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Thompson C, Evans B, Zhao D, Purcell E. Spatiotemporal Expression of RNA-Seq Identified Proteins at the Electrode Interface. Acta Biomater 2023; 164:209-222. [PMID: 37116634 DOI: 10.1016/j.actbio.2023.04.028] [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: 12/20/2022] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
Implantation of electrodes in the brain can be used to record from or stimulate neural tissues to treat neurological disease and injury. However, the tissue response to implanted devices can limit their functional longevity. Recent RNA-seq datasets identify hundreds of genes associated with gliosis, neuronal function, myelination, and cellular metabolism that are spatiotemporally expressed in neural tissues following the insertion of microelectrodes. To validate mRNA as a predictor of protein expression, this study evaluates a sub-set of RNA-seq identified proteins (RSIP) at 24-hours, 1-week, and 6-weeks post-implantation using quantitative immunofluorescence methods. This study found that expression of RSIPs associated with glial activation (Glial fibrillary acidic protein (GFAP), Polypyrmidine tract binding protein-1 (Ptbp1)), neuronal structure (Neurofilament heavy chain (Nefh), Proteolipid protein-1 (Plp1), Myelin Basic Protein (MBP)), and iron metabolism (Transferrin (TF), Ferritin heavy chain-1 (Fth1)) reinforce transcriptional data. This study also provides additional context to the cellular distribution of RSIPs using a MATLAB-based approach to quantify immunofluorescence intensity within specific cell types. Ptbp1, TF, and Fth1 were found to be spatiotemporally distributed within neurons, astrocytes, microglia, and oligodendrocytes at the device interface relative to distal and contralateral tissues. The altered distribution of RSIPs relative to distal tissue is largely localized within 100µm of the device injury, which approaches the functional recording range of implanted electrodes. This study provides evidence that RNA-sequencing can be used to predict protein-level changes in cortical tissues and that RSIPs can be further investigated to identify new biomarkers of the tissue response that influence signal quality. STATEMENT OF SIGNIFICANCE: : Microelectrode arrays implanted into the brain are useful tools that can be used to study neuroscience and to treat pathological conditions in a clinical setting. The tissue response to these devices, however, can severely limit their functional longevity. Transcriptomics has deepened the understandings of the tissue response by revealing numerous genes which are differentially expressed following device insertion. This manuscript provides validation for the use of transcriptomics to characterize the tissue response by evaluating a subset of known differentially expressed genes at the protein level around implanted electrodes over time. In additional to validating mRNA-to-protein relationships at the device interface, this study has identified emerging trends in the spatiotemporal distribution of proteins involved with glial activation, neuronal remodeling, and essential iron binding proteins around implanted silicon devices. This study additionally provides a new MATLAB based methodology to quantify protein distribution within discrete cell types at the device interface which may be used as biomarkers for further study or therapeutic intervention in the future.
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Affiliation(s)
- Cort Thompson
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI 48824, United States of America; Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, United States of America
| | - Blake Evans
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI 48824, United States of America; Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, United States of America
| | - Dorothy Zhao
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI 48824, United States of America; Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, United States of America
| | - Erin Purcell
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI 48824, United States of America; Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, United States of America.
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Kale RP, Nguyen TTL, Price JB, Yates NJ, Walder K, Berk M, Sillitoe RV, Kouzani AZ, Tye SJ. Mood Regulatory Actions of Active and Sham Nucleus Accumbens Deep Brain Stimulation in Antidepressant Resistant Rats. Front Hum Neurosci 2021; 15:644921. [PMID: 34349629 PMCID: PMC8326323 DOI: 10.3389/fnhum.2021.644921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
The antidepressant actions of deep brain stimulation (DBS) are associated with progressive neuroadaptations within the mood network, modulated in part, by neurotrophic mechanisms. We investigated the antidepressant-like effects of chronic nucleus accumbens (NAc) DBS and its association with change in glycogen synthase kinase 3 (GSK3) and mammalian target of rapamycin (mTOR) expression in the infralimbic cortex (IL), and the dorsal (dHIP) and ventral (vHIP) subregions of the hippocampus of antidepressant resistant rats. Antidepressant resistance was induced via daily injection of adrenocorticotropic hormone (ACTH; 100 μg/day; 15 days) and confirmed by non-response to tricyclic antidepressant treatment (imipramine, 10 mg/kg). Portable microdevices provided continuous bilateral NAc DBS (130 Hz, 200 μA, 90 μs) for 7 days. A control sham electrode group was included, together with ACTH- and saline-treated control groups. Home cage monitoring, open field, sucrose preference, and, forced swim behavioral tests were performed. Post-mortem levels of GSK3 and mTOR, total and phosphorylated, were determined with Western blot. As previously reported, ACTH treatment blocked the immobility-reducing effects of imipramine in the forced swim test. In contrast, treatment with either active DBS or sham electrode placement in the NAc significantly reduced forced swim immobility time in ACTH-treated animals. This was associated with increased homecage activity in the DBS and sham groups relative to ACTH and saline groups, however, no differences in locomotor activity were observed in the open field test, nor were any group differences seen for sucrose consumption across groups. The antidepressant-like actions of NAc DBS and sham electrode placements were associated with an increase in levels of IL and vHIP phospho-GSK3β and phospho-mTOR, however, no differences in these protein levels were observed in the dHIP region. These data suggest that early response to electrode placement in the NAc, irrespective of whether active DBS or sham, has antidepressant-like effects in the ACTH-model of antidepressant resistance associated with distal upregulation of phospho-GSK3β and phospho-mTOR in the IL and vHIP regions of the mood network.
