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Maguire S, Kesby A, Brownlow R, Hunt GE, Kim M, McAulay C, Grisham JR, McGregor IS, Suraev A, Kevin RC, Russell J. A phase II randomised controlled trial of intranasal oxytocin in anorexia nervosa. Psychoneuroendocrinology 2024; 164:107032. [PMID: 38520886 DOI: 10.1016/j.psyneuen.2024.107032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/13/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Anorexia nervosa (AN) is an eating disorder (ED) with high mortality rates and limited response to existing treatments, prompting the need to identify effective agents and adjuncts. There is evidence for an emerging role for the neuropeptide oxytocin (OT) in the pathophysiology of AN, with studies showing a perturbed oxytocinergic system in patients with AN. Preliminary evidence has demonstrated that intranasal OT (IN-OT) can produce anxiolytic effects in AN, as well as reducing concern about eating, and dysfunctional attentional biases related to the disorder. IN-OT is a non-invasive treatment option for AN that requires investigation as an adjunct to nutritional rehabilitation. METHODS This multi-site study (Trial Registration:ACTRN1261000897460) sought to replicate and extend a previous randomised placebo-controlled pilot trial of repeated dose IN-OT in patients with AN hospitalised for nutritional rehabilitation. Patients with AN (N=61) received daily IN-OT (18 IU twice per day) or placebo for four weeks, whilst undergoing inpatient hospital treatment. Outcome measures included ED psychopathology (primary) as measured by the Eating Disorder Examination (EDE) and Body Mass Index (BMI; secondary). Participants were assessed pre- and post-treatment, and at six months following the intervention. The effects of the first and last doses of IN-OT on responses (anxiety ratings and salivary cortisol) to a high-energy snack were also examined. RESULTS Sixty-one female inpatients (Mage=24.36,SD=7.87) with an average BMI of 16.24 (range: 11.43-18.55), were recruited into the study. No significant differences were found between placebo and OT groups at any of the time points on the outcomes of interest, but significant improvements in almost all psychological parameters in both groups were evident over time. IN-OT did not significantly reduce anxiety nor salivary cortisol in response to a high-calorie snack. CONCLUSION This is the largest randomised placebo-controlled trial of repeated dose intranasal OT in people with AN, during refeeding. The therapeutically promising findings of the pilot study were not replicated. Limitations and reasons for the non-replication included relatively large variance, baseline psychopathology scores being higher in this patient group, potential ceiling effects in BMI and ED psychopathology as well as differing comorbidities.
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Affiliation(s)
- Sarah Maguire
- Inside Out Institute, Charles Perkins Building, University of Sydney, NSW 2006, Australia; Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Faculty of Medicine & Health, University of Sydney, NSW 2006, Australia.
| | - Alice Kesby
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia.
| | - Rachel Brownlow
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia
| | - Glenn E Hunt
- Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Discipline of Psychiatry, University of Sydney, Sydney, NSW 2006, Australia
| | - Marcellinus Kim
- Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Claire McAulay
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia
| | - Jessica R Grisham
- UNSW Sydney, Faculty of Science, School of Psychology, Anzac Parade, Randwick, NSW 2031, Australia
| | - Iain S McGregor
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia; University of Sydney, Brain and Mind Centre, Mallet St, Camperdown, NSW 2050, Australia; University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Brain Mind Centre, Mallet St, Camperdown, NSW 2050, Australia
| | - Anastasia Suraev
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia; University of Sydney, Brain and Mind Centre, Mallet St, Camperdown, NSW 2050, Australia; University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Brain Mind Centre, Mallet St, Camperdown, NSW 2050, Australia
| | - Richard C Kevin
- Faculty of Medicine & Health, University of Sydney, NSW 2006, Australia; University of Sydney, Brain and Mind Centre, Mallet St, Camperdown, NSW 2050, Australia; University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Brain Mind Centre, Mallet St, Camperdown, NSW 2050, Australia
| | - Janice Russell
- Inside Out Institute, Charles Perkins Building, University of Sydney, NSW 2006, Australia; Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Faculty of Medicine & Health, University of Sydney, NSW 2006, Australia; Discipline of Psychiatry, University of Sydney, Sydney, NSW 2006, Australia; Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
