Clinical trial NCT02094196: The Role of Dopaminergic and Glutamatergic Neurotransmission for Dysfunctional Learning in Alcohol Use Disorders
Official title: The Role of Dopaminergic and Glutamatergic Neurotransmission for Dysfunctional Learning in Alcohol Use Disorders (LeAD P5)
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Alcohol Use Disorder
Keywords: Reward- based learning
Pavlovian-to-instrumental transfer
Relapse Risk
Positron emission tomography (PET)
Magnetic resonance spectroscopy (MRS)
Dopamine receptor availability
Glutamate
Lead sponsor: Technische Universität Dresden
Sponsor class: OTHER
Collaborators: name: Charite University, Berlin, Germany
First posted: 2014-03-21
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Detoxified alcohol- dependent patients and age- and gender matched healthy controls living in Germany

Brief summary: The aim of this project is to assess reward- based learning behavior and its association with alterations in dopaminergic and glutamatergic transmission in detoxified alcohol-dependent patients and matched controls.

The investigators will explore how these alterations interact with clinical and psychosocial factors which can modify the relapse risk and learning deficits.

Patients will be detoxified in an inpatient setting. Clinical assessments, behavioral paradigms of learning and brain imaging will be carried out within at least 4 half- lives after any psychotropic medication.

The investigators will implement and apply functional imaging paradigms assessing Pavlovian-to-instrumental transfer and reversal learning tasks and associate model parameters of learning with alcohol craving, intake and prospective relapse risk.

In this project, the impact of the dopamine x glutamate interaction on learning deficits and consecutive relapse probability is targeted with \[18F\]fallypride PET and the measurement of absolute concentrations of glutamate with magnetic resonance spectroscopy (MRS).

Detailed description: Alcohol consumption despite negative consequences may rely on impaired flexibility in adapting the behavior to environmental changes, i.e. learning in response to reward contingencies. This learning deficit is of clinical relevance particularly during therapy and for the psychosocial outcome.

The reduced availability of central dopamine D2-receptors in detoxified alcohol dependent patients observed in PET investigations and their hypothetical effects on reward-related learning are in line with evidence for learning deficits in hypodopaminergic states, particularly for avoidance learning in non-dependent samples. Growing evidence indicates that the learning-related striatal dopamine signals are modulated by higher executive functions involving, e.g., the prefrontal cortex.

Here, broad glutamatergic outputs of the prefrontal cortex are crucial for subcortical learning mechanisms and match with recent models of interactive dopamine-glutamate dysfunctions and models of neurotrophic signaling in alcohol dependence.

Eligibility criteria: Inclusion Criteria:

* Alcohol dependence according to DSM-IV
* Minimum of 72 hours of abstinence, maximum of 21 days of abstinence
* Minimum of three years of alcohol dependence
* Low severity of withdrawal symptoms
* Ability to provide fully informed consent and to use self- rating scales

Exclusion Criteria:

* Lifetime history of DSM- IV bipolar or psychotic disorder
* Current threshold DSM-IV diagnosis of any following disorders: current major - depressive disorder, generalized anxiety disorder, PTSD, borderline personality disorder or obsessive- compulsive disorder
* History of substance dependence other than alcohol or nicotine dependence

Primary outcomes:
measure: Striatal D2-receptor availability (PET) and prefrontal glutamate concentration (MRS)
timeFrame: first assessment time point (alc. dependent pat. up to 21 days after detoxification)
Secondary outcomes:
measure: behavioral data in reward-habit-learning paradigms
timeFrame: first assessment time point (alc. dependent pat. up to 21 days after detoxification)
measure: Treatment response
timeFrame: 12-month follow-up period beginning after first assessment timepoint
Other outcomes:
measure: striatal-prefrontal connectivity (fMRI)
timeFrame: first assessment time point (alc. dependent pat. up to 21 days after detoxification)
Locations:
city: Berlin
country: Germany
facility: Charité Berlin, Division of Neuroimaging
city: Berlin
country: Germany
facility: Charité - Universitätsmedizin Berlin
Study officials:
affiliation: Charite University, Berlin, Germany
name: Jürgen Gallinat, Prof MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Charite University, Berlin, Germany
name: Andreas Heinz, Prof MD
role: STUDY_CHAIR
affiliation: Technische Universität Dresden, Dresden, Germany
name: Hans-Ulrich Wittchen, Prof PhD
role: STUDY_DIRECTOR
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