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Affiliation(s)
- Rajas P. Kale
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- School of Engineering, Deakin University, Geelong, VIC, Australia
| | - Thanh Thanh L. Nguyen
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Biology and Psychology, Green Mountain College, Poultney, VT, United States
| | - J. Blair Price
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Neurosurgery Research, Mayo Clinic, Rochester, MN, United States
| | - Nathanael J. Yates
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Ken Walder
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Michael Berk
- IMPACT–The Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC, Australia
- Orygen Youth Health Research Centre, The Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Roy V. Sillitoe
- Department of Pathology and Immunology, Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX, United States
| | - Abbas Z. Kouzani
- School of Engineering, Deakin University, Geelong, VIC, Australia
| | - Susannah J. Tye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- Department of Psychiatry, University of Minnesota, Houston, TX, United States
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
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A case-control study investigating food addiction in Parkinson patients. Sci Rep 2021; 11:10934. [PMID: 34035366 PMCID: PMC8149641 DOI: 10.1038/s41598-021-90266-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/18/2021] [Indexed: 02/07/2023] Open
Abstract
Eating disorders (EDs) in patients with Parkinson’s disease (PD) are mainly described through impulse control disorders but represent one end of the spectrum of food addiction (FA). Although not formally recognized by DSM-5, FA is well described in the literature on animal models and humans, but data on prevalence and risk factors compared with healthy controls (HCs) are lacking. We conducted a cross-sectional study including 200 patients with PD and 200 age- and gender-matched HCs. Characteristics including clinical data (features of PD/current medication) were collected. FA was rated using DSM-5 criteria and the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Patients with PD had more EDs compared to HCs (27.0% vs. 13.0%, respectively, p < 0.001). They mainly had FA (24.5% vs. 12.0%, p = 0.001) and night eating syndrome (7.0% vs. 2.5% p = 0.03). In PD patients, FA was associated with female gender (p = 0.04) and impulsivity (higher attentional non-planning factor) but not with the dose or class of dopaminergic therapy. Vigilance is necessary, especially for PD women and in patients with specific impulsive personality traits. Counterintuitively, agonist dopaminergic treatment should not be used as an indication for screening FA in patients with PD.
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Constant A, Moirand R, Thibault R, Val-Laillet D. Meeting of Minds around Food Addiction: Insights from Addiction Medicine, Nutrition, Psychology, and Neurosciences. Nutrients 2020; 12:nu12113564. [PMID: 33233694 PMCID: PMC7699750 DOI: 10.3390/nu12113564] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
This review, focused on food addiction (FA), considers opinions from specialists with different expertise in addiction medicine, nutrition, health psychology, and behavioral neurosciences. The concept of FA is a recurring issue in the clinical description of abnormal eating. Even though some tools have been developed to diagnose FA, such as the Yale Food Addiction Scale (YFAS) questionnaire, the FA concept is not recognized as an eating disorder (ED) so far and is even not mentioned in the Diagnostic and Statistical Manuel of Mental Disorders version 5 (DSM-5) or the International Classification of Disease (ICD-11). Its triggering mechanisms and relationships with other substance use disorders (SUD) need to be further explored. Food addiction (FA) is frequent in the overweight or obese population, but it remains unclear whether it could articulate with obesity-related comorbidities. As there is currently no validated therapy against FA in obese patients, FA is often underdiagnosed and untreated, so that FA may partly explain failure of obesity treatment, addiction transfer, and weight regain after obesity surgery. Future studies should assess whether a dedicated management of FA is associated with better outcomes, especially after obesity surgery. For prevention and treatment purposes, it is necessary to promote a comprehensive psychological approach to FA. Understanding the developmental process of FA and identifying precociously some high-risk profiles can be achieved via the exploration of the environmental, emotional, and cognitive components of eating, as well as their relationships with emotion management, some personality traits, and internalized weight stigma. Under the light of behavioral neurosciences and neuroimaging, FA reveals a specific brain phenotype that is characterized by anomalies in the reward and inhibitory control processes. These anomalies are likely to disrupt the emotional, cognitive, and attentional spheres, but further research is needed to disentangle their complex relationship and overlap with obesity and other forms of SUD. Prevention, diagnosis, and treatment must rely on a multidisciplinary coherence to adapt existing strategies to FA management and to provide social and emotional support to these patients suffering from highly stigmatized medical conditions, namely overweight and addiction. Multi-level interventions could combine motivational interviews, cognitive behavioral therapies, and self-help groups, while benefiting from modern exploratory and interventional tools to target specific neurocognitive processes.
