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Cribb L, Sarris J, Savage KM, Byrne GJ, Metri NJ, Scholey A, Stough C, Bousman CA. Effect of kava (Piper methysticum) on peripheral gene expression among individuals with generalized anxiety disorder: A post hoc analysis of a randomized controlled trial. Phytother Res 2023; 37:5897-5903. [PMID: 37767766 DOI: 10.1002/ptr.7999] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023]
Abstract
Kava is a South Pacific plant-based medicine with anxiolytic properties, but little is known about the impact kava has on gene expression or whether gene expression can serve as a marker of kava response. This study aimed to determine whether kava treatment alters the expression of genes with physiological relevance to anxiety pathophysiology and whether the baseline expression of these physiologically relevant genes modifies the efficacy of kava treatment. In this post hoc analysis, we examined the expression of 48 genes relevant to the pathophysiology of anxiety collected from a double-blind randomized controlled trial that assessed the efficacy of kava treatment in generalized anxiety disorder. Peripheral blood gene expression was measured in 71 (34 kava, 37 placebo) adults at baseline and in 40 (19 kava, 21 placebo) after 8 weeks of treatment by reverse transcription polymerase chain reaction (PCR). Results revealed that kava decreased the expression of a subunit of the GABAA -rho receptor gene (GABRR2) and catechol-O-methyltransferase (COMT), a gene related to catecholamine metabolism. Kava efficacy was not found to be modified by baseline (pretreatment) expression of relevant genes. Although these results did not withstand statistical correction for multiple comparisons and require external validation, they support the notion that kava's mechanism of action includes interaction with GABAergic and catecholaminergic systems.
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Affiliation(s)
- Lachlan Cribb
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Karen M Savage
- Department of Psychiatry, ACT Health, Canberra, Australia
| | - Gerard J Byrne
- Department of Psychiatry, ACT Health, Canberra, Australia
- School of Clinical Medicine, Discipline of Psychiatry, The University of Queensland, Queensland, Australia
| | - Najwa-Joelle Metri
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Hawthorn, Swinburne University of Technology, Victoria, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Hawthorn, Swinburne University of Technology, Victoria, Australia
| | - Chad A Bousman
- Department of Medical Genetics, Psychiatry, Physiology & Pharmacology Calgary, Alberta, Canada
- Department of Psychiatry Parkville, Victoria, Australia
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Fard MT, Savage KM, Stough CK. Peripheral inflammation marker relationships to cognition in healthy older adults - A systematic review. Psychoneuroendocrinology 2022; 144:105870. [PMID: 35908534 DOI: 10.1016/j.psyneuen.2022.105870] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 12/15/2021] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
Several cognitive domains show decline with increasing age, which is associated with poorer work performance and reduced quality of life. As many nations show a rise in the number of citizens aged over 60 years, the study of the mechanisms underlying age-related cognitive functional reductions, such as inflammation, is important. Inflammaging has been implicated in progressive minor decline through to dementia typologies, with peripheral cytokine patterns investigated for their potential role in cognitive function. Assessing the relationship between these markers and cognitive performance could elucidate mechanisms with aging beyond neuropathologies. The research literature suggests peripheral cytokines/chemokines such as interleukin-6 and c-reactive protein are associated with cognitive processing. In this systematic review, we examine the evidence for a relationship between a range of peripheral inflammatory markers and domains of cognitive function in healthy older adults. To do this, a literature search was conducted using the following databases: SCOPUS, PubMed, Web of Science, and PsycINFO. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Twenty-nine studies met our inclusion criteria. Although a wide range of systemic inflammatory biomarkers were examined, IL-6 and CRP were the most studied. The evidence suggests an inverse inflammatory biomarker-cognitive function relationship whereby elevations in most cytokines were associated with poorer performance across cognitive domains. The findings contribute to our understanding of peripheral inflammation and domains of cognitive function, offering insight into inflammaging processes.
