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Kilpatrick LA, Labus JS, Coveleskie K, Hammer C, Rappold G, Tillisch K, Bueller JA, Suyenobu B, Jarcho JM, McRoberts JA, Niesler B, Mayer EA. The HTR3A polymorphism c. -42C>T is associated with amygdala responsiveness in patients with irritable bowel syndrome. Gastroenterology 2011; 140:1943-51. [PMID: 21420406 PMCID: PMC3757951 DOI: 10.1053/j.gastro.2011.03.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 02/02/2011] [Accepted: 03/07/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS 5-Hydroxytryptamine (5-HT)3 receptor (5-HT3R) antagonists are effective in treating patients with irritable bowel syndrome (IBS) and have anxiolytic effects. Their therapeutic effects are related, in part, to reducing amygdala engagement during expected visceral pain. A single nucleotide polymorphism in HTR3A, c.-42C>T;(C178T; rs1062613), is associated with altered reactivity of the amygdala during emotional face processing in healthy subjects (controls). We evaluated the influence of this single nucleotide polymorphism on amygdala reactivity to emotional faces and nonemotional stimuli in female patients with IBS and controls. METHODS We measured brain responses during an affect-matching paradigm in 54 women (26 with IBS, 29 controls) using functional magnetic resonance imaging. We examined associations between HTR3A c.-42C>T genotype (C/C vs T carrier) and responses in amygdala and other regions of brain that expressed high levels of 5-HT3R. RESULTS The C/C genotype was associated with greater anxiety symptoms in patients with IBS and controls and increased activation of the amygdala under emotional and nonemotional conditions. Among patients with IBS, C/C genotype was associated with greater symptom ratings. A subset of IBS patients with the C/C genotype had increased amygdala responses to nonemotional stimuli, compared with other subjects with C/C genotype. CONCLUSIONS Regardless of diagnosis, the C/C genotype of the c.-42C>T polymorphism in HTR3A, compared with T carrier status, is associated with increased anxiety and amygdala responsiveness during emotional and nonemotional tasks. This polymorphism was associated with severity of IBS symptoms. Although this genotype is not sufficient for diagnosis of IBS, it is associated with severity of symptoms.
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Affiliation(s)
- LA Kilpatrick
- Center for Neurobiology of Stress, Ahmanson-Lovelace Brain Mapping Center, UCLA, Department of Medicine, Ahmanson-Lovelace Brain Mapping Center, UCLA
| | - JS Labus
- Center for Neurobiology of Stress, Ahmanson-Lovelace Brain Mapping Center, UCLA, Department of Psychiatry & Biobehavioral Sciences, Ahmanson-Lovelace Brain Mapping Center, UCLA, Brain Research Institute, David Geffen School of Medicine, UCLA
| | - K Coveleskie
- Center for Neurobiology of Stress, Ahmanson-Lovelace Brain Mapping Center, UCLA
| | - C Hammer
- Department of Human Molecular Genetics, University of Heidelberg, Germany
| | - G Rappold
- Department of Human Molecular Genetics, University of Heidelberg, Germany
| | - K Tillisch
- Center for Neurobiology of Stress, Ahmanson-Lovelace Brain Mapping Center, UCLA, Department of Medicine, Ahmanson-Lovelace Brain Mapping Center, UCLA
| | - JA Bueller
- Center for Neurobiology of Stress, Ahmanson-Lovelace Brain Mapping Center, UCLA, Department of Medicine, Ahmanson-Lovelace Brain Mapping Center, UCLA
| | - B Suyenobu
- Center for Neurobiology of Stress, Ahmanson-Lovelace Brain Mapping Center, UCLA, Department of Medicine, Ahmanson-Lovelace Brain Mapping Center, UCLA
| | - JM Jarcho
- Center for Neurobiology of Stress, Ahmanson-Lovelace Brain Mapping Center, UCLA, Department of Medicine, Ahmanson-Lovelace Brain Mapping Center, UCLA
| | - JA McRoberts
- Center for Neurobiology of Stress, Ahmanson-Lovelace Brain Mapping Center, UCLA, Department of Medicine, Ahmanson-Lovelace Brain Mapping Center, UCLA
| | - B Niesler
- Department of Human Molecular Genetics, University of Heidelberg, Germany
| | - EA Mayer
- Center for Neurobiology of Stress, Ahmanson-Lovelace Brain Mapping Center, UCLA, Department of Medicine, Ahmanson-Lovelace Brain Mapping Center, UCLA, Department of Psychiatry & Biobehavioral Sciences, Ahmanson-Lovelace Brain Mapping Center, UCLA, Brain Research Institute, David Geffen School of Medicine, UCLA
