Role of Substance P in Post-Traumatic Stress Disorder
Role of Substance P in Post-Traumatic Stress Disorder
This study will examine the role of substance P, a chemical messenger in the brain, in
 post-traumatic stress disorder (PTSD), a chronic anxiety disorder. PTSD can develop after
 exposure to a terrifying event or ordeal, such as a violent personal assault, natural or
 human-caused disaster, accident, or military combat. Substance P is a peptide that may be
 important in the response to certain psychiatric and neurological diseases and conditions,
 including anxiety.

 Healthy normal volunteers and people with PTSD who are between 18 and 65 years of age may be
 eligible for this study. Candidates are screened with a physical examination, blood and urine
 tests, pregnancy test for women who can become pregnant, and a neuropsychological evaluation.

 Participants undergo positron emission tomography (PET) and magnetic resonance imaging (MRI)
 scanning. An optional lumbar puncture (spinal tap) is also requested.

 PET Scanning

 PET uses small amounts of a radioactive chemical called a tracer that "labels" active areas
 of the brain. The tracer used in this study is [18F]SPA-RQ. For the procedure, the subject
 lies still on the scanner bed. A special mask is fitted to the head to help keep the
 subject's head still during the scan so the images will be clear. A 20-minute "transmission"
 scan is done before the radioactive tracer is injected to provide measures of the brain that
 will help in the precise calculation of information from subsequent scans. After the tracer
 is injected through a needle in the arm, pictures are taken continuously for about 2 hours.
 Then, 20- to 40-minute images are taken every hour until about 5 hours after the injection.

 MRI Scanning

 An MRI scan is scheduled at some time within 1 year of the PET scan. MRI uses a magnetic
 field and radio waves to obtain images of body tissues and organs. The subject lies still on
 a table inside the tunnel-like MRI scanner. Earplugs are worn to muffle loud noises that
 occur during the scanning. The maximum duration of the scan is 60 minutes.

 Lumbar Puncture

 Lumbar puncture is used to examine the cerebrospinal fluid (CSF) that surrounds both the
 brain and the spinal cord. For this procedure, a local anesthetic is given to numb the skin
 in the lower back area. A small needle is then inserted into the space between the bones in
 the lower back where the CSF circulates below the spinal cord. A small amount of fluid is
 collected through the needle.

 Blood Draw

 A blood sample is collected to generate cell lines that can be used to extract DNA (genetic
 material) for gene studies and that can be frozen for future use.
Posttraumatic stress disorder (PTSD) is a chronic, debilitating disorder that places a
 significant burden on individuals and society. Abnormalities in the serotonergic and
 noradrenergic systems and dysregulation of the hypothalamic-pituitary adrenal (HPA) axis have
 been proposed as neurobiological mechanisms in the development of the disorder, however the
 exact underpinnings of the neurobiology of the disorder must be elucidated.

 Distribution of substance P (SP) and its receptor, neurokinin 1 (NK1) receptor, includes
 regions implicated in the pathophysiology of PTSD, namely the amygdala, hippocampus,
 hypothalamus, and locus ceruleus. There is a considerable spatial (and therefore functional)
 overlap between the SP-NK1 receptor system and other neurotransmitter (e.g., norepinephrine,
 serotonin) pathways with well established roles in anxiety. Preclinical studies indicate that
 stress regulates levels of SP in several brain regions. In addition, in several animal
 models, NK1 receptor antagonists demonstrate anxiolytic-like property. These anxiolytic-like
 effects seem to involve different mechanisms than those of currently available anxiolytics.

 In this protocol, we will use a PET ligand that acts as an NK1 receptor antagonist,
 [18F]SPA-RQ ([18F]-labeled Substance P Antagonist Receptor Quantifier). Using this tracer, we
 will look for regional differences in NK1 receptor binding in 20 patients with PTSD and 20
 healthy controls. The goal of the present study is to demonstrate the involvement of SP in
 PTSD, and thereby, further our understanding of its role in the psychopathology of this
 illness.
INCLUSION CRITERIA:

 PTSD Samples:

 Twenty subjects (age 18-65) with current PTSD, as defined by DSM-IV criteria, of any
 ethnicity without other significant medical conditions will be selected.

 Healthy Control Samples:

 Twenty healthy subjects (age 18-65) without a known personal or family history of
 psychiatric disorders in first-degree relatives will be selected.

 A control subject will be matched to each subject with PTSD for age, gender, and
 handedness, respectively.

 They must not be actively using illicit drugs or engaged in heavy consumption of alcohol,
 had no metallic implants that are ferromagnetic, and competent to sign consent forms to
 participate in the study.

 EXCLUSION CRITERIA:

 Patients must not have taken antidepressant or other medications likely to alter SP-NK1
 receptor system. Effective medications will not be discontinued for the purpose of this
 study.

 Subjects will be excluded if they have:

 1. DSM-IV Axis I diagnostic criteria other than PTSD and Major depression (All controls
 must not meet any of the Axis I diagnoses);

 2. DSM-IV criteria for psychoactive substance abuse/dependence within six months;

 3. take psychotropic medication in last 3 weeks (8 weeks for fluoxetine);

 4. abnormal MRI other than minor atrophy;

 5. abnormal laboratory test, including HIV test;

 6. are currently pregnant or breast feeding (as documented by pregnancy testing at
 screening or at days of the scanning);

 7. prior participation in other research protocols within the past year such that a
 radiation exposure together with the present study would exceed the annual limits (A
 total effective dose 5.0 rem in a year and a 5 rad per year to the lens of the eyes,
 gonads and blood-forming organs; and 15 rad annually for all other organs);

 8. are unable to lay on one's back for PET/MRI scans (PET and MRI scans take
 approximately 5 and 1 hour, respectively);

 9. any condition that increases risk for MRI (e.g., pacemaker, metallic foreign body in
 the eye, etc.);

 10. individuals who recently donated blood;

 11. serious suicidal ideation or behavior;

 12. Xylocaine allergy;

 13. positive HIV test.

 For healthy subjects, exclusion criteria b) through m) are same to those for PTSD subjects.
 As for item a), subjects will be excluded if they meet any current DSM-IV Axis I diagnostic
 criteria.