronto, 1 King’s College Circle, Toronto, ON, Canada
| | - Chelsea M Cox
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Ari S Kazanjian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Neil Paterson
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Shahrdad Lotfipour
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Gerhard S Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Nicole Petersen
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Celia Vigil
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA,Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90025, USA, Tel: 310 825 0606, Fax: 310 825-0812, E-mail:
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22
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Garcia-Rivas V, Cannella N, Deroche-Gamonet V. Individual Variations in the Mechanisms of Nicotine Seeking: A Key for Research on Nicotine Dependence. Neuropsychopharmacology 2017; 42:584-586. [PMID: 27577600 PMCID: PMC5240183 DOI: 10.1038/npp.2016.176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Vernon Garcia-Rivas
- INSERM U1215, Pathophysiology of Addiction, NeuroCentre Magendie, Bordeaux, France,University of Bordeaux, Bordeaux, France
| | - Nazzareno Cannella
- INSERM U1215, Pathophysiology of Addiction, NeuroCentre Magendie, Bordeaux, France,University of Bordeaux, Bordeaux, France
| | - Véronique Deroche-Gamonet
- INSERM U1215, Pathophysiology of Addiction, NeuroCentre Magendie, Bordeaux, France,University of Bordeaux, Bordeaux, France,INSERM U1215, Pathophysiology of Addiction, Neuro Centre Magendie, 146 rue Léo Saignat, Bordeaux 33077, France, Tel: +33 5 57 57 36 80, Fax: +33 5 57 57 36 69, E-mail:
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23
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Chenoweth MJ, Tyndale RF. Pharmacogenetic Optimization of Smoking Cessation Treatment. Trends Pharmacol Sci 2017; 38:55-66. [PMID: 27712845 PMCID: PMC5195866 DOI: 10.1016/j.tips.2016.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/08/2016] [Accepted: 09/12/2016] [Indexed: 12/12/2022]
Abstract
Worldwide, approximately one billion people smoke cigarettes. Cigarette smoking persists in part because long-term smoking cessation rates are modest on existing treatments. Smoking cessation outcomes are influenced by genetic factors, including genetic variation in enzymes that metabolize nicotine and smoking cessation medications, as well as in receptor targets for nicotine and treatment medications. For example, smokers with genetically slow nicotine metabolism have higher cessation success on behavioural counseling and nicotine patches compared with smokers with genetically fast nicotine metabolism. In this review, we highlight new progress in our understanding of how genetic variation in the pharmacological targets of nicotine and smoking cessation medications could be used to tailor smoking cessation therapy, increase quit rates, and reduce tobacco-related harm.
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Affiliation(s)
- Meghan J Chenoweth
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ONT, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ONT, Canada
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ONT, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ONT, Canada; Department of Psychiatry, University of Toronto, Toronto, ONT, Canada.
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24
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Yip SW, Balodis IM, Carroll KM, Krishnan-Sarin S, Potenza MN. Intra-individual changes in Stroop-related activations linked to cigarette abstinence in adolescent tobacco smokers: Preliminary findings. Drug Alcohol Depend 2016; 167:182-9. [PMID: 27567966 PMCID: PMC5082713 DOI: 10.1016/j.drugalcdep.2016.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/05/2016] [Accepted: 08/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescence is a crucial time for initiation of tobacco-smoking. Developing more effective treatment interventions for tobacco-smoking in youth is therefore critical to reduce smoking rates in both adolescent and adult populations. Elucidation of the neural mechanisms of successful behavioral change (abstinence) will allow for improvement of therapies based on known brain mechanisms. METHODS Twenty-one adolescent tobacco-smokers (14-19 years) participated in functional magnetic resonance imaging (fMRI) during performance of a cognitive control (Stroop) task prior to randomization to smoking cessation treatment (trial of combined nicotine replacement therapy/placebo and contingency management for attendance/abstinence; NCT01145001). Fourteen adolescents also participated in fMRI scanning following completion of the six-week trial. fMRI data were analyzed using random-effects models in SPM12. Paired t-tests were used to identify group-level changes (main effect of treatment exposure) in neural functional responses. Regression models were used to identify individual-level changes associated with treatment-outcomes (percent days abstinent, maximum days of consecutive abstinence). RESULTS Main effects of Stroop task performance (contrast of incongruent versus congruent trials) were seen across a priori ROIs at both pre- and post-treatment (pFWE<0.05). At the group-level, no changes in neural responses were found following treatment. However, intra-individual reductions in Stroop-related activity (within the insula and anterior cingulate) were positively associated with measures of smoking abstinence during treatment (pFWE<0.05). CONCLUSIONS Abstinence from tobacco during smoking cessation treatment among adolescents is associated with cognitive-control related reductions in neural activity within specific regions (anterior cingulate, insula), suggesting that increases in cognitive efficiency may underlie optimal treatment responses in this population.
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Affiliation(s)
- Sarah W. Yip
- The National Center on Addiction and Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Iris M. Balodis
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Psychiatry and Behavioural Neurosciences, Peter Borris Centre for Addictions Research, McMaster University, Hamilton, ON, Canada
| | - Kathleen M. Carroll
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Suchitra Krishnan-Sarin
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N. Potenza
- The National Center on Addiction and Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA,Yale Child Study Center, Yale University School of Medicine, New Haven, CT, US
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25
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Allenby CE, Boylan KA, Lerman C, Falcone M. Precision Medicine for Tobacco Dependence: Development and Validation of the Nicotine Metabolite Ratio. J Neuroimmune Pharmacol 2016; 11:471-83. [PMID: 26872457 PMCID: PMC5479354 DOI: 10.1007/s11481-016-9656-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
Quitting smoking significantly reduces the risk of tobacco-related morbidity and mortality, yet there is a high rate of relapse amongst smokers who try to quit. Phenotypic biomarkers have the potential to improve smoking cessation outcomes by identifying the best available treatment for an individual smoker. In this review, we introduce the nicotine metabolite ratio (NMR) as a reliable and stable phenotypic measure of nicotine metabolism that can guide smoking cessation treatment among smokers who wish to quit. We address how the NMR accounts for sources of variation in nicotine metabolism including genotype and other biological and environmental factors such as estrogen levels, alcohol use, body mass index, or menthol exposure. Then, we highlight clinical trials that validate the NMR as a biomarker to predict therapeutic response to different pharmacotherapies for smoking cessation. Current evidence supports the use of nicotine replacement therapy for slow metabolizers, and non-nicotine treatments such as varenicline for normal metabolizers. Finally, we discuss future research directions to elucidate mechanisms underlying NMR associations with treatment response, and facilitate the implementation of the NMR as biomarker in clinical practice to guide smoking cessation.
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Affiliation(s)
- Cheyenne E Allenby
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA
| | - Kelly A Boylan
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA
| | - Caryn Lerman
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA
| | - Mary Falcone
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, 19104, USA.
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