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Kilpatrick LA, Suyenobu BY, Smith SR, Bueller JA, Goodman T, Creswell JD, Tillisch K, Mayer EA, Naliboff BD. Impact of Mindfulness-Based Stress Reduction training on intrinsic brain connectivity. Neuroimage 2011; 56:290-8. [PMID: 21334442 DOI: 10.1016/j.neuroimage.2011.02.034] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 01/11/2011] [Accepted: 02/10/2011] [Indexed: 02/08/2023] Open
Abstract
The beneficial effects of mindful awareness and mindfulness meditation training on physical and psychological health are thought to be mediated in part through changes in underlying brain processes. Functional connectivity MRI (fcMRI) allows identification of functional networks in the brain. It has been used to examine state-dependent activity and is well suited for studying states such as meditation. We applied fcMRI to determine if Mindfulness-Based Stress Reduction (MBSR) training is effective in altering intrinsic connectivity networks (ICNs). Healthy women were randomly assigned to participate in an 8-week Mindfulness-Based Stress Reduction (MBSR) training course or an 8-week waiting period. After 8 weeks, fMRI data (1.5T) was acquired while subjects rested with eyes closed, with the instruction to pay attention to the sounds of the scanner environment. Group independent component analysis was performed to investigate training-related changes in functional connectivity. Significant MBSR-related differences in functional connectivity were found mainly in auditory/salience and medial visual networks. Relative to findings in the control group, MBSR subjects showed (1) increased functional connectivity within auditory and visual networks, (2) increased functional connectivity between auditory cortex and areas associated with attentional and self-referential processes, (3) stronger anticorrelation between auditory and visual cortex, and (4) stronger anticorrelation between visual cortex and areas associated with attentional and self-referential processes. These findings suggest that 8 weeks of mindfulness meditation training alters intrinsic functional connectivity in ways that may reflect a more consistent attentional focus, enhanced sensory processing, and reflective awareness of sensory experience.
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Affiliation(s)
- Lisa A Kilpatrick
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Seminowicz DA, Labus JS, Bueller JA, Tillisch K, Naliboff BD, Bushnell MC, Mayer EA. Regional gray matter density changes in brains of patients with irritable bowel syndrome. Gastroenterology 2010; 139:48-57.e2. [PMID: 20347816 PMCID: PMC2902717 DOI: 10.1053/j.gastro.2010.03.049] [Citation(s) in RCA: 226] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 03/14/2010] [Accepted: 03/22/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Several studies have examined structural brain changes associated with chronic pain syndromes, including irritable bowel syndrome (IBS), but study sample sizes have been small and heterogeneous. METHODS We used magnetic resonance imaging-based techniques, voxel-based morphometry, and cortical thickness analysis to examine brain anatomical differences in a relatively large, tightly screened sample of IBS patients (n = 55); we compared data with that from healthy persons (controls; n = 48). RESULTS IBS was associated with decreased gray matter density (GMD) in widespread areas of the brain, including medial prefrontal and ventrolateral prefrontal cortex, posterior parietal cortex, ventral striatum, and thalamus. Compared with controls, we observed increased GMD in patients with IBS in the pregenual anterior cingulate cortex and the orbitofrontal cortex, as well as trends in the posterior insula/secondary somatosensory cortex, (para)hippocampus, and left dorsolateral prefrontal cortex. In accounting for anxiety and depression, we found that several of the regions involved in affective processing no longer differed between patients with IBS and controls, whereas the differences in prefrontal and posterior parietal cortices remained. The areas of decreased GMD associated with IBS were largely consistent across clinical subgroups, based on predominant bowel habit and pain predominance of symptoms. No overall or regional differences were observed in cortical thickness between patients with IBS and controls. CONCLUSIONS Changes in density of gray matter among regions involved in cognitive/evaluative functions are specifically observed in patients with IBS, whereas changes in other areas of the brain can be explained by levels of anxiety and depression.