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Rogers CI, Pacanowski CR. The relationship between cannabis and anorexia nervosa: a scoping review. J Eat Disord 2023; 11:186. [PMID: 37858278 PMCID: PMC10585887 DOI: 10.1186/s40337-023-00887-9] [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: 02/02/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Relapse rates in Anorexia Nervosa (AN) remain high, warranting exploration of further treatments. Cannabinoid agonists are of interest as they have shown successful outcomes in the treatment of associated conditions, such as post-traumatic stress disorder. This scoping review explores the endocannabinoid system (ECS), benefits/harms/null effects of cannabinoid treatment, and harms of cannabis use in AN. METHODS PubMed, PsycINFO, Cochrane, and Web of Science were searched for studies published between 2010 and August 2023, with human participants that explored the ECS, cannabinoid treatment, or cannabis use, and included 1 or more keywords for both cannabis and AN in the title and or abstract. Reports describing secondary anorexia, reports not available in English, grey literature, reports combining data from AN with other conditions, and reports only reporting the prevalence of cannabis abuse/dependence were excluded. Data were extracted from 17 reports (n = 15 studies). For the ECS, outcomes included genetics such as allele expression related to the ECS, cannabinoid receptor availability, and circulating levels of endocannabinoids. For benefits/harms/null effects of cannabinoid treatment, outcomes included changes in weight, eating disorder (ED) symptoms, physical activity (PA), and hormones. For harms of cannabis use, outcomes included genetics related to cannabis use disorder and associations between cannabis use and ED symptoms. RESULTS Eight studies (n = 8 reports) found abnormalities in the ECS in AN including expression of related alleles, genotypes, and haplotypes, availability of cannabinoid receptors, and levels of endocannabinoids. Three studies (n = 5 reports) found benefits/harms/null effects of cannabinoid treatment. Benefits included weight gain, improved ED symptoms and reduced PA, while null effects included no changes in weight or ED symptoms, and harms included increased PA and lowered adipose hormones. Four studies (n = 4 reports) expanded upon harms of cannabis use, including genetic predispositions to cannabis use disorder, and compensatory behaviors related to cannabis use. CONCLUSION Limited evidence suggests that abnormalities in the ECS in AN may render cannabis a potential treatment for weight restoration and associated symptoms. Future research may wish to investigate individualized dosing approaches to maximize beneficial effects while minimizing harms. Level II Evidence: Scoping Review.
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Affiliation(s)
- Chloe I Rogers
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA.
| | - Carly R Pacanowski
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
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Aulinas A, Muhammed M, Becker KR, Asanza E, Hauser K, Stern C, Gydus J, Holmes T, Murray HB, Breithaupt L, Micali N, Misra M, Eddy KT, Thomas JJ, Lawson EA. Oxytocin response to food intake in avoidant/restrictive food intake disorder. Eur J Endocrinol 2023; 189:149-155. [PMID: 37474111 PMCID: PMC10396082 DOI: 10.1093/ejendo/lvad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To investigate the response of anorexigenic oxytocin to food intake among adolescents and young adults with avoidant/restrictive food intake disorder (ARFID), a restrictive eating disorder characterized by lack of interest in food or eating, sensory sensitivity to food, and/or fear of aversive consequences of eating, compared with healthy controls (HC). DESIGN Cross-sectional. METHODS A total of 109 participants (54 with ARFID spectrum and 55 HC) were instructed to eat a ∼400-kcal standardized mixed meal. We sampled serum oxytocin at fasting and at 30-, 60-, and 120-min postmeal. We tested the hypothesis that ARFID would show higher mean oxytocin levels across time points compared with HC using a mixed model ANOVA. We then used multivariate regression analysis to identify the impact of clinical characteristics (sex, age, and body mass index [BMI] percentile) on oxytocin levels in individuals with ARFID. RESULTS Participants with ARFID exhibited greater mean oxytocin levels at all time points compared with HC, and these differences remained significant even after controlling for sex and BMI percentile (P = .004). Clinical variables (sex, age, and BMI percentile) did not show any impact on fasting and postprandial oxytocin levels among individuals with ARFID. CONCLUSIONS Consistently high oxytocin levels might be involved in low appetite and sensory aversions to food, contributing to food avoidance in individuals with ARFID.
