Inflammation in the Neurocircuitry of Obsessive-Compulsive Disorder
IMPORTANCE: For a small percentage of obsessive-compulsive disorder (OCD) cases exhibiting additional neuropsychiatric symptoms, it was proposed that neuroinflammation occurs in the basal ganglia as an autoimmune response to infections. However, it is possible that elevated neuroinflammation, induci...
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| Veröffentlicht in: | JAMA psychiatry (Chicago, Ill.) Ill.), 2017-08, Vol.74 (8), p.833-840 |
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| creator | Attwells, Sophia Setiawan, Elaine Wilson, Alan A Rusjan, Pablo M Mizrahi, Romina Miler, Laura Xu, Cynthia Richter, Margaret Anne Kahn, Alan Kish, Stephen J Houle, Sylvain Ravindran, Lakshmi Meyer, Jeffrey H |
| description | IMPORTANCE: For a small percentage of obsessive-compulsive disorder (OCD) cases exhibiting additional neuropsychiatric symptoms, it was proposed that neuroinflammation occurs in the basal ganglia as an autoimmune response to infections. However, it is possible that elevated neuroinflammation, inducible by a diverse range of mechanisms, is important throughout the cortico-striato-thalamo-cortical circuit of OCD. Identifying brain inflammation is possible with the recent advance in positron emission tomography (PET) radioligands that bind to the translocator protein (TSPO). Translocator protein density increases when microglia are activated during neuroinflammation and the TSPO distribution volume (VT) is an index of TSPO density. OBJECTIVE: To determine whether TSPO VT is elevated in the dorsal caudate, orbitofrontal cortex, thalamus, ventral striatum, dorsal putamen, and anterior cingulate cortex in OCD. DESIGN, SETTING, AND PARTICIPANTS: This case-control study was conducted at a tertiary care psychiatric hospital from May 1, 2010, to November 30, 2016. Participants with OCD (n = 20) and age-matched healthy control individuals (n = 20) underwent a fluorine F 18–labeled N-(2-(2-fluoroethoxy)benzyl)-N-(4-phenoxypyridin-3-yl)acetamide PET scan. It is a high-quality second-generation TSPO-binding PET radiotracer. All participants were drug and medication free, nonsmoking, and otherwise healthy. MAIN OUTCOMES AND MEASURES: The TSPO VT was measured in the dorsal caudate, orbitofrontal cortex, thalamus, ventral striatum, dorsal putamen, and anterior cingulate cortex. Compulsions were assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: In the OCD and healthy groups, the mean (SD) ages were 27.4 (7.1) years and 27.6 (6.6) years, respectively, and 11 (55%) and 8 (40%) were women, respectively. In OCD, TSPO VT was significantly elevated in these brain regions (mean, 32%; range, 31%-36% except anterior cingulate cortex, 24%; analysis of variance, effect of diagnosis: P |
| doi_str_mv | 10.1001/jamapsychiatry.2017.1567 |
| format | Article |
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However, it is possible that elevated neuroinflammation, inducible by a diverse range of mechanisms, is important throughout the cortico-striato-thalamo-cortical circuit of OCD. Identifying brain inflammation is possible with the recent advance in positron emission tomography (PET) radioligands that bind to the translocator protein (TSPO). Translocator protein density increases when microglia are activated during neuroinflammation and the TSPO distribution volume (VT) is an index of TSPO density. OBJECTIVE: To determine whether TSPO VT is elevated in the dorsal caudate, orbitofrontal cortex, thalamus, ventral striatum, dorsal putamen, and anterior cingulate cortex in OCD. DESIGN, SETTING, AND PARTICIPANTS: This case-control study was conducted at a tertiary care psychiatric hospital from May 1, 2010, to November 30, 2016. Participants with OCD (n = 20) and age-matched healthy control individuals (n = 20) underwent a fluorine F 18–labeled N-(2-(2-fluoroethoxy)benzyl)-N-(4-phenoxypyridin-3-yl)acetamide PET