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Affiliation(s)
- David A. Seminowicz
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Jennifer S. Labus
- Center for Neurobiology of Stress, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA and VA Greater Los Angeles Health Care System
| | - Joshua A. Bueller
- Center for Neurobiology of Stress, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA and VA Greater Los Angeles Health Care System
| | - Kirsten Tillisch
- Center for Neurobiology of Stress, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA and VA Greater Los Angeles Health Care System
| | - Bruce D. Naliboff
- Center for Neurobiology of Stress, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA and VA Greater Los Angeles Health Care System
| | | | - Emeran A. Mayer
- Center for Neurobiology of Stress, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA and VA Greater Los Angeles Health Care System
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Kilpatrick LA, Suyenobu BY, Smith SR, Bueller JA, Mayer EA, Naliboff BD. Impact of Mindfulness Meditation Training on the Default Network. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bueller JA, Labus JS, Suyenobu BY, Stains J, Tillisch K, Vianna EP, Jarcho J, Naliboff BD, Mayer EA. Increased coupling within an emotional arousal circuit following threat conditioning in patients with Irritable Bowel Syndrome (IBS). Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)72023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Labus JS, Naliboff BN, Fallon J, Berman SM, Suyenobu B, Bueller JA, Mandelkern M, Mayer EA. Sex differences in brain activity during aversive visceral stimulation and its expectation in patients with chronic abdominal pain: a network analysis. Neuroimage 2008; 41:1032-43. [PMID: 18450481 DOI: 10.1016/j.neuroimage.2008.03.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Revised: 02/23/2008] [Accepted: 03/03/2008] [Indexed: 12/22/2022] Open
Abstract
Differences in brain responses to aversive visceral stimuli may underlie previously reported sex differences in symptoms as well as perceptual and emotional responses to such stimuli in patients with irritable bowel syndrome (IBS). The goal of the current study was to identify brain networks activated by expected and delivered aversive visceral stimuli in male and female patients with chronic abdominal pain, and to test for sex differences in the effective connectivity of the circuitry comprising these networks. Network analysis was applied to assess the brain response of 46 IBS patients (22 men and 24 women) recorded using [15O] water positron emission tomography during rest/baseline and expected and delivered aversive rectal distension. Functional connectivity results from partial least squares analyses provided support for the hypothesized involvement of 3 networks corresponding to: 1) visceral afferent information processing (thalamus, insula and dorsal anterior cingulate cortex, orbital frontal cortex), 2) emotional-arousal (amygdala, rostral and subgenual cingulate regions, and locus coeruleus complex) and 3) cortical modulation (frontal and parietal cortices). Effective connectivity results obtained via structural equation modeling indicated that sex-related differences in brain response are largely due to alterations in the effective connectivity of emotional-arousal circuitry rather than visceral afferent processing circuits. Sex differences in the cortico-limbic circuitry involved in emotional-arousal, pain facilitation and autonomic responses may underlie the observed differences in symptoms, and in perceptual and emotional responses to aversive visceral stimuli.
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Affiliation(s)
- J S Labus
- Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, USA.