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Affiliation(s)
- Anna Aulinas
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08041 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER Unidad 747), ISCIII, 08025 Barcelona, Spain
- Department of Medicine, University of Vic—Central University of Catalonia, 08500 Vic, Barcelona, Spain
| | - Maged Muhammed
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Kendra R Becker
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Elisa Asanza
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Kristine Hauser
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Casey Stern
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Julia Gydus
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Tara Holmes
- Translational and Clinical Research Center, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Helen Burton Murray
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Lauren Breithaupt
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Nadia Micali
- Eating Disorders Research Unit, Mental Health Services of the Capital Region of Denmark, Psychiatric Centre Ballerup, 2750 Ballerup, Denmark
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, WC1N 1EH, London, United Kingdom
| | - Madhusmita Misra
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Division of Pediatric Endocrinology, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Kamryn T Eddy
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Jennifer J Thomas
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 02114 Boston, MA, United States
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, 02114 Boston, MA, United States
- Department of Medicine, Harvard Medical School, 02115 Boston, MA, United States
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Becetti I, Singhal V, Nimmala S, Lee H, Lawson EA, Bredella MA, Misra M. Serum Oxytocin Levels Decrease 12 Months Following Sleeve Gastrectomy and Are Associated with Decreases in Lean Mass. Int J Mol Sci 2023; 24:10144. [PMID: 37373292 DOI: 10.3390/ijms241210144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Oxytocin (OXT), an anorexigenic hormone, is also bone anabolic. Further, OXT administration results in increases in lean mass (LM) in adults with sarcopenic obesity. We examine, for the first time, associations of OXT with body composition and bone endpoints in 25 youth 13-25 years old with severe obesity who underwent sleeve gastrectomy (SG) and 27 non-surgical controls (NS). Forty participants were female. Subjects underwent fasting blood tests for serum OXT and DXA for areal bone mineral density (aBMD) and body composition. At baseline, SG vs. NS had higher median body mass index (BMI) but did not differ for age or OXT levels. Over 12 months, SG vs. NS had greater reductions in BMI, LM, and fat mass (FM). OXT decreased in SG vs. NS 12 months post-SG. While baseline OXT predicted a 12-month BMI change in SG, decreases in OXT levels 12 months post-SG were not associated with decreases in weight or BMI. In SG, decreases in OXT were positively associated with decreases in LM but not with decreases in FM or aBMD. Loss of LM, a strong predictor of BMD, after bariatric surgery may reduce functional and muscular capacity. OXT pathways may be targeted to prevent LM loss following SG.
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Affiliation(s)
- Imen Becetti
- Division of Pediatric Endocrinology, Mass General for Children and Harvard Medical School, Boston, MA 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Vibha Singhal
- Division of Pediatric Endocrinology, Mass General for Children and Harvard Medical School, Boston, MA 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Pediatric Program, MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Supritha Nimmala
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Miriam A Bredella
- Department of Radiology, Musculoskeletal Imaging and Interventions, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Mass General for Children and Harvard Medical School, Boston, MA 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Russell J, Hunt GE. Oxytocin and eating disorders: Knowledge gaps and future directions. Psychoneuroendocrinology 2023; 154:106290. [PMID: 37178641 DOI: 10.1016/j.psyneuen.2023.106290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/11/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Eating disorders continue to be a major public health issue and important cause of morbidity and premature mortality, particularly for young people. Yet in a concerning dialectic, this occurs in the context of an epidemic of obesity which, with its medical complications, constitutes another vexing public health challenge. While it is not an eating disorder per se obesity is often comorbid with eating disorders. Effective treatment for both eating disorders and obesity has proven to be elusive and in the search for novel therapeutic interventions, the prosocial, anxiolytic, brain plasticity and metabolic effects of oxytocin (OT) have been examined from this perspective. The availability of intranasal oxytocin (IN-OT) has led to a number of interventional treatment studies in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), their atypical and subclinical forms and in medical and psychiatric conditions co-occurring or comorbid with these, obesity with BED would be included here. The aim of this mini review is to collate recent findings on OT as a novel therapeutic intervention in eating disorders and obesity and to identify and address some of the knowledge gaps in the use of IN-OT. The wider clinical perspective utilised here might better address some of the gaps and identify future directions of research. Clearly much remains to be done for OT to fulfil its therapeutic promise in eating disorders. OT might yet be of therapeutic promise and will be appreciated where treatment advances have been hard to come by and prevention challenging for these disorders.