scan. It is a high-quality second-generation TSPO-binding PET radiotracer. All participants were drug and medication free, nonsmoking, and otherwise healthy. MAIN OUTCOMES AND MEASURES: The TSPO VT was measured in the dorsal caudate, orbitofrontal cortex, thalamus, ventral striatum, dorsal putamen, and anterior cingulate cortex. Compulsions were assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: In the OCD and healthy groups, the mean (SD) ages were 27.4 (7.1) years and 27.6 (6.6) years, respectively, and 11 (55%) and 8 (40%) were women, respectively. In OCD, TSPO VT was significantly elevated in these brain regions (mean, 32%; range, 31%-36% except anterior cingulate cortex, 24%; analysis of variance, effect of diagnosis: P < .001 to P = .004). Slightly lower elevations in TSPO VT (22%-29%) were present in other gray matter regions. The Yale-Brown Obsessive Compulsive Scale measure of distress associated with preventing compulsive behaviors significantly correlated with TSPO VT in the orbitofrontal cortex (uncorrected Pearson correlation r = 0.62; P = .005). CONCLUSIONS AND RELEVANCE: To our knowledge, this is the first study demonstrating inflammation within the neurocircuitry of OCD. The regional distribution of elevated TSPO VT argues that the autoimmune/neuroinflammatory theories of OCD should extend beyond the basal ganglia to include the cortico-striato-thalamo-cortical circuit. Immunomodulatory therapies should be investigated in adult OCD, rather than solely childhood OCD, particularly in cases with prominent distress when preventing compulsions.</description><identifier>ISSN: 2168-622X</identifier><identifier>EISSN: 2168-6238</identifier><identifier>DOI: 10.1001/jamapsychiatry.2017.1567</identifier><identifier>PMID: 28636705</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adult ; Anilides - metabolism ; Brain ; Case-Control Studies ; Correlation analysis ; Encephalitis - metabolism ; Female ; Functional Neuroimaging ; Humans ; Male ; Obsessive compulsive disorder ; Obsessive-Compulsive Disorder - metabolism ; Online First ; Original Investigation ; Positron-Emission Tomography ; Proteins ; Pyridines - metabolism ; Receptors, GABA - metabolism ; Tomography ; Young Adult</subject><ispartof>JAMA psychiatry (Chicago, Ill.), 2017-08, Vol.74 (8), p.833-840</ispartof><rights>Copyright American Medical Association Aug 2017</rights><rights>Copyright 2017 American Medical Association. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a533t-bd46b928299f1c675d1100f2c1d52ccdae098b04a1477ca779041d3d932f5dcf3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamapsychiatry/articlepdf/10.1001/jamapsychiatry.2017.1567$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2017.1567$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,776,780,881,3327,27901,27902,76231,76234</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28636705$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Attwells, Sophia</creatorcontrib><creatorcontrib>Setiawan, Elaine</creatorcontrib><creatorcontrib>Wilson, Alan A</creatorcontrib><creatorcontrib>Rusjan, Pablo M</creatorcontrib><creatorcontrib>Mizrahi, Romina</creatorcontrib><creatorcontrib>Miler, Laura</creatorcontrib><creatorcontrib>Xu, Cynthia</creatorcontrib><creatorcontrib>Richter, Margaret Anne</creatorcontrib><creatorcontrib>Kahn, Alan</creatorcontrib><creatorcontrib>Kish, Stephen J</creatorcontrib><creatorcontrib>Houle, Sylvain</creatorcontrib><creatorcontrib>Ravindran, Lakshmi</creatorcontrib><creatorcontrib>Meyer, Jeffrey H</creatorcontrib><title>Inflammation in the Neurocircuitry of Obsessive-Compulsive Disorder</title><title>JAMA psychiatry (Chicago, Ill.)