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Review
. 2018;16(5):533-558.
doi: 10.2174/1570159X15666171123201142.

Imaging the Role of Inflammation in Mood and Anxiety-related Disorders

Affiliations
Review

Imaging the Role of Inflammation in Mood and Anxiety-related Disorders

Jennifer C Felger. Curr Neuropharmacol. 2018.

Abstract

Background: Studies investigating the impact of a variety of inflammatory stimuli on the brain and behavior have reported evidence that inflammation and release of inflammatory cytokines affect circuitry relevant to both reward and threat sensitivity to contribute to behavioral change. Of relevance to mood and anxiety-related disorders, biomarkers of inflammation such as inflammatory cytokines and acute-phase proteins are reliably elevated in a significant proportion of patients with major depressive disorder (MDD), bipolar disorder, anxiety disorders and post-traumatic stress disorder (PTSD).

Methods: This review summarized clinical and translational work demonstrating the impact of peripheral inflammation on brain regions and neurotransmitter systems relevant to both reward and threat sensitivity, with a focus on neuroimaging studies involving administration of inflammatory stimuli. Recent translation of these findings to further understand the role of inflammation in mood and anxiety-related disorders is also discussed.

Results: Inflammation was consistently found to affect basal ganglia and cortical reward and motor circuits to drive reduced motivation and motor activity, as well as anxiety-related brain regions including amygdala, insula and anterior cingulate cortex, which may result from cytokine effects on monoamines and glutamate. Similar relationships between inflammation and altered neurocircuitry have been observed in MDD patients with increased peripheral inflammatory markers, and such work is on the horizon for anxiety disorders and PTSD.

Conclusion: Neuroimaging effects of inflammation on reward and threat circuitry may be used as biomarkers of inflammation for future development of novel therapeutic strategies to better treat mood and anxiety-related disorders in patients with high inflammation.

Keywords: Neuroimaging; PTSD; anxiety; cytokines; depression; inflammation; microglia; motivation; motor slowing..

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Figures

Fig. (1)
Fig. (1)
Inflammation is increased in patients with mood and anxiety-related disorders due to environmental challenges such as diet and lifestyle factors, medical illness and psychosocial stress. Immune activation involves intracellular signal transduction pathways and the inflammasome, which can respond to a variety of environmental stressors beyond pathogens including psychosocial stress, to produce release of inflammatory cytokines. Increased inflammatory cytokines are in turn associated with increased oxidative stress and generation of reactive oxygen and reactive nitrogen species (ROS and RNS). Increased ROS and RNS contribute to oxidation of tetrahydrobiopterin (BH4), a cofactor required for the enzymatic synthesis of monoamines via phenylalanine hydroxylase (PAH), tryptophan hydroxylase (TPH) and tyrosine hydroxylase (TH), thus disrupting the synthesis of serotonin (5-HT), dopamine (DA) and norepinephrine (NE) through effects on the availability of monoamine precursors such as tryptophan and tyrosine. Inflammation and the release of cytokines also stimulate enzyme pathways such as indoleamine 2,3 dioxygenase (IDO), which can then lead to the release of neurotoxic metabolites of kynurenine that affect glutamate (Glu) including quinolinic acid. In the brain, inflammation causes release of Glu from microglia and reduced uptake by astrocytes. These actions of inflammatory cytokines ultimately contribute to alterations in neurocircuits in the brain including those related to basal ganglia to prefrontal reward and motor circuits, as well as fear and anxiety-related amygdala, prefrontal and insular circuitry, which may contribute to symptoms of depression and anxiety. 5-HT - serotonin; ACC - anterior cingulate cortex; BH4 - tetrahydrobiopterin; DA - dopamine; Glu - glutamate; NLRP3 - NACHT domain- leucine-rich repeat- and pyrin domain-containing protein 3; I - imaging; IDO - indoleamine 2,3 dioxygenase; MR – magnetic resonance; NE - norepinephrine; NO-nitric oxide; NOS-nitric oxide synthase; NSAIDS-non-steroidal anti-inflammatory drugs; PFC - prefrontal cortex; PHA - phenylalanine hydroxylase; ROS - reactive oxygen species; TH - tyrosine hydroxylase; Trp – tryptophan. (The color version of the figure is available in the electronic copy of the article).

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