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Affiliation(s)
- Janice Russell
- University of Sydney, Sydney, NSW, Australia; Marie Bashir Centre, Royal Prince Alfred Hospital, Sydney Local Area Health Service, Camperdown, NSW, Australia; Specialty of Psychiatry, University of Sydney, Australia.
| | - Glenn E Hunt
- University of Sydney, Sydney, NSW, Australia; Speciality of Psychiatry, University of Sydney, Concord Hospital, Concord, NSW, Australia
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Breithaupt L, Kahn DL, Slattery M, Plessow F, Mancuso C, Izquierdo A, Dreier MJ, Becker K, Franko DL, Thomas JJ, Holsen L, Lawson EA, Misra M, Eddy KT. Eighteen-month Course and Outcome of Adolescent Restrictive Eating Disorders: Persistence, Crossover, and Recovery. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:715-725. [PMID: 35476589 PMCID: PMC9444807 DOI: 10.1080/15374416.2022.2034634] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE In adults, low-weight restrictive eating disorders, including anorexia nervosa (AN), are marked by chronicity and diagnostic crossover from restricting to binge-eating/purging. Less is known about the naturalistic course of these eating disorders in adolescents, particularly atypical AN (atyp-AN) and avoidant/restrictive food intake disorder (ARFID). To inform nosology of low-weight restrictive eating disorders in adolescents, we examined outcomes including persistence, crossover, and recovery in an 18-month observational study. METHOD We assessed 82 women (ages 10-23 years) with low-weight eating disorders including AN (n = 40; 29 restricting, 11 binge-eating/purging), atyp-AN (n = 26; 19 restricting, seven binge-eating/purging), and ARFID (n = 16) at baseline, nine months (9 M; 75% retention), and 18 months (18 M; 73% retention) via semi-structured interviews. First-order Markov modeling was used to determine diagnostic persistence, crossover, and recovery occurring at 9 M or 18 M. RESULTS Among all diagnoses, the likelihood of remaining stable within a given diagnosis was greater than that of transitioning, with the greatest probability among ARFID (0.84) and AN-R (0.62). Persistence of BP and atypical presentations at follow-up periods was less stable (AN-BP probability 0.40; atyp-AN-R probability 0.48; atyp-AN-BP probability, 0.50). Crossover from binge-eating/purging to restricting occurred 72% of the time; crossover from restricting to binge-eating/purging occurred 23% of the time. The likelihood of stable recovery (e.g., recovery at both 9 M and 18 M) was between 0.00 and 0.36. CONCLUSION Across groups, intake diagnosis persisted in about two-thirds, and recovery was infrequent, underscoring the urgent need for innovative treatment approaches to these illnesses. Frequent crossover between AN and atyp-AN supports continuity between typical and atypical presentations, whereas no crossover to ARFID supports its distinction.