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Abstract
Despite considerable efforts by academic researchers and by the pharmaceutical industry, the development of novel pharmacological treatments for irritable bowel syndrome (IBS) and other functional gastrointestinal (GI) disorders has been slow and disappointing. The traditional approach to identifying and evaluating novel drugs for these symptom-based syndromes has relied on a fairly standard algorithm using animal models, experimental medicine models and clinical trials. In the current article, the empirical basis for this process is reviewed, focusing on the utility of the assessment of visceral hypersensitivity and GI transit, in both animals and humans, as well as the predictive validity of preclinical and clinical models of IBS for identifying successful treatments for IBS symptoms and IBS-related quality of life impairment. A review of published evidence suggests that abdominal pain, defecation-related symptoms (urgency, straining) and psychological factors all contribute to overall symptom severity and to health-related quality of life. Correlations between readouts obtained in preclinical and clinical models and respective symptoms are small, and the ability to predict drug effectiveness for specific as well as for global IBS symptoms is limited. One possible drug development algorithm is proposed which focuses on pharmacological imaging approaches in both preclinical and clinical models, with decreased emphasis on evaluating compounds in symptom-related animal models, and more rapid screening of promising candidate compounds in man.
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Affiliation(s)
- E A Mayer
- UCLA Center for Neurovisceral Sciences & Women's Health, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA.
| | - S Bradesi
- UCLA Center for Neurovisceral Sciences & Women’s Health, Departments of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - L Chang
- UCLA Center for Neurovisceral Sciences & Women’s Health, Departments of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - B M R Spiegel
- UCLA Center for Neurovisceral Sciences & Women’s Health, Departments of Medicine, Center for Outcomes Research and Education, David Geffen School of Medicine at UCLA, Los Angeles, CA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - J A Bueller
- UCLA Center for Neurovisceral Sciences & Women’s Health, Departments of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - B D Naliboff
- UCLA Center for Neurovisceral Sciences & Women’s Health, Departments of Medicine and Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Liberzon I, Taylor SF, Phan KL, Britton JC, Fig LM, Bueller JA, Koeppe RA, Zubieta JK. Altered central micro-opioid receptor binding after psychological trauma. Biol Psychiatry 2007; 61:1030-8. [PMID: 16945349 DOI: 10.1016/j.biopsych.2006.06.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 06/15/2006] [Accepted: 06/15/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Functional neuroimaging studies have detected abnormal limbic and paralimbic activation to emotional probes in posttraumatic stress disorder (PTSD), but few studies have examined neurochemical mechanisms that underlie functional alterations in regional cerebral blood flow. The mu-opioid neurotransmitter system, implicated in responses to stress and suppression of pain, is distributed in and is thought to regulate the function of brain regions that are implicated in affective processing. METHODS Here we examined the micro-opioid system with positron emission tomography and the micro-opioid receptor-selective radiotracer [11C] carfentanil in 16 male patients with PTSD and two non-PTSD male control groups, with (n = 14) and without combat exposure (n = 15). Differences in micro-opioid receptor binding potential (BP2) were detected within discrete limbic and paralimbic regions. RESULTS Relative to healthy controls, both trauma-exposed groups had lower micro-opioid receptor BP2 in extended amygdala, nucleus accumbens, and dorsal frontal and insular cortex but had higher BP2 in the orbitofrontal cortex. PTSD patients exhibited reduced BP2 in anterior cingulate cortex compared with both control groups. Micro-opioid receptor BP2 in combat-exposed subjects without PTSD was lower in the amygdala but higher in the orbitofrontal cortex compared with both PTSD patients and healthy controls. CONCLUSIONS These findings differentiate the general response of the micro-opioid system to trauma from more specific changes associated with PTSD.
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Affiliation(s)
- Israel Liberzon
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan 48109-0118, USA.
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Smith YR, Stohler CS, Nichols TE, Bueller JA, Koeppe RA, Zubieta JK. Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women. J Neurosci 2006; 26:5777-85. [PMID: 16723535 PMCID: PMC1808228 DOI: 10.1523/jneurosci.5223-05.2006] [Citation(s) in RCA: 223] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Prominent interindividual and sex-dependent differences have been described in responses to sustained pain and other stressful stimuli. Variations in mu-opioid receptor-mediated endogenous opioid neurotransmission may underlie some of these processes. We examined both baseline mu-opioid receptor levels and the activation of this neurotransmitter system during sustained pain using positron emission tomography in a sample of young healthy men and women. Women were studied twice, during low and high estrogen states. The high-estrogen state was associated with regional increases in baseline mu-opioid receptor availability in vivo and a greater activation of endogenous opioid neurotransmission during the pain stressor. The latter did not differ from that obtained in males. During the low estrogen condition, however, significant reductions in endogenous opioid tone were observed at the level of thalamus, nucleus accumbens, and amygdala, which were associated with hyperalgesic responses. Estrogen-associated variations in the activity of mu-opioid neurotransmission correlated with individual ratings of the sensory and affective perceptions of the pain and the subsequent recall of that experience. These data demonstrate a significant role of estrogen in modulating endogenous opioid neurotransmission and associated psychophysical responses to a pain stressor in humans.
