Key result
NOS1 ex1f-VNTR L/L-allele carriers showed higher amygdala and hippocampus activation than S/S-allele carriers prior to CBT, and these genotype-associated effects were not altered after treatment.
Why the study?
The short allele of NOS1 ex1f-VNTR is linked to anxiety and altered fear conditioning, but its role as a pathophysiological correlate in panic disorder and agoraphobia required exploration.
Does NOS1 ex1f-VNTR allelic variation affect neural activation in the amygdala and hippocampus during fear conditioning and extinction in patients with panic disorder and agoraphobia?
RCT (n=82)
Yes
Does NOS1 ex1f-VNTR allelic variation affect neural activation in the amygdala and hippocampus during fear conditioning and extinction in patients with panic disorder and agoraphobia?
NOS1 ex1f-VNTR allelic variation is associated with dysfunctional neural fear conditioning and extinction in the amygdala and hippocampus in patients with panic disorder and agoraphobia.
NOS1 genotype may mark persistent fear-circuit hyperactivity after CBT in panic disorder; hypothesis-generating, should not yet guide clinical decisions.
Neuronal nitric oxide synthase (NOS-I) impacts on fear/anxiety-like behavior in animals. In humans, the short (S) allele of a functional promotor polymorphism of NOS1 (NOS1 ex1f-VNTR) has been shown to be associated with higher anxiety and altered fear conditioning in healthy subjects in the amygdala and hippocampus (AMY/HIPP). Here, we explore the role of NOS1 ex1f-VNTR as a pathophysiological correlate of panic disorder and agoraphobia (PD/AG). In a sub-sample of a multicenter cognitive behavioral therapy (CBT) randomized controlled trial in patients with PD/AG (n = 48: S/S-genotype n=15, S/L-genotype n=21, L/L-genotype n=12) and healthy control subjects, HS (n = 34: S/S-genotype n=7, S/L-genotype n=17, L/L-genotype=10), a differential fear conditioning and extinction fMRI-paradigm was used to investigate how NOS1 ex1f-VNTR genotypes are associated with differential neural activation in AMY/HIPP. Prior to CBT, L/L-allele carriers showed higher activation than S/S-allele carriers in AMY/HIPP. A genotype × diagnosis interaction revealed that the S-allele in HS was associated with a pronounced deactivation in AMY/HIPP, while patients showed contrary effects. The interaction of genotype × stimulus type (CS+, conditioned stimulus associated with an aversive stimulus vs. CS-, unassociated) showed effects on differential learning in AMY/HIPP. All effects were predominately found during extinction. Genotype associated effects in patients were not altered after CBT. Low statistical power due to small sample size in each subgroup is a major limitation. However, our findings provide first preliminary evidence for dysfunctional neural fear conditioning/extinction associated with NOS1 ex1f-VNTR genotype in the context of PD/AG, shedding new light on the complex interaction between genetic risk, current psychopathology and treatment-related effects.
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Ridderbusch et al. (2020) conducted an RCT in Panic disorder and agoraphobia (n=82). Cognitive behavioral therapy (CBT) vs. Healthy controls and different NOS1 ex1f-VNTR genotypes was evaluated on Differential neural activation in the amygdala and hippocampus (AMY/HIPP) during fear conditioning and extinction. NOS1 ex1f-VNTR L/L-allele carriers showed higher amygdala and hippocampus activation than S/S-allele carriers prior to CBT, and these genotype-associated effects were not altered after treatment.
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