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Affiliation(s)
- Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Danielle L. Kahn
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Franziska Plessow
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Alyssa Izquierdo
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa J. Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kendra Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura Holsen
- Harvard Medical School, Boston, MA, USA
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elizabeth A. Lawson
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Madhusmita Misra
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Marazziti D, Diep PT, Carter S, Carbone MG. Oxytocin: An Old Hormone, A Novel Psychotropic Drug And Possible Use In Treating Psychiatric Disorders. Curr Med Chem 2022; 29:5615-5687. [PMID: 35894453 DOI: 10.2174/0929867329666220727120646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/17/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Historically, this molecule has been involved as a key factor in the formation of infant attachment, maternal behavior and pair bonding and, more generally, in linking social signals with cognition, behaviors and reward. In the last decades, the whole oxytocin system has gained a growing interest as it was proposed to be implicated in etiopathogenesis of several neurodevelopmental and neuropsychiatric disorders. METHODS With the main goal of an in-depth understanding of the oxytocin role in the regulation of different functions and complex behaviors as well as its intriguing implications in different neuropsychiatric disorders, we performed a critical review of the current state of art. We carried out this work through PubMed database up to June 2021 with the search terms: 1) "oxytocin and neuropsychiatric disorders"; 2) "oxytocin and neurodevelopmental disorders"; 3) "oxytocin and anorexia"; 4) "oxytocin and eating disorders"; 5) "oxytocin and obsessive-compulsive disorder"; 6) "oxytocin and schizophrenia"; 7) "oxytocin and depression"; 8) "oxytocin and bipolar disorder"; 9) "oxytocin and psychosis"; 10) "oxytocin and anxiety"; 11) "oxytocin and personality disorder"; 12) "oxytocin and PTSD". RESULTS Biological, genetic, and epigenetic studies highlighted quality and quantity modifications in the expression of oxytocin peptide or in oxytocin receptor isoforms. These alterations would seem to be correlated with a higher risk of presenting several neuropsychiatric disorders belonging to different psychopathological spectra. Collaterally, the exogenous oxytocin administration has shown to ameliorate many neuropsychiatric clinical conditions. CONCLUSION Finally, we briefly analyzed the potential pharmacological use of oxytocin in patient with severe symptomatic SARS-CoV-2 infection due to its anti-inflammatory, anti-oxidative and immunoregulatory properties.
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Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Phuoc-Tan Diep
- Department of Histopathology, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, United Kingdom
| | - Sue Carter
- Director Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Manuel G Carbone
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy
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Plessow F, Galbiati F, Eddy KT, Misra M, Miller KK, Klibanski A, Aulinas A, Lawson EA. Low oxytocin levels are broadly associated with more pronounced psychopathology in anorexia nervosa with primarily restricting but not binge/purge eating behavior. Front Endocrinol (Lausanne) 2022; 13:1049541. [PMID: 36798485 PMCID: PMC9927219 DOI: 10.3389/fendo.2022.1049541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/28/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Anorexia nervosa (AN) is commonly associated with depression, anxiety, and deficits in socioemotional functioning. Basal levels of oxytocin, a neurohormone with antidepressant, anxiolytic, and prosocial properties, are low in women with AN. However, the relationship between oxytocin and psychopathology of AN/atypical AN has not been examined in individuals with primarily food restriction (AN/AtypAN-R) or those with restriction plus binge/purge behaviors (AN/AtypAN-BP) alone, which is important to further elucidate the neurobiology of different AN presentations. We investigated whether oxytocin levels are related to eating, affective, and socioemotional psychopathology in women with AN/AtypAN-R and separately AN/AtypAN-BP. METHODS In a cross-sectional study of 53 women with low-weight AN or atypical AN based on DSM-5 (AN/AtypAN-R: n=21, AN/AtypAN-BP: n=32), we obtained fasting serum oxytocin levels and self-report measures of psychopathology, including the Eating Disorder Examination-Questionnaire (EDE-Q), Beck Depression Inventory-IA (BDI), State-Trait Anxiety Inventory (STAI), and Toronto Alexithymia Scale (TAS-20). RESULTS In individuals with AN/AtypAN-R, oxytocin levels were negatively associated with eating psychopathology (EDE-Q Global Score: r=-0.49, p=0.024), depressive and anxiety symptoms (BDI Total Score: r=-0.55, p=0.009; STAI Trait Score: r=-0.63, p=0.002), and socioemotional symptoms (TAS-20 Difficulty Identifying Feelings Score: r=-0.49, p=0.023). In contrast, in those with AN/AtypAN-BP oxytocin levels were negatively associated with depressive symptoms only (BDI Total Score: r=-0.52, p=0.049). CONCLUSIONS These findings support the notion that AN/AtypAN-R and AN/AtypAN-BP might have divergent underlying neurobiology. Understanding these differences is crucial to develop targeted treatments for a population with high levels of chronicity, for which no specific pharmacological treatments are currently available. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov, identifier: NCT01121211.
