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Labus JS, Hubbard CS, Bueller J, Ebrat B, Tillisch K, Chen M, Stains J, Dukes GE, Kelleher DL, Naliboff BD, Fanselow M, Mayer EA. Impaired emotional learning and involvement of the corticotropin-releasing factor signaling system in patients with irritable bowel syndrome. Gastroenterology 2013; 145:1253-61.e1-3. [PMID: 23954313 PMCID: PMC4069031 DOI: 10.1053/j.gastro.2013.08.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 07/22/2013] [Accepted: 08/06/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Alterations in central corticotropin-releasing factor signaling pathways have been implicated in the pathophysiology of anxiety disorders and irritable bowel syndrome (IBS). We aimed to characterize the effects of the corticotropin-releasing factor receptor 1 (CRF-R1) antagonist, GW876008, on brain and skin conductance responses during acquisition and extinction of conditioned fear to the threat of abdominal pain in subjects with IBS and healthy individuals (controls). METHODS We performed a single-center, randomized, double-blind, 3-period crossover study of 11 women with IBS (35.50 ± 12.48 years old) and 15 healthy women (controls) given a single oral dose (20 mg or 200 mg) of the CRF-R1 antagonist or placebo. Blood-oxygen level-dependent responses were analyzed using functional magnetic resonance imaging in a tertiary care setting. RESULTS Controls had greater skin conductance responses during acquisition than extinction, validating the fear-conditioning paradigm. In contrast, during extinction, women with IBS had greater skin conductance responses than controls-an effect normalized by administration of a CRF-R1 antagonist. Although the antagonist significantly reduced activity in the thalamus in patients with IBS and controls during acquisition, the drug produced greater suppression of blood-oxygen level-dependent activity in a wide range of brain regions in IBS patients during extinction, including the medial prefrontal cortex, pons, hippocampus, and anterior insula. CONCLUSIONS Although CRF signaling via CRF-R1 is involved in fear acquisition and extinction learning related to expected abdominal pain in patients with IBS and controls, this system appears to be up-regulated in patients with IBS. This up-regulation might contribute to the previously reported abnormal brain responses to expected abdominal pain.
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Affiliation(s)
- Jennifer S. Labus
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA
- Department of Medicine, UCLA, Los Angeles, CA
- Department of Psychiatry, UCLA, Los Angeles, CA
| | - Catherine S. Hubbard
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA
- Department of Medicine, UCLA, Los Angeles, CA
| | - Joshua Bueller
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA
- Department of Medicine, UCLA, Los Angeles, CA
| | - Bahar Ebrat
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA
- Department of Medicine, UCLA, Los Angeles, CA
| | - Kirsten Tillisch
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA
- Department of Medicine, UCLA, Los Angeles, CA
| | - Michelle Chen
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA
- Department of Medicine, UCLA, Los Angeles, CA
| | - Jean Stains
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA
- Department of Medicine, UCLA, Los Angeles, CA
| | | | | | - Bruce D. Naliboff
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA
- Department of Medicine, UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Michael Fanselow
- Department of Psychiatry, UCLA, Los Angeles, CA
- Department of Psychology, UCLA, Los Angeles, CA
| | - Emeran A. Mayer
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA
- Department of Medicine, UCLA, Los Angeles, CA
- Department of Physiology, UCLA, Los Angeles, CA
- Department of Psychiatry, UCLA, Los Angeles, CA
- Department of Psychology, UCLA, Los Angeles, CA
- Ahmanson-Lovelace Brain Mapping Center, UCLA, Los Angeles, CA
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