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Brain lesions disrupting addiction map to a common human brain circuit.

Hot Off the Press – June 15, 2022

A portion of a figure from this studyPublished in Nature Medicine, with contributions by Khaled Moussawi, M.D., Ph.D., Harshwardhan Deshpande, Ph.D., Thomas Ross, Ph.D. and Elliot Stein, Ph.D. of NIDA-IRP.

Summary

Sometimes regional brain damage (also called a lesion – for example from a stroke) leads to spontaneous remission of addiction – in the present study cigarette smoking. However, if you look at where these lesions occur (compared to lesions that do not lead to remission), there is little overlap. It is possible, then, that the remission was not directly attributable to the location of the lesion, but rather to one or more brain regions connected with (and thus affected by) the lesion. To investigate this, a team of scientists, including three from the NIDA IRP, used a functional MRI (fMRI) technique called ‘functional connectivity.’ Whole-brain functional connectivity maps were generated using the lesion locations as seeds and these maps were compared between remission-causing lesions and non-remission-causing lesions. Given that we lack fMRI data in the patients with lesions, and that the lesions would cause connectivity alterations, the resting state analyses were performed in ‘normal’ samples – both using data from a public dataset and, additionally, a cohort of ‘healthy smokers.’  In contrast to the lack of lesion overlap, there were significant differences between the connectivity maps generated from the 2 groups, and these differences were independent of which ‘normal’ cohort that was used to generate the maps. These differences were centered around brain areas thought to be involved in addiction: bilateral insula, anterior cingulate cortex and medial prefrontal cortex. Finally, aspects of the analyses generalized to data from an alcohol-using population, suggesting a level of common neuronal processing across different drug-induced addictions.

Publication Information

Joutsa, Juho; Moussawi, Khaled; Siddiqi, Shan H; Abdolahi, Amir; Drew, William; Cohen, Alexander L; Ross, Thomas J; Deshpande, Harshawardhan U; Wang, Henry Z; Bruss, Joel; Stein, Elliot A; Volkow, Nora D; Grafman, Jordan H; van Wijngaarden, Edwin; Boes, Aaron D; Fox, Michael D

Brain lesions disrupting addiction map to a common human brain circuit Journal Article

In: Nat Med, 2022, ISSN: 1546-170X.

Abstract | Links

@article{pmid35697842,
title = {Brain lesions disrupting addiction map to a common human brain circuit},
author = {Juho Joutsa and Khaled Moussawi and Shan H Siddiqi and Amir Abdolahi and William Drew and Alexander L Cohen and Thomas J Ross and Harshawardhan U Deshpande and Henry Z Wang and Joel Bruss and Elliot A Stein and Nora D Volkow and Jordan H Grafman and Edwin van Wijngaarden and Aaron D Boes and Michael D Fox},
url = {https://pubmed.ncbi.nlm.nih.gov/35697842/},
doi = {10.1038/s41591-022-01834-y},
issn = {1546-170X},
year = {2022},
date = {2022-06-01},
urldate = {2022-06-01},
journal = {Nat Med},
abstract = {Drug addiction is a public health crisis for which new treatments are urgently needed. In rare cases, regional brain damage can lead to addiction remission. These cases may be used to identify therapeutic targets for neuromodulation. We analyzed two cohorts of patients addicted to smoking at the time of focal brain damage (cohort 1 n = 67; cohort 2 n = 62). Lesion locations were mapped to a brain atlas and the brain network functionally connected to each lesion location was computed using human connectome data (n = 1,000). Associations with addiction remission were identified. Generalizability was assessed using an independent cohort of patients with focal brain damage and alcohol addiction risk scores (n = 186). Specificity was assessed through comparison to 37 other neuropsychological variables. Lesions disrupting smoking addiction occurred in many different brain locations but were characterized by a specific pattern of brain connectivity. This pattern involved positive connectivity to the dorsal cingulate, lateral prefrontal cortex, and insula and negative connectivity to the medial prefrontal and temporal cortex. This circuit was reproducible across independent lesion cohorts, associated with reduced alcohol addiction risk, and specific to addiction metrics. Hubs that best matched the connectivity profile for addiction remission were the paracingulate gyrus, left frontal operculum, and medial fronto-polar cortex. We conclude that brain lesions disrupting addiction map to a specific human brain circuit and that hubs in this circuit provide testable targets for therapeutic neuromodulation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

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Drug addiction is a public health crisis for which new treatments are urgently needed. In rare cases, regional brain damage can lead to addiction remission. These cases may be used to identify therapeutic targets for neuromodulation. We analyzed two cohorts of patients addicted to smoking at the time of focal brain damage (cohort 1 n = 67; cohort 2 n = 62). Lesion locations were mapped to a brain atlas and the brain network functionally connected to each lesion location was computed using human connectome data (n = 1,000). Associations with addiction remission were identified. Generalizability was assessed using an independent cohort of patients with focal brain damage and alcohol addiction risk scores (n = 186). Specificity was assessed through comparison to 37 other neuropsychological variables. Lesions disrupting smoking addiction occurred in many different brain locations but were characterized by a specific pattern of brain connectivity. This pattern involved positive connectivity to the dorsal cingulate, lateral prefrontal cortex, and insula and negative connectivity to the medial prefrontal and temporal cortex. This circuit was reproducible across independent lesion cohorts, associated with reduced alcohol addiction risk, and specific to addiction metrics. Hubs that best matched the connectivity profile for addiction remission were the paracingulate gyrus, left frontal operculum, and medial fronto-polar cortex. We conclude that brain lesions disrupting addiction map to a specific human brain circuit and that hubs in this circuit provide testable targets for therapeutic neuromodulation.

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  • https://pubmed.ncbi.nlm.nih.gov/35697842/
  • doi:10.1038/s41591-022-01834-y

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