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Affiliation(s)
- Franziska Plessow
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Francesca Galbiati
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Madhusmita Misra
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, United States
| | - Karen K. Miller
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Anne Klibanski
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Anna Aulinas
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Elizabeth A. Lawson,
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Ellis BJ, Horn AJ, Carter CS, van IJzendoorn MH, Bakermans-Kranenburg MJ. Developmental programming of oxytocin through variation in early-life stress: Four meta-analyses and a theoretical reinterpretation. Clin Psychol Rev 2021; 86:101985. [DOI: 10.1016/j.cpr.2021.101985] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 01/02/2023]
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Increased plasma asprosin levels in patients with drug-naive anorexia nervosa. Eat Weight Disord 2021; 26:313-321. [PMID: 32026376 DOI: 10.1007/s40519-020-00845-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/07/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Asprosin is a centrally acting appetite-promoting hormone and promotes glucose production in the liver. This study is the first to investigate the difference in asprosin in the plasma between anorexia nervosa (AN) and healthy controls, and to explore the relationship between asprosin changes and plasma glucose levels and AN symptoms. METHODS Plasma asprosin and glucose concentrations were detected in AN patients (n = 46) and healthy control subjects (n = 47). Eating Disorder Inventory-2 (EDI-2) was used to assess subjects' eating disorder symptoms and related personality traits. The patient's concomitant levels of depression and anxiety were also measured using the beck depression inventory and beck anxiety inventory, respectively. RESULTS Results indicate that AN patients had a higher asprosin concentration in their plasma compared to healthy controls (p = 0.033). Among AN patients, plasma asprosin levels correlated positively with EDI-2 interoceptive awareness subscale score (p = 0.030) and negatively with duration of illness (p = 0.036). Multiple linear regression analyses showed that increases in asprosin levels (p = 0.029), glucose levels (p = 0.024) and body mass index (p = 0.003) were associated with an increase of the score of EDI-2 bulimia subscale. CONCLUSIONS Our findings suggest that the increase in plasma asprosin concentration in patients with AN may be a compensation for the body's energy shortage, and asprosin may be involved in the development of bulimia and lack of interoceptive awareness in AN patients. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Carter CS, Kenkel WM, MacLean EL, Wilson SR, Perkeybile AM, Yee JR, Ferris CF, Nazarloo HP, Porges SW, Davis JM, Connelly JJ, Kingsbury MA. Is Oxytocin "Nature's Medicine"? Pharmacol Rev 2021; 72:829-861. [PMID: 32912963 PMCID: PMC7495339 DOI: 10.1124/pr.120.019398] [Citation(s) in RCA: 181] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Oxytocin is a pleiotropic, peptide hormone with broad implications for general health, adaptation, development, reproduction, and social behavior. Endogenous oxytocin and stimulation of the oxytocin receptor support patterns of growth, resilience, and healing. Oxytocin can function as a stress-coping molecule, an anti-inflammatory, and an antioxidant, with protective effects especially in the face of adversity or trauma. Oxytocin influences the autonomic nervous system and the immune system. These properties of oxytocin may help explain the benefits of positive social experiences and have drawn attention to this molecule as a possible therapeutic in a host of disorders. However, as detailed here, the unique chemical properties of oxytocin, including active disulfide bonds, and its capacity to shift chemical forms and bind to other molecules make this molecule difficult to work with and to measure. The effects of oxytocin also are context-dependent, sexually dimorphic, and altered by experience. In part, this is because many of the actions of oxytocin rely on its capacity to interact with the more ancient peptide molecule, vasopressin, and the vasopressin receptors. In addition, oxytocin receptor(s) are epigenetically tuned by experience, especially in early life. Stimulation of G-protein–coupled receptors triggers subcellular cascades allowing these neuropeptides to have multiple functions. The adaptive properties of oxytocin make this ancient molecule of special importance to human evolution as well as modern medicine and health; these same characteristics also present challenges to the use of oxytocin-like molecules as drugs that are only now being recognized.