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Affiliation(s)
- Aymery Constant
- INRAE, INSERM, University Rennes, NuMeCan, Nutrition Metabolisms Cancer, 35590 St Gilles, 35000 Rennes, France; (A.C.); (R.M.); (R.T.)
- EHESP, School of Public Health, 35043 Rennes, France
| | - Romain Moirand
- INRAE, INSERM, University Rennes, NuMeCan, Nutrition Metabolisms Cancer, 35590 St Gilles, 35000 Rennes, France; (A.C.); (R.M.); (R.T.)
- Unité d’Addictologie, CHU Rennes, 35000 Rennes, France
| | - Ronan Thibault
- INRAE, INSERM, University Rennes, NuMeCan, Nutrition Metabolisms Cancer, 35590 St Gilles, 35000 Rennes, France; (A.C.); (R.M.); (R.T.)
- Unité de Nutrition, CHU Rennes, 35000 Rennes, France
| | - David Val-Laillet
- INRAE, INSERM, University Rennes, NuMeCan, Nutrition Metabolisms Cancer, 35590 St Gilles, 35000 Rennes, France; (A.C.); (R.M.); (R.T.)
- Correspondence:
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Assari S, Boyce S, Bazargan M. Nucleus Accumbens Functional Connectivity with the Frontoparietal Network Predicts Subsequent Change in Body Mass Index for American Children. Brain Sci 2020; 10:brainsci10100703. [PMID: 33022949 PMCID: PMC7600639 DOI: 10.3390/brainsci10100703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Nucleus accumbens (NAc) is a brain structure with a well-established role in the brain reward processing system. Altered function of the NAc is shown to have a role in the development of food addiction and obesity. However, less is known about sex differences in the role of NAc function as a predictor of children’s change in body mass index (BMI) over time. Aim: We used the Adolescent Brain Cognitive Development data (version 2.01) to investigate sex differences in the predictive role of the NAc functional connectivity with the frontoparietal network on children’s BMI change over a one-year follow-up period. Methods: This 1-year longitudinal study successfully followed 3784 9–10-year-old children. Regression models were used to analyze the data. The predictor variable was NAc functional connectivity with the frontoparietal network measured using resting-state functional magnetic resonance imaging (fMRI). The primary outcome was BMI at the end of the 1-year follow up. Covariates included race, ethnicity, age, socioeconomic factors, and baseline BMI. Sex was the effect modifier. Results: NAc functional connectivity with the frontoparietal network was predictive of BMI changes over time. This association remained significant above and beyond all covariates. The above association, however, was only significant in female, not male children. Conclusion: The epidemiological observation that NAc functional connectivity is associated with BMI changes in children is an extension of well-controlled laboratory studies that have established the role of the NAc in the brain reward processing. More research is needed on sex differences in the brain regions that contribute to childhood obesity.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles Drew University, Los Angeles, CA 90059, USA;
- Department of Urban Public Health, Charles Drew University, Los Angeles, CA 90059, USA
- Correspondence: ; Tel.: +(734)-232-0445; Fax: +734-615-8739
| | - Shanika Boyce
- Department of Pediatrics, Charles Drew University, Los Angeles, CA 90059, USA;
| | - Mohsen Bazargan
- Department of Family Medicine, Charles Drew University, Los Angeles, CA 90059, USA;
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Thompson CH, Riggins TE, Patel PR, Chestek CA, Li W, Purcell E. Toward guiding principles for the design of biologically-integrated electrodes for the central nervous system. J Neural Eng 2020; 17:021001. [PMID: 31986501 PMCID: PMC7523527 DOI: 10.1088/1741-2552/ab7030] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Innovation in electrode design has produced a myriad of new and creative strategies for interfacing the nervous system with softer, less invasive, more broadly distributed sites with high spatial resolution. However, despite rapid growth in the use of implanted electrode arrays in research and clinical applications, there are no broadly accepted guiding principles for the design of biocompatible chronic recording interfaces in the central nervous system (CNS). Studies suggest that the architecture and flexibility of devices play important roles in determining effective tissue integration: device feature dimensions (varying from 'sub'- to 'supra'-cellular