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Bueller JA, Aftab M, Sen S, Gomez-Hassan D, Burmeister M, Zubieta JK. BDNF Val66Met allele is associated with reduced hippocampal volume in healthy subjects. Biol Psychiatry 2006; 59:812-5. [PMID: 16442082 DOI: 10.1016/j.biopsych.2005.09.022] [Citation(s) in RCA: 347] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Revised: 08/22/2005] [Accepted: 09/30/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND A frequent polymorphism of the brain-derived neurotrophic factor (BDNF) gene (val(66)met) has been suggested to modulate hippocampal neuronal plasticity and has been associated with individual variations in emotional reactivity traits and episodic memory. METHODS The hippocampal formation was outlined in high-resolution anatomical magnetic resonance imaging (MRI) data in a sample of 36 healthy volunteers and compared between individuals as a function of the presence of the met-BDNF allele. Both whole-brain volume corrected and uncorrected data were tested for effects of genotype, sex, and age. RESULTS The met-BDNF allele was associated with an 11% reduction in the volume of the hippocampal formation. CONCLUSIONS In spite of a relatively small sample size, the presence of the met-BDNF allele was found associated with a reduced volume of the hippocampal formation in healthy volunteers and may represent a vulnerability factor for the development of disease processes associated with the dysfunction of this brain region.
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Affiliation(s)
- Joshua A Bueller
- Mental Health Research Institute, The University of Michigan, Ann Arbor, Michigan, USA
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Berman SM, Naliboff BD, Suyenobu B, Labus JS, Stains J, Bueller JA, Ruby K, Mayer EA. Sex differences in regional brain response to aversive pelvic visceral stimuli. Am J Physiol Regul Integr Comp Physiol 2006; 291:R268-76. [PMID: 16614061 DOI: 10.1152/ajpregu.00065.2006] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To explore sex differences in the response of seven brain regions to an aversive pelvic visceral stimulus, functional magnetic resonance images were acquired from 13 healthy adults (6 women) during 15 s of cued rectal distension at two pressures: 25 mmHg (uncomfortable), and 45 mmHg (mild pain), as well as during an expectation condition (no distension). Random-effects analyses combining subject data voxelwise found 45-mmHg pressure significantly activated the insular and anterior cingulate cortices in both sexes. In men only, the left thalamus and ventral striatum were also activated. Although all activations appeared more extensive in men, no sex difference attained significance. To explore the presence of deactivations, which are generally cancelled by more numerous activations when subjects are combined for each voxel, the number of activated voxels, number of deactivated voxels, and ratio of deactivated voxels to total voxels affected were assessed via random-effects, mixed-model analyses combining subject data at the region level. Greater insula activation in men compared with women was seen during the expectation condition and during the 25-mmHg distension. Greater deactivations in women were seen in the amygdala (25-mmHg distension) and midcingulate (45-mmHg distension). Women had a significantly higher proportion of deactivated voxels than men in all four subcortical structures during 25-mmHg distension. Greater familiarity of females with physiological pelvic visceral discomfort may have enhanced brain systems that dampen arousal networks during lower levels of discomfort.
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Affiliation(s)
- Steven M Berman
- University of California, Los Angeles (UCLA), Center for Neurovisceral Sciences & Women's Health, Department of Medicine, and Veterans Affairs Greater Los Angeles Healthcare System, CA 90073, USA.