</title><addtitle>JAMA Psychiatry</addtitle><description>IMPORTANCE: For a small percentage of obsessive-compulsive disorder (OCD) cases exhibiting additional neuropsychiatric symptoms, it was proposed that neuroinflammation occurs in the basal ganglia as an autoimmune response to infections. However, it is possible that elevated neuroinflammation, inducible by a diverse range of mechanisms, is important throughout the cortico-striato-thalamo-cortical circuit of OCD. Identifying brain inflammation is possible with the recent advance in positron emission tomography (PET) radioligands that bind to the translocator protein (TSPO). Translocator protein density increases when microglia are activated during neuroinflammation and the TSPO distribution volume (VT) is an index of TSPO density. OBJECTIVE: To determine whether TSPO VT is elevated in the dorsal caudate, orbitofrontal cortex, thalamus, ventral striatum, dorsal putamen, and anterior cingulate cortex in OCD. DESIGN, SETTING, AND PARTICIPANTS: This case-control study was conducted at a tertiary care psychiatric hospital from May 1, 2010, to November 30, 2016. Participants with OCD (n = 20) and age-matched healthy control individuals (n = 20) underwent a fluorine F 18–labeled N-(2-(2-fluoroethoxy)benzyl)-N-(4-phenoxypyridin-3-yl)acetamide PET scan. It is a high-quality second-generation TSPO-binding PET radiotracer. All participants were drug and medication free, nonsmoking, and otherwise healthy. MAIN OUTCOMES AND MEASURES: The TSPO VT was measured in the dorsal caudate, orbitofrontal cortex, thalamus, ventral striatum, dorsal putamen, and anterior cingulate cortex. Compulsions were assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: In the OCD and healthy groups, the mean (SD) ages were 27.4 (7.1) years and 27.6 (6.6) years, respectively, and 11 (55%) and 8 (40%) were women, respectively. In OCD, TSPO VT was significantly elevated in these brain regions (mean, 32%; range, 31%-36% except anterior cingulate cortex, 24%; analysis of variance, effect of diagnosis: P < .001 to P = .004). Slightly lower elevations in TSPO VT (22%-29%) were present in other gray matter regions. The Yale-Brown Obsessive Compulsive Scale measure of distress associated with preventing compulsive behaviors significantly correlated with TSPO VT in the orbitofrontal cortex (uncorrected Pearson correlation r = 0.62; P = .005). CONCLUSIONS AND RELEVANCE: To our knowledge, this is the first study demonstrating inflammation within the neurocircuitry of OCD. The regional distribution of elevated TSPO VT argues that the autoimmune/neuroinflammatory theories of OCD should extend beyond the basal ganglia to include the cortico-striato-thalamo-cortical circuit. Immunomodulatory therapies should be investigated in adult OCD, rather than solely childhood OCD, particularly in cases with prominent distress when preventing compulsions.</description><subject>Adult</subject><subject>Anilides - metabolism</subject><subject>Brain</subject><subject>Case-Control Studies</subject><subject>Correlation analysis</subject><subject>Encephalitis - metabolism</subject><subject>Female</subject><subject>Functional Neuroimaging</subject><subject>Humans</subject><subject>Male</subject><subject>Obsessive compulsive disorder</subject><subject>Obsessive-Compulsive Disorder - metabolism</subject><subject>Online First</subject><subject>Original Investigation</subject><subject>Positron-Emission Tomography</subject><subject>Proteins</subject><subject>Pyridines - metabolism</subject><subject>Receptors, GABA - metabolism</subject><subject>Tomography</subject><subject>Young Adult</subject><issn>2168-622X</issn><issn>2168-6238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUU1LAzEQDaLYov4BD7LgeWs-Nh97EaR-FYpeFLyFbJK1Kd1NTXYL_fdmqVY7lxmYN-_NzAMgQ3CCIEQ3S9WoddzqhVNd2E4wRHyCKONHYIwREznDRBzva_wxAhcxLmEKAWFBxCkYYcEI45COwXTW1ivVNKpzvs1cm3ULm73YPnjtgu5dUsh8nb1W0cboNjaf-mbdr4Yyu3fRB2PDOTip1Srai598Bt4fH96mz_n89Wk2vZvnihLS5ZUpWFVigcuyRppxalC6p8YaGYq1NsrCUlSwUKjgXCvOS1ggQ0xJcE2NrskZuN3xrvuqsUbbtgtqJdfBNSpspVdOHnZat5CffiMpR5BSlgiufwiC_-pt7OTS96FNO0tUEoopLiBMKLFD6eBjDLbeKyAoBwfkoQNycEAODqTRq_8b7gd__50AlztAYvjrMoJEScg3nw-Qig</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Attwells, Sophia</creator><creator>Setiawan, Elaine</creator><creator>Wilson, Alan