scales, <10 µm to >100 µm), Young's modulus, and bending modulus have all been identified as key features of design. However, critical knowledge gaps remain in the field with respect to the underlying motivation for these designs: (1) a systematic study of the relationship between device design features (materials, architecture, flexibility), biointegration, and signal quality needs to be performed, including controls for interaction effects between design features, (2) benchmarks for success need to be determined (biological integration, recording performance, longevity, stability), and (3) user results, particularly those that champion a specific design or electrode modification, need to be replicated across laboratories. Finally, the ancillary effects of factors such as tethering, site impedance and insertion method need to be considered. Here, we briefly review observations to-date of device design effects on tissue integration and performance, and then highlight the need for comprehensive and systematic testing of these effects moving forward.
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Affiliation(s)
- Cort H Thompson
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI, United States of America
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Cassin SE, Buchman DZ, Leung SE, Kantarovich K, Hawa A, Carter A, Sockalingam S. Ethical, Stigma, and Policy Implications of Food Addiction: A Scoping Review. Nutrients 2019; 11:E710. [PMID: 30934743 PMCID: PMC6521112 DOI: 10.3390/nu11040710] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/08/2019] [Accepted: 03/20/2019] [Indexed: 12/12/2022] Open
Abstract
The concept of food addiction has generated much controversy. In comparison to research examining the construct of food addiction and its validity, relatively little research has examined the broader implications of food addiction. The purpose of the current scoping review was to examine the potential ethical, stigma, and health policy implications of food addiction. Major themes were identified in the literature, and extensive overlap was identified between several of the themes. Ethics sub-themes related primarily to individual responsibility and included: (i) personal control, will power, and choice; and (ii) blame and weight bias. Stigma sub-themes included: (i) the impact on self-stigma and stigma from others, (ii) the differential impact of substance use disorder versus behavioral addiction on stigma, and (iii) the additive stigma of addiction plus obesity and/or eating disorder. Policy implications were broadly derived from comparisons to the tobacco industry and focused on addictive foods as opposed to food addiction. This scoping review underscored the need for increased awareness of food addiction and the role of the food industry, empirical research to identify specific hyperpalatable food substances, and policy interventions that are not simply extrapolated from tobacco.
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Affiliation(s)
- Stephanie E Cassin
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada.
- Centre for Mental Health, University Health Network, Network - Toronto General Hospital, 200 Elizabeth Street, 8th Floor, Toronto, ON M5G 2C4, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
| | - Daniel Z Buchman
- University of Toronto Joint Centre of Bioethics, 155 College Street, Suite 754, Toronto, ON M5T 1P8, Canada.
- Bioethics Program and Krembil Brain Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON M5T 1P8, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 1R8, Canada.
| | - Samantha E Leung
- Centre for Mental Health, University Health Network, Network - Toronto General Hospital, 200 Elizabeth Street, 8th Floor, Toronto, ON M5G 2C4, Canada.
- Bariatric Surgery Program, University Health Network - Toronto Western Hospital, 399 Bathurst Street, East Wing ⁻ 4th Floor, Toronto, ON M5T 2S8, Canada.
| | - Karin Kantarovich
- Centre for Mental Health, University Health Network, Network - Toronto General Hospital, 200 Elizabeth Street, 8th Floor, Toronto, ON M5G 2C4, Canada.
- Bariatric Surgery Program, University Health Network - Toronto Western Hospital, 399 Bathurst Street, East Wing ⁻ 4th Floor, Toronto, ON M5T 2S8, Canada.
| | - Aceel Hawa
- Department of Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
| | - Adrian Carter
- School of Psychological Sciences, Monash University, Melbourne, VIC 3181, Australia.
