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Ravanfar P, Rushmore RJ, Lyall AE, Cropley V, Makris N, Desmond P, Velakoulis D, Shenton ME, Bush AI, Rossell SL, Pantelis C, Syeda WT, Phillipou A. Investigation of brain iron in anorexia nervosa, a quantitative susceptibility mapping study. J Eat Disord 2023; 11:142. [PMID: 37605216 PMCID: PMC10441741 DOI: 10.1186/s40337-023-00870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a potentially fatal psychiatric condition, associated with structural brain changes such as gray matter volume loss. The pathophysiological mechanisms for these changes are not yet fully understood. Iron is a crucial element in the development and function of the brain. Considering the systemic alterations in iron homeostasis in AN, we hypothesized that brain iron would be altered as a possible factor associated with structural brain changes in AN. METHODS In this study, we used quantitative susceptibility mapping (QSM) magnetic resonance imaging to investigate brain iron in current AN (c-AN) and weight-restored AN compared with healthy individuals. Whole-brain voxel wise comparison was used to probe areas with possible group differences. Further, the thalamus, caudate nucleus, putamen, nucleus accumbens, hippocampus, and amygdala were selected as the regions of interest (ROIs) for ROI-based comparison of mean QSM values. RESULTS Whole-brain voxel-wise and ROI-based comparison of QSM did not reveal any differences between groups. Exploratory analyses revealed a correlation between higher regional QSM (higher iron) and lower body mass index, higher illness severity, longer illness duration, and younger age at onset in the c-AN group. CONCLUSIONS This study did not find evidence of altered brain iron in AN compared to healthy individuals. However, the correlations between clinical variables and QSM suggest a link between brain iron and weight status or biological processes in AN, which warrants further investigation.
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Affiliation(s)
- Parsa Ravanfar
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Royal Melbourne Hospital, Level 3, Alan Gilbert Building, 161 Barry ST, Carlton South, VIC, 3053, Australia.
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - R Jarrett Rushmore
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Center for Morphometric Analysis (CMA), Massachusetts General Hospital, Charlestown, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Amanda E Lyall
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Royal Melbourne Hospital, Level 3, Alan Gilbert Building, 161 Barry ST, Carlton South, VIC, 3053, Australia
| | - Nikos Makris
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Center for Morphometric Analysis (CMA), Massachusetts General Hospital, Charlestown, MA, USA
| | - Patricia Desmond
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Royal Melbourne Hospital, Level 3, Alan Gilbert Building, 161 Barry ST, Carlton South, VIC, 3053, Australia
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Ashley I Bush
- Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health and Brain Sciences, Swinburne University, Hawthorn, VIC, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Royal Melbourne Hospital, Level 3, Alan Gilbert Building, 161 Barry ST, Carlton South, VIC, 3053, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Warda T Syeda
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Royal Melbourne Hospital, Level 3, Alan Gilbert Building, 161 Barry ST, Carlton South, VIC, 3053, Australia
| | - Andrea Phillipou
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Mental Health, Austin Health, Melbourne, Australia
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Leenaerts N, Jongen D, Ceccarini J, Van Oudenhove L, Vrieze E. The neurobiological reward system and binge eating: A critical systematic review of neuroimaging studies. Int J Eat Disord 2022; 55:1421-1458. [PMID: 35841198 DOI: 10.1002/eat.23776] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Changes in reward processing are hypothesized to play a role in the onset and maintenance of binge eating (BE). However, despite an increasing number of studies investigating the neurobiological reward system in individuals who binge eat, no comprehensive systematic review exists on this topic. Therefore, this review has the following objectives: (1) identify structural and functional changes in the brain reward system, either during rest or while performing a task; and (2) formulate directions for future research. METHODS A search was conducted of articles published until March 31, 2022. Neuroimaging studies were eligible if they wanted to study the reward system and included a group of individuals who binge eat together with a comparator group. Their results were summarized in a narrative synthesis. RESULTS A total of 58 articles were included. At rest, individuals who binge eat displayed a lower striatal dopamine release, a change in the volume of the striatum, frontal cortex, and insula, as well as a lower frontostriatal connectivity. While performing a task, there was a higher activity of the brain reward system when anticipating or receiving food, more model-free reinforcement learning, and more habitual behavior. Most studies only included one patient group, used general reward-related measures, and did not evaluate the impact of comorbidities, illness duration, race, or sex. DISCUSSION Confirming previous hypotheses, this review finds structural and functional changes in the neurobiological reward system in BE. Future studies should compare disorders, use measures that are specific to BE, and investigate the impact of confounding factors. PUBLIC SIGNIFICANCE STATEMENT This systematic review finds that individuals who binge eat display structural and functional changes in the brain reward system. These changes could be related to a higher sensitivity to food, relying more on previous experiences when making decisions, and more habitual behavior. Future studies should use a task that is specific to binge eating, look across different patient groups, and investigate the impact of comorbidities, illness duration, race, and sex.
