Background

Varenicline is considered one of the most effective treatment options for smoking cessation. Nonetheless, it is only modestly effective. A deeper comprehension of the effects of varenicline by means of the in-depth review of relevant fMRI studies may assist in paving the development of more targeted and effective treatments.

Methodology

A search of PubMed and Google Scholar databases was conducted with the keywords “functional magnetic resonance imaging” or “fMRI”, and “varenicline”. All peer-reviewed articles regarding the assessment of smokers with fMRI while undergoing treatment with varenicline and meeting the predefined criteria were included.

Results

Several studies utilizing different methodologies and targeting different aspects of brain function were identified. During nicotine withdrawal, decreased mesocorticolimbic activity and increased amygdala activity, as well as elevated amygdala-insula and insula-default-mode-network functional connectivity are alleviated by varenicline under specific testing conditions. However, other nicotine withdrawal-induced changes, including the decreased reward responsivity of the ventral striatum, the bilateral dorsal striatum and the anterior cingulate cortex are not influenced by varenicline suggesting a task-dependent divergence in neurocircuitry activation. Under satiety, varenicline treatment is associated with diminished cue-induced activation of the ventral striatum and medial orbitofrontal cortex concomitant with reduced cravings; during the resting state, varenicline induces activation of the lateral orbitofrontal cortex and suppression of the right amygdala.

Conclusions

The current review provides important clues with regard to the neurobiological mechanism of action of varenicline and highlights promising research opportunities regarding the development of more selective and effective treatments and predictive biomarkers for treatment efficacy.

中文翻译：

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伐尼克兰戒烟治疗期间通过功能磁共振成像识别的不同大脑系统的变化：综述

背景

伐尼克兰被认为是戒烟最有效的治疗选择之一。尽管如此，它的效果还是有限的。通过深入回顾相关功能磁共振成像研究，更深入地理解伐尼克兰的作用可能有助于开发更有针对性和更有效的治疗方法。

方法

使用关键词“功能磁共振成像”或“fMRI”和“伐尼克兰”对 PubMed 和 Google Scholar 数据库进行搜索。所有关于在接受伐尼克兰治疗时使用功能磁共振成像评估吸烟者并满足预定标准的同行评审文章均被纳入。

结果

确定了几项利用不同方法并针对大脑功能不同方面的研究。在尼古丁戒断期间，在特定的测试条件下，伐尼克兰可以缓解中皮质边缘活动的减少和杏仁核活动的增加，以及杏仁核-岛叶和岛叶默认模式网络功能连接的升高。然而，其他尼古丁戒断引起的变化，包括腹侧纹状体、双侧背侧纹状体和前扣带皮层的奖赏反应性降低，不受伐尼克兰的影响，表明神经回路激活存在任务依赖性分歧。在饱腹感下，伐尼克兰治疗会减少提示诱导的腹侧纹状体和内侧眶额皮质的激活，同时减少食欲；在静息状态下，伐尼克兰诱导外侧眶额皮层的激活和右侧杏仁核的抑制。

结论

当前的综述提供了有关伐尼克兰作用的神经生物学机制的重要线索，并强调了在开发更具选择性和更有效的治疗方法以及治疗效果的预测生物标志物方面有前景的研究机会。