- UQ Centre for Clinical Research, University of Queensland, Herston, QLD 4029, Australia.
| | - Sanjeev Sockalingam
- Centre for Mental Health, University Health Network, Network - Toronto General Hospital, 200 Elizabeth Street, 8th Floor, Toronto, ON M5G 2C4, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
- Bariatric Surgery Program, University Health Network - Toronto Western Hospital, 399 Bathurst Street, East Wing ⁻ 4th Floor, Toronto, ON M5T 2S8, Canada.
- Department of Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
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Pleger B. Invasive and Non-invasive Stimulation of the Obese Human Brain. Front Neurosci 2018; 12:884. [PMID: 30555295 PMCID: PMC6281888 DOI: 10.3389/fnins.2018.00884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/13/2018] [Indexed: 01/18/2023] Open
Abstract
Accumulating evidence suggests that non-invasive and invasive brain stimulation may reduce food craving and calorie consumption rendering these techniques potential treatment options for obesity. Non-invasive transcranial direct current stimulation (tDCS) or repetitive transcranial magnet stimulation (rTMS) are used to modulate activity in superficially located executive control regions, such as the dorsolateral prefrontal cortex (DLPFC). Modulation of the DLPFC’s activity may alter executive functioning and food reward processing in interconnected dopamine-rich regions such as the striatum or orbitofrontal cortex. Modulation of reward processing can also be achieved by invasive deep brain stimulation (DBS) targeting the nucleus accumbens. Another target for DBS is the lateral hypothalamic area potentially leading to improved energy expenditure. To date, available evidence is, however, restricted to few exceptional cases of morbid obesity. The vagal nerve plays a crucial role in signaling the homeostatic demand to the brain. Invasive or non-invasive vagal nerve stimulation (VNS) is thus assumed to reduce appetite, rendering VNS another possible treatment option for obesity. Based on currently available evidence, the U.S. Food and Drug Administration recently approved VNS for the treatment of obesity. This review summarizes scientific evidence regarding these techniques’ efficacy in modulating food craving and calorie intake. It is time for large controlled clinical trials that are necessary to translate currently available research discoveries into patient care.
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Affiliation(s)
- Burkhard Pleger
- Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,IFB AdiposityDiseases, Leipzig University Medical Centre, Leipzig, Germany.,BMBF nutriCARD, Center of Veterinary Public Health, University of Leipzig, Leipzig, Germany.,Collaborative Research Centre 1052 "Obesity Mechanisms", University Hospital Leipzig, Leipzig, Germany.,Collaborative Research Centre 874 "Integration and Representation of Sensory Processes", Ruhr-University Bochum, Bochum, Germany
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Atalayer D. Dürtüsellik ve Aşırı Yeme Arasındaki İlişki: Psikolojik ve Nörobiyolojik Yaklaşımlar. PSIKIYATRIDE GUNCEL YAKLASIMLAR 2018. [DOI: 10.18863/pgy.358090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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De Salles AAF, Barbosa DAN, Fernandes F, Abucham J, Nazato DM, Oliveira JD, Cury A, Biasi A, Rossi R, Lasagno C, Bueno PT, Santos RHN, Damiani LP, Gorgulho AA. An Open-Label Clinical Trial of Hypothalamic Deep Brain Stimulation for Human Morbid Obesity: BLESS Study Protocol. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Human morbid obesity is increasing worldwide in an alarming way. The hypothalamus is known to mediate its mechanisms. Deep brain stimulation (DBS) of the ventromedial hypothalamus (VMH) may be an alternative to treat patients refractory to standard medical and surgical therapies.
OBJECTIVE
To assess the safety, identify possible side effects, and to optimize stimulation parameters of continuous VMH-DBS. Additionally, this study aims to determine if continuous VMH-DBS will lead to weight loss by causing changes in body composition, basal metabolism, or food intake control.
METHODS
The BLESS study is a feasibility study, single-center open-label trial. Six patients (body mass index > 40) will undergo low-frequency VMH-DBS. Data concerning timing, duration, frequency, severity, causal relationships, and associated electrical stimulation patterns regarding side effects or weight changes will be recorded.
EXPECTED OUTCOMES
We expect to demonstrate the safety, identify possible side effects, and to optimize electrophysiological parameters related to VMH-DBS. No clinical or behavioral adverse changes are expected. Weight loss ≥ 3% of the basal weight after 3 mo of electrical stimulation will be considered adequate. Changes in body composition and increase in basal metabolism are expected. The amount of food intake is likely to remain unchanged.