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Zubieta JK, Bueller JA, Jackson LR, Scott DJ, Xu Y, Koeppe RA, Nichols TE, Stohler CS. Placebo effects mediated by endogenous opioid activity on mu-opioid receptors. J Neurosci 2006; 25:7754-62. [PMID: 16120776 PMCID: PMC6725254 DOI: 10.1523/jneurosci.0439-05.2005] [Citation(s) in RCA: 619] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Reductions in pain ratings when administered a placebo with expected analgesic properties have been described and hypothesized to be mediated by the pain-suppressive endogenous opioid system. Using molecular imaging techniques, we directly examined the activity of the endogenous opioid system on mu-opioid receptors in humans in sustained pain with and without the administration of a placebo. Significant placebo-induced activation of mu-opioid receptor-mediated neurotransmission was observed in both higher-order and sub-cortical brain regions, which included the pregenual and subgenual rostral anterior cingulate, the dorsolateral prefrontal cortex, the insular cortex, and the nucleus accumbens. Regional activations were paralleled by lower ratings of pain intensity, reductions in its sensory and affective qualities, and in the negative emotional state of the volunteers. These data demonstrate that cognitive factors (e.g., expectation of pain relief) are capable of modulating physical and emotional states through the site-specific activation of mu-opioid receptor signaling in the human brain.
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Affiliation(s)
- Jon-Kar Zubieta
- Department of Psychiatry, Mental Health Research Institute, The University of Michigan, Ann Arbor, Michigan 48109-0720, USA.
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Zubieta JK, Ketter TA, Bueller JA, Xu Y, Kilbourn MR, Young EA, Koeppe RA. Regulation of human affective responses by anterior cingulate and limbic mu-opioid neurotransmission. ACTA ACUST UNITED AC 2004; 60:1145-53. [PMID: 14609890 DOI: 10.1001/archpsyc.60.11.1145] [Citation(s) in RCA: 257] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Human affective responses appear to be regulated by limbic and paralimbic circuits. However, much less is known about the neurochemical systems engaged in this regulation. The mu-opioid neurotransmitter system is distributed in, and thought to regulate the function of, brain regions centrally implicated in affective processing. OBJECTIVE To examine the involvement of mu-opioid neurotransmission in the regulation of affective states in healthy human volunteers. DESIGN Measures of mu-opioid receptor availability in vivo were obtained with positron emission tomography and the mu-opioid receptor selective radiotracer [11C]carfentanil during a neutral state and during a sustained sadness state. Subtraction analyses of the binding potential maps were then performed within subjects, between conditions, on a voxel-by-voxel basis. SETTING Imaging center at a university medical center. PARTICIPANTS Fourteen healthy female volunteers. Intervention Sustained neutral and sadness states, randomized and counterbalanced in order, elicited by the cued recall of an autobiographical event associated with that emotion. MAIN OUTCOME MEASURES Changes in mu-opioid receptor availability and negative and positive affect ratings between conditions. Increases or reductions in the in vivo receptor measure reflect deactivation or activation of neurotransmitter release, respectively. RESULTS The sustained sadness condition was associated with a statistically significant deactivation in mu-opioid neurotransmission in the rostral anterior cingulate, ventral pallidum, amygdala, and inferior temporal cortex. This deactivation was reflected by increases in mu-opioid receptor availability in vivo. The deactivation of mu-opioid neurotransmission in the rostral anterior cingulate, ventral pallidum, and amygdala was correlated with the increases in negative affect ratings and the reductions in positive affect ratings during the sustained sadness state. CONCLUSIONS These data demonstrate dynamic changes in mu-opioid neurotransmission in response to an experimentally induced negative affective state. The direction and localization of these responses confirms the role of the mu-opioid receptor system in the physiological regulation of affective experiences in humans.
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Affiliation(s)
- Jon-Kar Zubieta
- Department of Psychiatry and Mental Health Research Institute, University of Michigan, 205 Zina Pitcher Place, Ann Arbor, MI 48109-0720, USA.