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Affiliation(s)
- C Sue Carter
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - William M Kenkel
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - Evan L MacLean
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - Steven R Wilson
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - Allison M Perkeybile
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - Jason R Yee
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - Craig F Ferris
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - Hossein P Nazarloo
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - Stephen W Porges
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - John M Davis
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - Jessica J Connelly
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
| | - Marcy A Kingsbury
- Kinsey Institute, Indiana University, Bloomington, Indiana (C.S.C., W.M.K., A.M.P., H.P.N., S.W.P.); School of Anthropology, Department of Psychology, and College of Veterinary Medicine, University of Arizona, Tucson, Arizona (E.L.M.); Department of Chemistry, University of Oslo, Oslo, Norway (S.R.W.); Institute of Animal Welfare Science, University of Veterinary Medicine, Vienna, Austria (J.R.Y.); Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts (C.F.F.); Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois (J.M.D.); Department of Psychology, University of Virginia, Charlottesville, Virginia (J.J.C.); and Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Charleston, Massachusetts (M.A.K.)
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Abstract
The hypothalamic peptide oxytocin has been increasingly recognized as a hormone and neurotransmitter with important effects on energy intake, metabolism, and body weight and is under investigation as a potential novel therapeutic agent for obesity. The main neurons producing oxytocin and expressing the oxytocin receptor are strategically located in brain areas known to be critically involved in homeostatic energy balance as well as hedonic and motivational aspects of eating behavior. In this chapter, we will review the central and peripheral physiology of oxytocin and the interaction of oxytocin with key hormones and neural circuitries that affect food intake and metabolism. Next, we will synthesize the available data on endogenous oxytocin levels related to caloric intake, body weight, and metabolic status. We will then review the effects of exogenous oxytocin administration on eating behavior, body weight, and metabolism in humans, including in healthy individuals as well as specific populations with suspected perturbations involving oxytocin pathways. Finally, we will address the promise and fundamental challenges of translating this line of research to clinical care.
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Affiliation(s)
- Liya Kerem
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
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Breithaupt L, Chunga-Iturry N, Lyall AE, Cetin-Karayumak S, Becker KR, Thomas JJ, Slattery M, Makris N, Plessow F, Pasternak O, Holsen LM, Kubicki M, Misra M, Lawson EA, Eddy KT. Developmental stage-dependent relationships between ghrelin levels and hippocampal white matter connections in low-weight anorexia nervosa and atypical anorexia nervosa. Psychoneuroendocrinology 2020; 119:104722. [PMID: 32512249 PMCID: PMC8629489 DOI: 10.1016/j.psyneuen.2020.104722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Disruptions in homeostatic and hedonic food motivation are proposed to underlie anorexia nervosa (AN) and atypical AN, restrictive eating disorders which commonly onset in puberty. Ghrelin, a neuroprotective hormone that drives hedonic eating is increased in AN and is expressed in the hippocampus. White matter (WM) undergoes significant change during puberty in regions involved in food motivation, particularly WM tracts connected with the hippocampus. The association between ghrelin and WM region of interest (ROI) with hippocampal connections in restrictive eating disorders, particularly in adolescence during key neurodevelopmental growth, is unknown. METHODS We evaluated fasting plasma ghrelin and WM microstructure (measured by free-water corrected fractional anisotropy (FA-t)) in WM ROIs with hippocampal connections - the fornix and the hippocampal portion of the cingulum - in 56 adolescent females (age range: 11.9 - 22.1 y; mean: 19.0 y) with low-weight eating disorders including AN and atypical AN (N = 36) and healthy controls (N = 20). RESULTS FA-t in the fornix or hippocampal portion of the fornix did not differ between groups. Ghrelin was higher in AN/atypical AN vs. HC and was positively correlated with puberty stage in the AN/atypical AN group, but not the HC group. The correlation between