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Affiliation(s)
- Nicolas Leenaerts
- Mind-body Research, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Daniëlle Jongen
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jenny Ceccarini
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.,Cognitive & Affective Neuroscience Laboratory, Department of Psychological & Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Elske Vrieze
- Mind-body Research, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
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Breton E, Fotso Soh J, Booij L. Immunoinflammatory processes: Overlapping mechanisms between obesity and eating disorders? Neurosci Biobehav Rev 2022; 138:104688. [PMID: 35594735 DOI: 10.1016/j.neubiorev.2022.104688] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
Obesity and eating disorders are conditions that involve eating behaviors and are sometimes comorbid. Current evidence supports alterations in immunoinflammatory processes in both obesity and eating disorders. A plausible hypothesis is that immunoinflammatory processes may be involved in the pathophysiology of obesity and eating disorders. The aim of this review is to highlight the link between obesity and eating disorders, with a particular focus on immunoinflammatory processes. First, the relation between obesity and eating disorders will be presented, followed by a brief review of the literature on their association with immunoinflammatory processes. Second, developmental factors will be discussed to clarify the link between obesity, eating disorders, and immunoinflammatory processes. Genetic and epigenetic risk factors as well as the potential roles of stress pathways and early life development will be presented. Finally, implications of these findings for future research are discussed. This review highlighted biological and developmental aspects that overlap between obesity and EDs, emphasizing the need for biopsychosocial research approaches to advance current knowledge and practice in these fields.
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Affiliation(s)
- E Breton
- Sainte-Justine Hospital Research Centre, Montreal, Canada; Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada
| | - J Fotso Soh
- Sainte-Justine Hospital Research Centre, Montreal, Canada; Department of Psychology, Concordia University, Montreal, Canada
| | - L Booij
- Sainte-Justine Hospital Research Centre, Montreal, Canada; Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada; Department of Psychology, Concordia University, Montreal, Canada.
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Pruccoli J, Parmeggiani A, Cordelli DM, Lanari M. The Role of the Noradrenergic System in Eating Disorders: A Systematic Review. Int J Mol Sci 2021; 22:11086. [PMID: 34681746 PMCID: PMC8537146 DOI: 10.3390/ijms222011086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 01/30/2023] Open
Abstract
Noradrenaline (NE) is a catecholamine acting as both a neurotransmitter and a hormone, with relevant effects in modulating feeding behavior and satiety. Several studies have assessed the relationship between the noradrenergic system and Eating Disorders (EDs). This systematic review aims to report the existing literature on the role of the noradrenergic system in the development and treatment of EDs. A total of 35 studies were included. Preclinical studies demonstrated an involvement of the noradrenergic pathways in binge-like behaviors. Genetic studies on polymorphisms in genes coding for NE transporters and regulating enzymes have shown conflicting evidence. Clinical studies have reported non-unanimous evidence for the existence of absolute alterations in plasma NE values in patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN). Pharmacological studies have documented the efficacy of noradrenaline-modulating therapies in the treatment of BN and Binge Eating Disorder (BED). Insufficient evidence was found concerning the noradrenergic-mediated genetics of BED and BN, and psychopharmacological treatments targeting the noradrenergic system in AN. According to these data, further studies are required to expand the existing knowledge on the noradrenergic system as a potential target for treatments of EDs.