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Affiliation(s)
- Masoumeh Tangestani Fard
- Centre for Human Psychopharmacology, School of Health Sciences, Swinburne University of Technology, Burwood Road, Hawthorn, Australia, 3122
| | - Karen M Savage
- Centre for Human Psychopharmacology, School of Health Sciences, Swinburne University of Technology, Burwood Road, Hawthorn, Australia, 3122.
| | - Con K Stough
- Centre for Human Psychopharmacology, School of Health Sciences, Swinburne University of Technology, Burwood Road, Hawthorn, Australia, 3122
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Sarris J, Byrne GJ, Bousman CA, Cribb L, Savage KM, Holmes O, Murphy J, Macdonald P, Short A, Nazareth S, Jennings E, Thomas SR, Ogden E, Chamoli S, Scholey A, Stough C. Kava for generalised anxiety disorder: A 16-week double-blind, randomised, placebo-controlled study. Aust N Z J Psychiatry 2020; 54:288-297. [PMID: 31813230 DOI: 10.1177/0004867419891246] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Previous randomised, double-blind, placebo-controlled studies have shown that Kava (a South Pacific medicinal plant) reduced anxiety during short-term administration. The objective of this randomised, double-blind, placebo-controlled study was to perform a larger, longer-term trial assessing the efficacy and safety of Kava in the treatment of generalised anxiety disorder and to determine whether gamma-aminobutyric acid transporter (SLC6A1) single-nucleotide polymorphisms were moderators of response. METHODS The trial was a phase III, multi-site, two-arm, 16-week, randomised, double-blind, placebo-controlled study investigating an aqueous extract of dried Kava root administered twice per day in tablet form (standardised to 120 mg of kavalactones twice/day) in 171 currently non-medicated anxious participants with diagnosed generalised anxiety disorder. The trial took place in Australia. RESULTS An analysis of 171 participants revealed a non-significant difference in anxiety reduction between the Kava and placebo groups (a relative reduction favouring placebo of 1.37 points; p = 0.25). At the conclusion of the controlled phase, 17.4% of the Kava group were classified as remitted (Hamilton Anxiety Rating Scale score < 7) compared to 23.8% of the placebo group (p = 0.46). No SLC6A1 polymorphisms were associated with treatment response, while carriers of the rs2601126 T allele preferentially respond to placebo (p = 0.006). Kava was well tolerated aside from poorer memory (Kava = 36 vs placebo = 23; p = 0.044) and tremor/shakiness (Kava = 36 vs placebo = 23; p = 0.024) occurring more frequently in the Kava group. Liver function test abnormalities were significantly more frequent in the Kava group, although no participant met criteria for herb-induced hepatic injury. CONCLUSION While research has generally supported Kava in non-clinical populations (potentially for more 'situational' anxiety as a short-term anxiolytic), this particular extract was not effective for diagnosed generalised anxiety disorder.
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Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia.,Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Gerard J Byrne
- Discipline of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Chad A Bousman
- Departments of Medical Genetics, Psychiatry and Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Lachlan Cribb
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Karen M Savage
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Oliver Holmes
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jenifer Murphy
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Patricia Macdonald
- Discipline of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Anika Short
- Discipline of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Sonia Nazareth
- Discipline of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Jennings
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | - Edward Ogden
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Suneel Chamoli
- Department of Psychiatry, ACT Health, Canberra, ACT, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
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Savage KM, Stough CK, Byrne GJ, Scholey A, Bousman C, Murphy J, Macdonald P, Suo C, Hughes M, Thomas S, Teschke R, Xing C, Sarris J. Kava for the treatment of generalised anxiety disorder (K-GAD): study protocol for a randomised controlled trial. Trials 2015; 16:493. [PMID: 26527536 PMCID: PMC4630875 DOI: 10.1186/s13063-015-0986-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/30/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Generalised anxiety disorder (GAD) is a chronic and pervasive condition that generates high levels of psychological stress, and it is difficult to treat in the long term. Current pharmacotherapeutic options for GAD are in some cases only modestly effective, and may elicit undesirable side effects. Through targeted actions on the gamma-aminobutyric acid (GABA) pathway, the South Pacific medicinal plant kava (Piper methysticum) is a non-addictive, non-hypnotic anxiolytic with the potential to treat GAD. The evidence for the efficacy of kava for treating anxiety has been affirmed through clinical trials and meta-analyses. Recent research has also served to lessen safety concerns regarding the use of kava due to hepatotoxic risk, which is reflected in a recent German court overturning the previous kava ban in that country (which may in turn influence a reinstatement by the European Union). The aim of current research is to assess the efficacy of an 'aqueous noble cultivar rootstock extract' of kava in GAD in a larger longer term study. In addition, we plan to investigate the pharmacogenomic influence of GABA transporters on response, effects of kava on gene expression, and for the first time, the neurobiological correlates of treatment response via functional and metabolic imaging. METHODS/DESIGN This clinical trial is funded by the Australian National Health and Medical Research Council (APP1063383) and co-funded by MediHerb (Integria Healthcare (Australia) Pty. Ltd). The study is a phase III, multi-site, two-arm, 18-week, randomised, double-blind, placebo-controlled study using an aqueous extract of noble kava cultivar (standardised to 240 mg of kavalactones per day) versus matching placebo in 210 currently anxious participants with diagnosed GAD who are non-medicated. The study takes place at two sites: the Centre for Human Psychopharmacology (Swinburne University of Technology), Hawthorn, Melbourne, Australia; and the Academic Discipline of Psychiatry (The University of Queensland) based at the Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia. Written informed consent will be obtained from each participant prior to commencement in the study. The primary outcome is the Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A). The secondary outcomes involve a range of scales that assess affective disorder symptoms and quality of life outcomes, in addition to the study of mediating biomarkers of response (assessed via genomics and neuroimaging). DISCUSSION If this study demonstrates positive findings in support of the superiority of kava over placebo in the treatment of GAD, and also is shown to be safe, then this plant-medicine can be considered a 'first-line' therapy for GAD. Genomic and neuroimaging data may reveal clinical response patterns and provide more evidence of the neurobiological activity of the plant extract. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov: NCT02219880 Date: 13 August 2014:.
