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Hofford RS, Kiraly DD. Clinical and Preclinical Evidence for Gut Microbiome Mechanisms in Substance Use Disorders. Biol Psychiatry 2024; 95:329-338. [PMID: 37573004 PMCID: PMC10884738 DOI: 10.1016/j.biopsych.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/14/2023]
Abstract
Substance use disorders are a set of recalcitrant neuropsychiatric conditions that cause tremendous morbidity and mortality and are among the leading causes of loss of disability-adjusted life years worldwide. While each specific substance use disorder is driven by problematic use of a different substance, they all share a similar pattern of escalating and out-of-control substance use, continued use despite negative consequences, and a remitting/relapsing pattern over time. Despite significant advances in our understanding of the neurobiology of these conditions, current treatment options remain few and are ineffective for too many individuals. In recent years, there has been a rapidly growing body of literature demonstrating that the resident population of microbes in the gastrointestinal tract, collectively called the gut microbiome, plays an important role in modulating brain and behavior in preclinical and clinical studies of psychiatric disease. While these findings have not yet been translated into clinical practice, this remains an important and exciting avenue for translational research. In this review, we highlight the current state of microbiome-brain research within the substance use field with a focus on both clinical and preclinical studies. We also discuss potential neurobiological mechanisms underlying microbiome effects on models of substance use disorder and propose future directions to bring these findings from bench to bedside.
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Affiliation(s)
- Rebecca S Hofford
- Department of Physiology & Pharmacology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Drew D Kiraly
- Department of Physiology & Pharmacology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina; Department of Psychiatry, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina.
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Kerman IA, Glover ME, Lin Y, West JL, Hanlon AL, Kablinger AS, Clinton SM. Antibiotic exposure is associated with decreased risk of psychiatric disorders. Front Pharmacol 2024; 14:1290052. [PMID: 38259293 PMCID: PMC10801048 DOI: 10.3389/fphar.2023.1290052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/01/2023] [Indexed: 01/24/2024] Open
Abstract
Objective: This study sought to investigate the relationship between antibiotic exposure and subsequent risk of psychiatric disorders. Methods: This retrospective cohort study used a national database of 69 million patients from 54 large healthcare organizations. We identified a cohort of 20,214 (42.5% male; 57.9 ± 15.1 years old [mean ± SD]) adults without prior neuropsychiatric diagnoses who received antibiotics during hospitalization. Matched controls included 41,555 (39.6% male; 57.3 ± 15.5 years old) hospitalized adults without antibiotic exposure. The two cohorts were balanced for potential confounders, including demographics and variables with potential to affect: the microbiome, mental health, medical comorbidity, and overall health status. Data were stratified by age and by sex, and outcome measures were assessed starting 6 months after hospital discharge. Results: Antibiotic exposure was consistently associated with a significant decrease in the risk of novel mood disorders and anxiety and stressor-related disorders in: men (mood (OR 0.84, 95% CI 0.77, 0.91), anxiety (OR 0.88, 95% CI 0.82, 0.95), women (mood (OR 0.94, 95% CI 0.89,1.00), anxiety (OR 0.93, 95% CI 0.88, 0.98), those who are 26-49 years old (mood (OR 0.87, 95% CI 0.80, 0.94), anxiety (OR 0.90, 95% CI 0.84, 0.97)), and in those ≥50 years old (mood (OR 0.91, 95% CI 0.86, 0.97), anxiety (OR 0.92, 95% CI 0.87, 0.97). Risk of intentional harm and suicidality was decreased in men (OR 0.73, 95% CI 0.55, 0.98) and in those ≥50 years old (OR 0.67, 95% CI 0.49, 0.92). Risk of psychotic disorders was also decreased in subjects ≥50 years old (OR 0.83, 95 CI: 0.69, 0.99). Conclusion: Use of antibiotics in the inpatient setting is associated with protective effects against multiple psychiatric outcomes in an age- and sex-dependent manner.
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Affiliation(s)
- Ilan A. Kerman
- Mental Health Integrated Care Community, Minneapolis Veterans Administration Health Care System, Minneapolis, MN, United States
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
| | - Matthew E. Glover
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
| | - Yezhe Lin
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carillion School of Medicine, Roanoke, VA, United States
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, Tongji University, Shanghai, China
- Department of Psychiatry, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jennifer L. West
- Department of Statistics and Center for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, United States
| | - Alexandra L. Hanlon
- Department of Statistics and Center for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, United States
| | - Anita S. Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carillion School of Medicine, Roanoke, VA, United States
| | - Sarah M. Clinton
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
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Shafeek P, Clegg T, Kawmi N, Luciano S, Bone C, Graziane N. The temporal relationship between antibiotic and opioid prescription on the risk of developing an opioid use disorder: A national database study. J Addict Dis 2023; 41:274-281. [PMID: 35938745 DOI: 10.1080/10550887.2022.2108364] [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: 11/09/2022]
Abstract
Background: Previously, we discovered that subjects co-prescribed both antibiotics and opioids on the same day in a hospital setting displayed an increased risk of developing an opioid use disorder (OUD) 12 months following hospital discharge. The goal of this study was to examine whether prescribing antibiotics in the inpatient or emergency department setting at various time points before or after an opioid prescription impacted the risk OUD.Methods: A propensity score matched cohort study was conducted to identify subjects (18-65 years old) with no previous history of OUD. Two cohorts were defined: subjects who were prescribed antibiotics 0-1, 2-4, 5-7, 8-10, 11-12 months before or after the date of an opioid prescription while in the emergency department or inpatient setting, from the years 2010-2019. The diagnosis of an Opioid Related Disorder (F11.10-F11.20) 12 months following discharge from the emergency department or inpatient unit was then observed.Results: Primary analysis showed that subjects prescribed an antibiotic 0-1 month or 8-10 months before an opioid prescription showed a modest risk of developing an OUD 12 months following an opioid prescription (0.04% and 0.20%, respectively). Similarly, subjects prescribed an antibiotic 0-1 month, 5-7 months, or 8-10 months after an opioid prescription displayed a modest risk of developing OUD 12 months after an opioid prescription (0.02% risk, 0.14% risk, and 0.16% risk, respectively).Conclusions: These findings suggest that there is little to no effect on the risk of developing OUD when antibiotics are prescribed at various time points before or after opioid prescription.
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Affiliation(s)
- Peter Shafeek
- Doctor of Medicine Program, Penn State College of Medicine, Hershey, PA, USA
| | - Taylor Clegg
- Doctor of Medicine Program, Penn State College of Medicine, Hershey, PA, USA
| | - Noor Kawmi
- Doctor of Medicine Program, Penn State College of Medicine, Hershey, PA, USA
| | | | - Curtis Bone
- Departments of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Nicholas Graziane
- Departments of Anesthesiology and Perioperative Medicine and Pharmacology, Penn State College of Medicine, Hershey, PA, USA
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