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Affiliation(s)
- Jacopo Pruccoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell’Alimentazione in età Evolutiva, U.O. Neuropsichiatria dell’età Pediatrica, 40138 Bologna, Italy; (A.P.); (D.M.C.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy;
| | - Antonia Parmeggiani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell’Alimentazione in età Evolutiva, U.O. Neuropsichiatria dell’età Pediatrica, 40138 Bologna, Italy; (A.P.); (D.M.C.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy;
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Centro Regionale per i Disturbi della Nutrizione e dell’Alimentazione in età Evolutiva, U.O. Neuropsichiatria dell’età Pediatrica, 40138 Bologna, Italy; (A.P.); (D.M.C.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy;
| | - Marcello Lanari
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40138 Bologna, Italy;
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di S. Orsola, U.O. Pediatria d’urgenza, Pronto Soccorso Pediatrico e OBI, 40138 Bologna, Italy
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Dalton B, Maloney E, Rennalls SJ, Bartholdy S, Kekic M, McClelland J, Campbell IC, Schmidt U, O'Daly OG. A pilot study exploring the effect of repetitive transcranial magnetic stimulation (rTMS) treatment on cerebral blood flow and its relation to clinical outcomes in severe enduring anorexia nervosa. J Eat Disord 2021; 9:84. [PMID: 34243816 PMCID: PMC8268186 DOI: 10.1186/s40337-021-00420-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment option for people with severe enduring anorexia nervosa (SE-AN), but associated neurobiological changes are poorly understood. This study investigated the effect of rTMS treatment on regional cerebral blood flow (CBF) and whether any observed changes in CBF are associated with changes in clinical outcomes in people with SE-AN. METHODS As part of a randomised sham-controlled feasibility trial of 20 sessions of high-frequency rTMS to the left dorsolateral prefrontal cortex, 26 of 34 trial participants completed arterial spin labelling (ASL) functional magnetic resonance imaging (fMRI) to quantify regional and global resting state CBF before (pre-randomisation baseline) and after real or sham treatment (1-month post-randomisation). A group of healthy females (n = 30) were recruited for baseline comparison. Clinical outcomes, including BMI, and depression and anxiety symptoms, were assessed at baseline, 1-, 4-, and 18-months post-randomisation. RESULTS No group differences in regional CBF were identified between the SE-AN and healthy comparison participants. A significant treatment-by-time interaction in a medial temporal lobe cluster with the maximal peak in the right amygdala was identified, reflecting a greater reduction in amygdala CBF following real rTMS compared to sham. Participants with the greatest rTMS-related reduction in amygdala CBF (i.e., between baseline and 1-month post-randomisation) showed the greatest sustained weight gain at 18-months post-randomisation. Higher baseline CBF in the insula predicted greater weight gain between baseline and 1-month post-randomisation and between baseline and 4-months post-randomisation. CONCLUSIONS This exploratory pilot study identified rTMS treatment related changes in CBF in adults with SE-AN and these were associated with changes in weight. Our preliminary findings also suggest that CBF (as measured by ASL fMRI) may be a marker of rTMS treatment response in this patient group. Future rTMS studies in AN should employ longitudinal neuroimaging to further explore the neurobiological changes related to rTMS treatment. TRIAL REGISTRATION ISRCTN14329415 , registered 23rd July 2015.
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Affiliation(s)
- Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Erica Maloney
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samantha J Rennalls
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Kekic
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica McClelland
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Owen G O'Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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