A</creator><creator>Rusjan, Pablo M</creator><creator>Mizrahi, Romina</creator><creator>Miler, Laura</creator><creator>Xu, Cynthia</creator><creator>Richter, Margaret Anne</creator><creator>Kahn, Alan</creator><creator>Kish, Stephen J</creator><creator>Houle, Sylvain</creator><creator>Ravindran, Lakshmi</creator><creator>Meyer, Jeffrey H</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope></search><sort><creationdate>20170801</creationdate><title>Inflammation in the Neurocircuitry of Obsessive-Compulsive Disorder</title><author>Attwells, Sophia ; 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However, it is possible that elevated neuroinflammation, inducible by a diverse range of mechanisms, is important throughout the cortico-striato-thalamo-cortical circuit of OCD. Identifying brain inflammation is possible with the recent advance in positron emission tomography (PET) radioligands that bind to the translocator protein (TSPO). Translocator protein density increases when microglia are activated during neuroinflammation and the TSPO distribution volume (VT) is an index of TSPO density. OBJECTIVE: To determine whether TSPO VT is elevated in the dorsal caudate, orbitofrontal cortex, thalamus, ventral striatum, dorsal putamen, and anterior cingulate cortex in OCD. DESIGN, SETTING, AND PARTICIPANTS: This case-control study was conducted at a tertiary care psychiatric hospital from May 1, 2010, to November 30, 2016. Participants with OCD (n = 20) and age-matched healthy control individuals (n = 20) underwent a fluorine F 18–labeled N-(2-(2-fluoroethoxy)benzyl)-N-(4-phenoxypyridin-3-yl)acetamide PET scan. It is a high-quality second-generation TSPO-binding PET radiotracer. All participants were drug and medication free, nonsmoking, and otherwise healthy. MAIN OUTCOMES AND MEASURES: The TSPO VT was measured in the dorsal caudate, orbitofrontal cortex, thalamus, ventral striatum, dorsal putamen, and anterior cingulate cortex. Compulsions were assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: In the OCD and healthy groups, the mean (SD) ages were 27.4 (7.1) years and 27.6 (6.6) years, respectively, and 11 (55%) and 8 (40%) were women, respectively. In OCD, TSPO VT was significantly elevated in these brain regions (mean, 32%; range, 31%-36% except anterior cingulate cortex, 24%; analysis of variance, effect of diagnosis: P < .001 to P = .004). Slightly lower elevations in TSPO VT (22%-29%) were present in other gray matter regions. The Yale-Brown Obsessive Compulsive Scale measure of distress associated with preventing compulsive behaviors significantly correlated with TSPO VT in the orbitofrontal cortex (uncorrected Pearson correlation r = 0.62; P = .005). CONCLUSIONS AND RELEVANCE: To our knowledge, this is the first study demonstrating inflammation within the neurocircuitry of OCD. The regional distribution of elevated TSPO VT argues that the autoimmune/neuroinflammatory theories of OCD should extend beyond the basal ganglia to include the cortico-striato-thalamo-cortical circuit. Immunomodulatory therapies should be investigated in adult OCD, rather than solely childhood OCD, particularly in cases with prominent distress when preventing compulsions.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>28636705</pmid><doi>10.1001/jamapsychiatry.2017.1567</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Anilides - metabolism Brain Case-Control Studies Correlation analysis Encephalitis - metabolism Female Functional Neuroimaging Humans Male Obsessive compulsive disorder Obsessive-Compulsive Disorder - metabolism Online First Original Investigation Positron-Emission Tomography Proteins Pyridines - metabolism Receptors, GABA - metabolism Tomography Young Adult |
| title | Inflammation in the Neurocircuitry of Obsessive-Compulsive Disorder |
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