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Affiliation(s)
- Karen M Savage
- The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Melbourne, Australia.
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
| | - Con K Stough
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
| | - Gerard J Byrne
- Department of Psychiatry, The University of Queensland, Melbourne, Australia.
| | - Andrew Scholey
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
| | - Chad Bousman
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
- Department of Psychiatry, The University of Melbourne, Parkville, Australia.
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
- Department of General Practice, The University of Melbourne, Parkville, Australia.
| | - Jenifer Murphy
- The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Melbourne, Australia.
| | - Patricia Macdonald
- Department of Psychiatry, The University of Queensland, Melbourne, Australia.
| | - Chao Suo
- Brain and Mental Health Laboratory, School of Psychological Science, Monash University, Monash, Australia.
| | - Matthew Hughes
- Swinburne University of Technology, Brain and Psychological Sciences Centre, Swinburne, Australia.
| | - Stuart Thomas
- School of Psychological Science, Monash University, Monash, Australia.
| | - Rolf Teschke
- Department of Internal Medicine II, Section of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Johann Wolfgang Goethe University of Frankfurt/Main, Frankfurt, Germany.
| | - Chengguo Xing
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Duluth, USA.
| | - Jerome Sarris
- The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Melbourne, Australia.
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
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Sarris J, Stough C, Teschke R, Wahid ZT, Bousman CA, Murray G, Savage KM, Mouatt P, Ng C, Schweitzer I. Kava for the treatment of generalized anxiety disorder RCT: analysis of adverse reactions, liver function, addiction, and sexual effects. Phytother Res 2013; 27:1723-8. [PMID: 23348842 DOI: 10.1002/ptr.4916] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/19/2012] [Accepted: 11/27/2012] [Indexed: 12/15/2022]
Abstract
Presently, little is known about a number issues concerning kava (Piper methysticum), including (i) whether kava has any withdrawal or addictive effects; (ii) if genetic polymorphisms of the cytochrome (CYP) P450 2D6 liver enzyme moderates any potential adverse effects; and (iii) if medicinal application of kava has any negative or beneficial effect on sexual function and experience. The study design was a 6-week, double-blind, randomized controlled trial (n = 75) involving chronic administration of kava (one tablet of kava twice per day; 120 mg of kavalactones per day, titrated in non-response to two tablets of kava twice per day; 240 mg of kavalactones) or placebo for participants with generalized anxiety disorder. Results showed no significant differences across groups for liver function tests, nor were there any significant adverse reactions that could be attributed to kava. No differences in withdrawal or addiction were found between groups. Interesting, kava significantly increased female's sexual drive compared to placebo (p = 0.040) on a sub-domain of the Arizona Sexual Experience Scale (ASEX), with no negative effects seen in males. Further, it was found that there was a highly significant correlation between ASEX reduction (improved sexual function and performance) and anxiety reduction in the whole sample.
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Affiliation(s)
- J Sarris
- Department of Psychiatry, The University of Melbourne, Victoria, Australia; Swinburne University of Technology, Centre for Human Psychopharmacology, Victoria, Australia; NICM Collaborative Centre for Neurocognition, Victoria, Australia
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