DISCUSSION
The design of this study protocol is to define the safety of the procedure, the surgical parameters important for target localization, and additionally the safety of long-term stimulation of the VMH in morbidly obese patients. Novel neurosurgical approaches to treat metabolic and autonomic diseases can be developed based on the data made available by this investigation.
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Affiliation(s)
- Antonio A F De Salles
- Neuroscience Institute—Heart Hospital (HCor Neuro), University of São Paulo (USP), São Paulo, Brazil
- Research Institute—Heart Hospital (HCor IEP), University of São Paulo (USP), São Paulo, Brazil
| | - Daniel A N Barbosa
- Neuroscience Institute—Heart Hospital (HCor Neuro), University of São Paulo (USP), São Paulo, Brazil
| | - Fernando Fernandes
- Neuroscience Institute—Heart Hospital (HCor Neuro), University of São Paulo (USP), São Paulo, Brazil
- Department of Psychiatry, University of São Paulo (USP), São Paulo, Brazil
| | - Julio Abucham
- Department of Medicine, University Federal of São Paulo (UNIFESP), São Paulo, Brazil
| | - Debora M Nazato
- Department of Medicine, University Federal of São Paulo (UNIFESP), São Paulo, Brazil
| | - Juliana D Oliveira
- Research Institute—Heart Hospital (HCor IEP), University of São Paulo (USP), São Paulo, Brazil
| | - Abrão Cury
- Department of Medicine, University Federal of São Paulo (UNIFESP), São Paulo, Brazil
| | - Alexandre Biasi
- Neuroscience Institute—Heart Hospital (HCor Neuro), University of São Paulo (USP), São Paulo, Brazil
| | - Ronaldo Rossi
- Research Institute—Heart Hospital (HCor IEP), University of São Paulo (USP), São Paulo, Brazil
| | - Camila Lasagno
- Research Institute—Heart Hospital (HCor IEP), University of São Paulo (USP), São Paulo, Brazil
| | - Priscila T Bueno
- Research Institute—Heart Hospital (HCor IEP), University of São Paulo (USP), São Paulo, Brazil
| | - Renato H N Santos
- Research Institute—Heart Hospital (HCor IEP), University of São Paulo (USP), São Paulo, Brazil
| | - Lucas P Damiani
- Research Institute—Heart Hospital (HCor IEP), University of São Paulo (USP), São Paulo, Brazil
| | - Alessandra A Gorgulho
- Neuroscience Institute—Heart Hospital (HCor Neuro), University of São Paulo (USP), São Paulo, Brazil
- Research Institute—Heart Hospital (HCor IEP), University of São Paulo (USP), São Paulo, Brazil
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Tronnier VM, Rasche D, Thorns V, Alvarez-Fischer D, Münte TF, Zurowski B. Massive weight loss following deep brain stimulation of the nucleus accumbens in a depressed woman. Neurocase 2018; 24:49-53. [PMID: 29388475 DOI: 10.1080/13554794.2018.1431678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Obese individuals share behavioral characteristics with drug/alcohol addicts as well as obsessive compulsive disease. Deep brain stimulation (DBS) has been used successfully in these disorders, thus warranting an evaluation in obesity. A woman with treatment-resistant depression as well as severe obesity was selected for DBS of the nucleus accumbens (NAcc) bilaterally with depression being the primary and obesity being the secondary target of treatment. Compared to earlier bariatric surgery, the patient showed accelerated weight loss after DBS. Also, depression was significantly reduced. The current case suggests that DBS of the NAcc warrants further evaluation in patients unresponsive to other treatments.