ghrelin and FA-t in the fornix was significantly different in females with AN/atypical AN compared to controls. In AN/atypical AN, pubertal stage moderated the relation between fasting plasma ghrelin and FA-t in the fornix: higher fasting ghrelin was associated with lower FA-t in the fornix in late-post-puberty, but was not associated with FA-t in the early to mid stages of puberty. CONCLUSIONS In post-pubertal females with low-weight AN/atypical AN, higher levels of ghrelin are associated with lower FA-t in the fornix. This relationship is not evident in the early to mid stages of puberty in AN/atypical AN or in HC, and may reflect a lack of possible neuroprotective effects of ghrelin in late-post puberty only. Understanding the effects of ghrelin on WM microstructure longitudinally and following recovery from AN/Atypical AN and how this differs across pubertal stages will be an important next step. These findings could ultimately inform treatment staging and aid in diagnosis and detection of AN/atypical AN.
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Affiliation(s)
- Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Natalia Chunga-Iturry
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA
| | - Amanda E Lyall
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA
| | - Suheyla Cetin-Karayumak
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Nikos Makris
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA; Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States of America; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Franziska Plessow
- Harvard Medical School, Boston, MA, USA; Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Ofer Pasternak
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Laura M Holsen
- Harvard Medical School, Boston, MA, USA; Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Marek Kubicki
- Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, USA; Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States of America; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Madhusmita Misra
- Harvard Medical School, Boston, MA, USA; Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth A Lawson
- Harvard Medical School, Boston, MA, USA; Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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McCormack SE, Blevins JE, Lawson EA. Metabolic Effects of Oxytocin. Endocr Rev 2020; 41:5658523. [PMID: 31803919 PMCID: PMC7012298 DOI: 10.1210/endrev/bnz012] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/04/2019] [Indexed: 12/13/2022]
Abstract
There is growing evidence that oxytocin (OXT), a hypothalamic hormone well recognized for its effects in inducing parturition and lactation, has important metabolic effects in both sexes. The purpose of this review is to summarize the physiologic effects of OXT on metabolism and to explore its therapeutic potential for metabolic disorders. In model systems, OXT promotes weight loss by decreasing energy intake. Pair-feeding studies suggest that OXT-induced weight loss may also be partly due to increased energy expenditure and/or lipolysis. In humans, OXT appears to modulate both homeostatic and reward-driven food intake, although the observed response depends on nutrient milieu (eg, obese vs. nonobese), clinical characteristics (eg, sex), and experimental paradigm. In animal models, OXT is anabolic to muscle and bone, which is consistent with OXT-induced weight loss occurring primarily via fat loss. In some human observational studies, circulating OXT concentrations are also positively associated with lean mass and bone mineral density. The impact of exogenous OXT on human obesity is the focus of ongoing investigation. Future randomized, placebo-controlled clinical trials in humans should include rigorous, standardized, and detailed assessments of adherence, adverse effects, pharmacokinetics/pharmacodynamics, and efficacy in the diverse populations that may benefit from OXT, in particular those in whom hypothalamic OXT signaling may be abnormal or impaired (eg, individuals with Sim1 deficiency, Prader-Willi syndrome, or craniopharyngioma). Future studies will also have the opportunity to investigate the characteristics of new OXT mimetic peptides and the obligation to consider long-term effects, especially when OXT is given to children and adolescents. (Endocrine Reviews XX: XX - XX, 2020).
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Affiliation(s)
- Shana E McCormack
- Neuroendocrine Center, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James E Blevins
- VA Puget Sound Health Care System, Office of Research and Development Medical Research Service, Department of Veterans Affairs Medical Center, Seattle, Washington.,Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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