Cited by 61Attention Deficit Hyperactivity DisorderNeurotransmitter Receptor Influence on BehaviorSchizophrenia research and treatment

The Norepinephrine Transporter in Attention-Deficit/Hyperactivity Disorder Investigated With Positron Emission Tomography

Vanicek, Thomas, Spies, Marie, Rami-Mark, Christina, Savli, Markus, Höflich, Anna, Kranz, Georg S., Hahn, Andreas, Kutzelnigg, Alexandra +7 more·2014·JAMA Psychiatry

Abstract

IMPORTANCE: Attention-deficit/hyperactivity disorder (ADHD) research has long focused on the dopaminergic system's contribution to pathogenesis, although the results have been inconclusive. However, a case has been made for the involvement of the noradrenergic system, which modulates cognitive processes, such as arousal, working memory, and response inhibition, all of which are typically affected in ADHD. Furthermore, the norepinephrine transporter (NET) is an important target for frequently prescribed medication in ADHD. Therefore, the NET is suggested to play a critical role in ADHD. OBJECTIVE: To explore the differences in NET nondisplaceable binding potential (NET BPND) using positron emission tomography and the highly selective radioligand (S,S)-[18F]FMeNER-D2 [(S,S)-2-(α-(2-[18F]fluoro[2H2]methoxyphenoxy)benzyl)morpholine] between adults with ADHD and healthy volunteers serving as controls. DESIGN, SETTING, AND PARTICIPANTS: Twenty-two medication-free patients with ADHD (mean [SD] age, 30.7 [10.4] years; 15 [68%] men) without psychiatric comorbidities and 22 age- and sex-matched healthy controls (30.9 [10.6] years; 15 [68%] men) underwent positron emission tomography once. A linear mixed model was used to compare NET BPND between groups. MAIN OUTCOMES AND MEASURES: The NET BPND in selected regions of interest relevant for ADHD, including the hippocampus, putamen, pallidum, thalamus, midbrain with pons (comprising a region of interest that includes the locus coeruleus), and cerebellum. In addition, the NET BPND was evaluated in thalamic subnuclei (13 atlas-based regions of interest). RESULTS: We found no significant differences in NET availability or regional distribution between patients with ADHD and healthy controls in all investigated brain regions (F1,41<0.01; P=.96). Furthermore, we identified no significant association between ADHD symptom severity and regional NET availability. Neither sex nor smoking status influenced NET availability. We determined a significant negative correlation between age and NET availability in the thalamus (R2=0.29; P<.01 corrected) and midbrain with pons, including the locus coeruleus (R2=0.18; P<.01 corrected), which corroborates prior findings of a decrease in NET availability with aging in the human brain. CONCLUSIONS AND RELEVANCE: Our results do not indicate involvement of changes in brain NET availability or distribution in the pathogenesis of ADHD. However, the noradrenergic transmitter system may be affected on a different level, such as in cortical regions, which cannot be reliably quantified with this positron emission tomography ligand. Alternatively, different key proteins of noradrenergic neurotransmission might be affected.

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Authors
Vanicek, T., Spies, M., Rami-Mark, C., Savli, M., Höflich, A., Kranz, G. S., Hahn, A., Kutzelnigg, A., Traub-Weidinger, T., Mitterhauser, M., Wadsak, W., Hacker, M., Volkow, N. D., Kasper, S., & Lanzenberger, R.
Affiliations
  • Medical University of Vienna (AT)
  • Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
  • National Institutes of Health (US)
Corresponding author
Lanzenberger, Rupert
Venue
JAMA Psychiatry
Published
2014-12-01
Volume
71
Issue
12
Pages
1340
ISSN
2168-622X (ISSN-L)
OpenAlex
W2061577104
Cited by
61
References
76
Citations by year
2026: 6 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 4 · 2020: 9 · 2019: 5 · 2018: 1 · 2017: 6 · 2016: 8 · 2015: 3 · 2014: 2
FWCI
4.84
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
attention deficit hyperactivity disorder, norepinephrine transporter, noradrenergic system, thalamus, locus coeruleus, midbrain, hippocampus, putamen, globus pallidus, cerebellum, age-related decline, ADHD symptom severity
MeSH terms
Adult, Age Factors, Attention Deficit Disorder with Hyperactivity, Brain, Female, Fluorine Radioisotopes, Humans, Male, Morpholines, Case-Control Studies, Positron-Emission Tomography, Norepinephrine Plasma Membrane Transport Proteins, Young Adult, Functional Neuroimaging, Symptom Assessment

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