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Affiliation(s)
- Volker M Tronnier
- a Department of Neurosurgery , University of Lübeck , Lübeck , Germany
| | - Dirk Rasche
- a Department of Neurosurgery , University of Lübeck , Lübeck , Germany
| | - Veronika Thorns
- b Department of Psychiatry , University of Lübeck , Lübeck , Germany
| | - Daniel Alvarez-Fischer
- b Department of Psychiatry , University of Lübeck , Lübeck , Germany.,c Institute of Neurogenetics , University of Lübeck , Lübeck , Germany
| | - Thomas F Münte
- d Department of Neurology , University of Lübeck , Lübeck , Germany.,e Institute of Psychology II , University of Lübeck , Lübeck , Germany
| | - Bartosz Zurowski
- b Department of Psychiatry , University of Lübeck , Lübeck , Germany
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Crinò A, Fintini D, Bocchini S, Grugni G. Obesity management in Prader-Willi syndrome: current perspectives. Diabetes Metab Syndr Obes 2018; 11:579-593. [PMID: 30323638 PMCID: PMC6175547 DOI: 10.2147/dmso.s141352] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a complex multisystem disorder due to the absent expression of the paternally active genes in the PWS critical region on chromosome 15 (15q11.2-q13). The syndrome is considered the most common genetic cause of obesity, occurring in 1:10,000-1:30,000 live births. Its main characteristics include neonatal hypotonia, poor feeding, and lack of appetite in infancy, followed by weight gain, lack of satiety, and uncontrolled appetite, frequently after the age of 2-3 years. The clinical picture includes short stature, multiple endocrine abnormalities (hypogonadism, growth hormone/insulin-like growth factor-I axis dysfunction, hypothyroidism, central adrenal insufficiency), dysmorphic features, scoliosis, osteoporosis, mental retardation, and behavioral and psychiatric problems. Subjects with PWS will become severely obese unless their food intake is strictly controlled. Constant and obsessive food seeking behavior can make life very difficult for both the family and caretakers. Prevention of obesity is mandatory in these patients from the first years of life, because once obesity develops it is difficult to maintain the control of food intake. In fact, PWS subjects die prematurely from complications conventionally related to obesity, including diabetes mellitus, metabolic syndrome, sleep apnea, respiratory insufficiency, and cardiovascular disease. The mechanisms underlying hyperphagia in PWS are not completely known, and to date no drugs have proven their efficacy in controlling appetite. Consequently, dietary restriction, physical activity, and behavior management are fundamental in the prevention and management of obesity in PWS. In spite of all available therapeutic tools, however, successful weight loss and maintenance are hardly accomplished. In this context, clinical trials with new drugs have been initiated in order to find new possibilities of a therapy for obesity in these patients. The preliminary results of these studies seem to be encouraging. On the other hand, until well-proven medical treatments are available, bariatric surgery can be taken into consideration, especially in PWS patients with life-threatening comorbidities.
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Affiliation(s)
| | - Danilo Fintini
- Endocrinology Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome
| | | | - Graziano Grugni
- Division of Auxology, Italian Auxological Institute, Research Institute, Piancavallo, Verbania, Italy
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13
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14
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Linssen RSN, Oudijn MS, Mantione M, van den Munckhof P, Denys D, Schuurman PR. Body Weight Changes after Deep Brain Stimulation for Obsessive-Compulsive Disorder or Depression. Stereotact Funct Neurosurg 2017; 95:348-351. [PMID: 29017175 DOI: 10.1159/000480665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/23/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND In 2010, we published an often-cited case report describing smoking cessation and substantial weight loss after deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) in an obese patient. To test whether this single observation was also observed in the treated population at large, the weight changes of a larger cohort of patients who underwent DBS for OCD or major depressive disorder (MDD) were studied. RESULTS Data were available for 46 patients (30 OCD and 16 MDD patients; mean age 46.2 years, SD 10.9) with an average baseline body mass index (BMI) of 28.0 (SD 7.3), 26 of whom (57%) were overweight (n = 11), obese (n = 12), or morbidly obese (n = 3). Mean follow-up was 3.8 years (range 10 months to 8.7 years, SD 2.3), after which the average BMI was 28.1 (SD 7.0), not significantly different from baseline. The average BMI of the 15 patients with (morbid) obesity at baseline decreased from 36.8 to 34.6 (ns), while the average BMI of the 31 normal or "only" overweight patients at baseline increased from 23.8 to 25.0 (ns). CONCLUSION There was no significant change in body weight on group level after DBS for either OCD or MDD.
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Affiliation(s)
- Rosalie S N Linssen
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
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Franco R, Fonoff ET, Alvarenga P, Lopes AC, Miguel EC, Teixeira MJ, Damiani D, Hamani C. DBS for Obesity. Brain Sci 2016; 6:brainsci6030021. [PMID: 27438859 PMCID: PMC5039450 DOI: 10.3390/brainsci6030021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/09/2016] [Accepted: 07/12/2016] [Indexed: 12/11/2022] Open
Abstract
Obesity is a chronic, progressive and prevalent disorder. Morbid obesity, in particular, is associated with numerous comorbidities and early mortality. In patients with morbid obesity, pharmacological and behavioral approaches often have limited results. Bariatric surgery is quite effective but is associated with operative failures and a non-negligible incidence of side effects. In the last decades, deep brain stimulation (DBS) has been investigated as a neurosurgical modality to treat various neuropsychiatric disorders. In this article we review the rationale for selecting different brain targets, surgical results and future perspectives for the use of DBS in medically refractory obesity.
