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Review
. 2015 Apr;42(4):323-39.
doi: 10.1016/j.nucmedbio.2014.11.008. Epub 2014 Nov 26.

Corticotropin releasing hormone and imaging, rethinking the stress axis

Affiliations
Review

Corticotropin releasing hormone and imaging, rethinking the stress axis

Carlo Contoreggi. Nucl Med Biol. 2015 Apr.

Abstract

The stress system provides integration of both neurochemical and somatic physiologic functions within organisms as an adaptive mechanism to changing environmental conditions throughout evolution. In mammals and primates the complexity and sophistication of these systems have surpassed other species in triaging neurochemical and physiologic signaling to maximize chances of survival. Corticotropin releasing hormone (CRH) and its related peptides and receptors have been identified over the last three decades and are fundamental molecular initiators of the stress response. They are crucial in the top down regulatory cascade over a myriad of neurochemical, neuroendocrine and sympathetic nervous system events. From neuroscience, we've seen that stress activation impacts behavior, endocrine and somatic physiology and influences neurochemical events that one can capture in real time with current imaging technologies. To delineate these effects one can demonstrate how the CRH neuronal networks infiltrate critical cognitive, emotive and autonomic regions of the central nervous system (CNS) with somatic effects. Abundant preclinical and clinical studies show inter-regulatory actions of CRH with multiple neurotransmitters/peptides. Stress, both acute and chronic has epigenetic effects which magnify genetic susceptibilities to alter neurochemistry; stress system activation can add critical variables in design and interpretation of basic and clinical neuroscience and related research. This review will attempt to provide an overview of the spectrum of known functions and speculative actions of CRH and stress responses in light of imaging technology and its interpretation. Metabolic and neuroreceptor positron emission/single photon tomography (PET/SPECT), functional magnetic resonance imaging (fMRI), anatomic MRI, diffusion tensor imaging (DTI), and proton magnetic resonance spectroscopy (pMRS) are technologies that can delineate basic mechanisms of neurophysiology and pharmacology. Stress modulates the myriad of neurochemical and networks within and controlled through the central and peripheral nervous system and the effects of stress activation on imaging will be highlighted.

Keywords: Anxiety; CRH; Depression; Dopamine; GABA; MRI; MRS; PET; PTSD; Stress.

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Figures

Figure 1
Figure 1
Hypothalamic pituitary adrenal axis regulation of glucocorticoid/cortisol secretion in response to an acute stressor; this demonstrates multiple levels of feedback inhibition to the pituitary, hypothalamus and limbic structures critical for the autonomic and behavioral responses to stress. Nature Neuroscience 12, 241 – 243 (2009) 16 March 2009 doi:10.1038/nn0309-241
Figure 2
Figure 2
Schematic diagram shows the interface and complexity of multiple structures and functional neurochemical interactions during the chronic adaptation to stress. Normal responsivity of the HPA is lost, chronic activation of cortisol damages hippocampal memory consolidation, decreases prefrontal cortex suppression of a hyper-responsive amygdala; elevated cortisol and excitatory neurotransmitters (i.e. glutamate) can cause neuronal and white matter injury and atrophy. Other neurotransmitters and neuronal networks are subsequently affected. DA- dopamine, BZ – GABA and GABA agonists, GC – glucocorticoid/cortisol receptors, NE – norepinephrine, ACTH – adrenocorticotrophin, CRF - corticotropin releasing hormone, opiate – endorphin and related opioid peptides.
Figure 3
Figure 3. EPIGENETIC MECHANISMS
Figure 4
Figure 4
Proton Magnetic Resonance Spectroscopy region of interest spectra over the thalamus for recording glycine and glutamate/glutamine peaks for determination of the neurotransmitters and metabolites. The relative concentration of neurotransmitters can be quantified with this technique. Borsook et al. Molecular Pain 2007 3:25 doi:10.1186/1744-8069-3-25
Figure 5
Figure 5
PET and MRI images of mGLUr5 PET ligand [18F] SP203, showing raw and MRI fused receptor distribution in a human volunteer. Courtesy of Dr Robert Innis, National Institutes of Health, National Institute of Mental Health
Figure 6
Figure 6
Representative Proton Magnetic Resonance Spectroscopy (pMRS) signal from brain showing multiple peaks for CNS metabolic markers and neurotransmitters. Cho-choline, Cr-creatine, NAA- N-acetyl aspartate, Lac- lactate, GABA - gamma-aminobutyric acid, Glu-glutamine/glutamate, ml - myoinositol, PCh - phosphocholine, GPC - glycerophosphocholine Tau - taurine, Gsh - glutathione http://pubs.niaaa.nih.gov/publications/arh341/99-105.htm
Figure 7
Figure 7
Distribution of [11C]methylreboxetine for the norepinephrine transporter (NET) in thalamus, hypothalamus and brainstem nuclei.
Figure 8
Figure 8
Nociceptin PET Scan: This shows a first generation radiotracer for the neuropeptide Substance P/Nociceptin; the neuropeptide shows wide expression throughout critical stress regulating cortical areas i.e. prefrontal, cingulate, frontal, and temporal lobes; it is also seen in subcortical regions of the extended amygdala, entorhinal cortex and portions of the striatum. http://www.psychologytoday.com/blog/the-athletes-way/201401/scientists-discover-elixir-stress-called-nociceptin
Figure 9
Figure 9. Diffusion Tensor Imaging
Diffusion Tensor Imaging builds on MRI technology to measure the integrity of the brain's white matter. White-matter communicates between brain regions and the spinal cord. White matter damage can have serious, long-term consequences; pathologic changes are often seen in neurodegenerative disorders and psychiatric conditions where chronic stress is often contributory. In these images axons are colored according to orientation; fibers running between the front and back are blue, those between right and left are red, and those running between the brain's interior and exterior are green. Disruption in these tracts can be quantitated, are reproducible and validated in normal and disease states. http://www.pbs.org/wgbh/nova/sciencenow/0306/02-diag-03.html http://virtualneuro.net/neuroblog/wp-content/uploads/2010/06/temp48.jpg

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