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Zubieta JK, Heitzeg MM, Smith YR, Bueller JA, Xu K, Xu Y, Koeppe RA, Stohler CS, Goldman D. COMT val158met genotype affects mu-opioid neurotransmitter responses to a pain stressor. Science 2003; 299:1240-3. [PMID: 12595695 DOI: 10.1126/science.1078546] [Citation(s) in RCA: 768] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Responses to pain and other stressors are regulated by interactions between multiple brain areas and neurochemical systems. We examined the influence of a common functional genetic polymorphism affecting the metabolism of catecholamines on the modulation of responses to sustained pain in humans. Individuals homozygous for the met158 allele of the catechol-O-methyltransferase (COMT) polymorphism (val158met) showed diminished regional mu-opioid system responses to pain compared with heterozygotes. These effects were accompanied by higher sensory and affective ratings of pain and a more negative internal affective state. Opposite effects were observed in val158 homozygotes. The COMT val158met polymorphism thus influences the human experience of pain and may underlie interindividual differences in the adaptation and responses to pain and other stressful stimuli.
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Affiliation(s)
- Jon-Kar Zubieta
- Department of Psychiatry and Mental Health Research Institute, University of Michigan, Ann Arbor, MI 48109-0720, USA.
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Zubieta JK, Smith YR, Bueller JA, Xu Y, Kilbourn MR, Jewett DM, Meyer CR, Koeppe RA, Stohler CS. mu-opioid receptor-mediated antinociceptive responses differ in men and women. J Neurosci 2002; 22:5100-7. [PMID: 12077205 PMCID: PMC6757760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Sex differences in the experience of clinical and experimental pain have been reported. However, the neurobiological sources underlying the variability in pain responses between sexes have not been adequately explored, especially in humans. The endogenous opioid neurotransmitters and mu-opioid receptors are centrally implicated in responses to stress, in the suppression of pain, and in the action of opiate analgesic drugs. Here we examined sex differences in the activation of the mu-opioid system in response to an intensity-controlled sustained deep-tissue pain challenge with positron emission tomography and a mu-opioid receptor-selective radiotracer. Twenty-eight young healthy volunteers (14 men and 14 women) were studied during saline control and pain conditions using a double-blind, randomized, and counterbalanced design. Women were scanned during the early follicular phase of their menstrual cycles after ovulatory cycles. Significant sex differences in the regional activation of the mu-opioid system in response to sustained pain were detected compared with saline controls. Men demonstrated larger magnitudes of mu-opioid system activation than women in the anterior thalamus, ventral basal ganglia, and amygdala. Conversely, women demonstrated reductions in the basal state of activation of the mu-opioid system during pain in the nucleus accumbens, an area previously associated with hyperalgesic responses to the blockade of opioid receptors in experimental animals. These data demonstrate that at matched levels of pain intensity, men and women during their follicular phase differ in the magnitude and direction of response of the mu-opioid system in distinct brain nuclei.
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Affiliation(s)
- Jon-Kar Zubieta
- Department of Psychiatry and Mental Health Research Institute, University of Michigan, Ann Arbor, Michigan 48109-0720, USA
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Zubieta JK, Smith YR, Bueller JA, Xu Y, Kilbourn MR, Jewett DM, Meyer CR, Koeppe RA, Stohler CS. Regional mu opioid receptor regulation of sensory and affective dimensions of pain. Science 2001; 293:311-5. [PMID: 11452128 DOI: 10.1126/science.1060952] [Citation(s) in RCA: 587] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The endogenous opioid system is involved in stress responses, in the regulation of the experience of pain, and in the action of analgesic opiate drugs. We examined the function of the opioid system and mu-opioid receptors in the brains of healthy human subjects undergoing sustained pain. Sustained pain induced the regional release of endogenous opioids interacting with mu-opioid receptors in a number of cortical and subcortical brain regions. The activation of the mu-opioid receptor system was associated with reductions in the sensory and affective ratings of the pain experience, with distinct neuroanatomical involvements. These data demonstrate the central role of the mu-opioid receptors and their endogenous ligands in the regulation of sensory and affective components of the pain experience.
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Affiliation(s)
- J K Zubieta
- Department of Psychiatry and Mental Health Research Institute, Medical School, The University of Michigan, Ann Arbor, MI 48104-1687, USA.
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