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Affiliation(s)
- Ruth Franco
- Division of Pediatric Endocrinology, Children's Hospital, University of São Paulo Medical School, São Paulo 05403-000, Brazil.
| | - Erich T Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo 01060-970, Brazil.
| | - Pedro Alvarenga
- Department of Psychiatry, Institute of Psychiatry, University of São Paulo Medical School, São Paulo 01060-970, Brazil.
| | - Antonio Carlos Lopes
- Department of Psychiatry, Institute of Psychiatry, University of São Paulo Medical School, São Paulo 01060-970, Brazil.
| | - Euripides C Miguel
- Department of Psychiatry, Institute of Psychiatry, University of São Paulo Medical School, São Paulo 01060-970, Brazil.
| | - Manoel J Teixeira
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo 01060-970, Brazil.
| | - Durval Damiani
- Division of Pediatric Endocrinology, Children's Hospital, University of São Paulo Medical School, São Paulo 05403-000, Brazil.
| | - Clement Hamani
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo 01060-970, Brazil.
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 1R8, Canada.
- Division of Neuroimaging, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada.
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Huvenne H, Dubern B, Clément K, Poitou C. Rare Genetic Forms of Obesity: Clinical Approach and Current Treatments in 2016. Obes Facts 2016; 9:158-73. [PMID: 27241181 PMCID: PMC5644891 DOI: 10.1159/000445061] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/03/2016] [Indexed: 12/28/2022] Open
Abstract
Obesity results from a synergistic relationship between genes and the environment. The phenotypic expression of genetic factors involved in obesity is variable, allowing to distinguish several clinical pictures of obesity. Monogenic obesity is described as rare and severe early-onset obesity with abnormal feeding behavior and endocrine disorders. This is mainly due to autosomal recessive mutations in genes of the leptin-melanocortin pathway which plays a key role in the hypothalamic control of food intake. Melanocortin 4 receptor(MC4R)-linked obesity is characterized by the variable severity of obesity and no notable additional phenotypes. Mutations in the MC4R gene are involved in 2-3% of obese children and adults; the majority of these are heterozygous. Syndromic obesity is associated with mental retardation, dysmorphic features, and organ-specific developmental abnormalities. Additional genes participating in the development of hypothalamus and central nervous system have been regularly identified. But to date, not all involved genes have been identified so far. New diagnostic tools, such as whole-exome sequencing, will probably help to identify other genes. Managing these patients is challenging. Indeed, specific treatments are available only for specific types of monogenic obesity, such as leptin deficiency. Data on bariatric surgery are limited and controversial. New molecules acting on the leptin-melanocortin pathway are currently being developed.
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Affiliation(s)
- Hélène Huvenne
- GHICL, Saint-Vincent de Paul Hospital, Department of Pediatrics, Lille, France
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TEKRIWAL A, BALTUCH G. Deep Brain Stimulation: Expanding Applications. Neurol Med Chir (Tokyo) 2015; 55:861-77. [PMID: 26466888 PMCID: PMC4686449 DOI: 10.2176/nmc.ra.2015-0172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/15/2015] [Indexed: 12/13/2022] Open
Abstract
For over two decades, deep brain stimulation (DBS) has shown significant efficacy in treatment for refractory cases of dyskinesia, specifically in cases of Parkinson's disease and dystonia. DBS offers potential alleviation from symptoms through a well-tolerated procedure that allows personalized modulation of targeted neuroanatomical regions and related circuitries. For clinicians contending with how to provide patients with meaningful alleviation from often debilitating intractable disorders, DBSs titratability and reversibility make it an attractive treatment option for indications ranging from traumatic brain injury to progressive epileptic supra-synchrony. The expansion of our collective knowledge of pathologic brain circuitries, as well as advances in imaging capabilities, electrophysiology techniques, and material sciences have contributed to the expanding application of DBS. This review will examine the potential efficacy of DBS for neurologic and psychiatric disorders currently under clinical investigation and will summarize findings from recent animal models.
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Affiliation(s)
- Anand TEKRIWAL
- University of Pennsylvania, Department of Neurosurgery, Philadelphia, USA
- University of Colorado School of Medicine and Graduate School of Neuroscience, MSTP, Colorado, USA (current affiliation)
| | - Gordon BALTUCH
- University of Pennsylvania, Department of Neurosurgery, Philadelphia, USA
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