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出境医 / 临床实验 / Noradrenaline, Acetylcholine and Dynamic Learning in Healthy Humans

Noradrenaline, Acetylcholine and Dynamic Learning in Healthy Humans

Study Description
Brief Summary:
The aim of this study is to characterize the role of central norepinephrine and acetylcholine on reward and emotion related information processing in healthy volunteers using behavioural tasks and pupillometry (with eye tracking equipment). The pharmacological compounds used in the study (reboxetine and rivastigmine) are used as tools to manipulate these systems rather than to treat patients. The aim of the study is not to study the clinical effects, pharmacodynamics, adverse reactions, absorption, distribution, metabolism or excretion of the drugs. Further, the population studied is non-clinical, the drugs are not administered in a therapeutic dosing regimen (only a single dose of study drug will be administered) and the investigators do not measure clinically significant outcomes.

Condition or disease Intervention/treatment Phase
Healthy Drug: Reboxetine Drug: Rivastigmine Drug: Placebo oral tablet Not Applicable

Detailed Description:

Background: Previous research has shown that human learners are able to encode the probabilities of positive and negative outcomes in parallel, and adjust their learning behaviour to the information content of positive and negative outcomes (Pulcu and Browning 2017). In reinforcement learning tasks, the volatility (also known as unexpected uncertainty arising when the environment changes suddenly) of outcomes directly influences how informative the outcomes are perceived to be (Behrens, Woolrich et al. 2007). Previous studies consistently shown that human participants use a higher learning rate while learning from outcomes with high volatility (Behrens, Woolrich et al. 2007, Browning, Behrens et al. 2015, Pulcu and Browning 2017). Another source of uncertainty is expected uncertainty, which arises from naturally varying outcomes (e.g. day to day changes in temperature). Different sources of uncertainty in the environment are argued to be associated with the activity of different neurotransmitter systems in the human brain (Yu and Dayan, 2005)(Angela and Dayan 2005). For example, outcome volatility (unexpected uncertainty) is thought to be associated with the activity of the central norepinephrine (NE) system, whereas outcome variation (expected uncertainty) has been linked to the cholinergic (ACY) system.

Studies using pupillometry (a non-invasive way of inferring central norepinephrine activity in the human brain) showed that pupil size is associated with the volatility of outcomes during reinforcement learning tasks (Browning, Behrens et al. 2015, Pulcu and Browning 2017). However, pupil size can also be influenced by the activity of other neurotransmitters including acetylcholine limiting the degree to which these results can be attributed to the NE system. Further, previous human studies have been associational in nature and thus the causal role of the NE and ACY systems in human learning under uncertainty have yet to be tested. The current study will address this knowledge gap by investigating how administering a single dose of the norepinephrine reuptake inhibitor reboxetine or cholinesterase inhibitor rivastigmine influence choice behaviour and pupillary correlates of human reinforcement learning.

Study Structure: All participants will be recruited via the recruitment pipeline described below. The randomisation procedure used will treat participants as if 2 parallel studies were running: a reboxetine vs. placebo and a rivastigmine vs. placebo study. Researchers will assign participants to either the reboxetine or rivastigmine arm (NB researchers will not be blind to this allocation although participants will be). Both studies will randomise participants in a 1:1 ratio, stratified by gender, to either the active drug or placebo (NB both researchers and participants will remain blind to this allocation). This will result in an overall group size for the reboxetine:rivastigmine:placebo groups of 30:30:60 (with participants randomised to placebo being specifically associated with the reboxetine or rivastigmine group). The rationale for this approach is that, while study procedures are identical for all participants, the investigators are addressing 2 separate questions in this study (the effect of NE manipulation and the effect of ACY manipulation on learning) which are more straightforwardly assessed using two, separate, placebo controlled comparisons rather than a larger three group study.

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 107 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Three group parallel design
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Masking Description: Overencapsulated drug/placebo capsule used. Investigator and participant blind to allocation. Randomisation schedule drawn up by independent researcher and kept in locked cabinet.
Primary Purpose: Basic Science
Official Title: Noradrenaline, Acetylcholine and Dynamic Learning in Healthy Humans
Actual Study Start Date : June 1, 2019
Actual Primary Completion Date : June 1, 2020
Actual Study Completion Date : June 1, 2020
Arms and Interventions
Arm Intervention/treatment
Experimental: Reboxetine
Single dose of 4mg
Drug: Reboxetine
Single dose used to increase central norepinepherine

Experimental: Rivastigmine
Single dose of 3mg
Drug: Rivastigmine
Single dose to increase central acetylcholine

Placebo Comparator: Placebo
Single dose of placebo
Drug: Placebo oral tablet
Single dose as control condition

Outcome Measures
Primary Outcome Measures :
  1. Change in learning rates [ Time Frame: 2 hours after dosing (NB outcome is the change from the baseline measure to this time point) ]
    Learning rates from negative and positive outcomes received in a reinforcement learning task


Secondary Outcome Measures :
  1. Pupil size [ Time Frame: 2 hours after dosing (NB outcome is the change from the baseline measure to this time point) ]
    High temporal resolution pupil size measurement during a reinforcement learning task

  2. Affective processing [ Time Frame: 2 hours after dose ]
    Response accuracy in the Facial Emotion Recognition Task (FERT).


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years to 45 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Male or female
  • Age: 18 to 45 years
  • Good physical and mental health
  • Participant is willing and able to give informed consent for participation in the study
  • Sufficient knowledge of English language to understand and complete study tasks
  • Willingness to refrain from driving, cycling, or operating heavy machinery on the day of the study

Exclusion Criteria:

  • Current or past psychiatric disorder (e.g. depression, bipolar disorder etc.)
  • BMI outside of range 187.5 and 2530
  • Any severe medical condition not stabilized at the time of the experiment that, in the opinion of the study medic, would compromise the safety or conduct of the study including significant hypertension (diastolic pressure > 100mmHg) or bradycardia (pulse less than 50 bpm).
  • Any history of seizures, glaucoma or pancreatitis
  • Lactose intolerance
  • Any current or past physical illness that has the potential to significantly affect mental functioning (e.g. epilepsy, hypothyroidism, Parkinson's disease, multiple sclerosis etc.)
  • Pregnant, or lactating woman
  • Sexually active woman who does not use any medically accepted method of contraception
  • Current or previous intake (last month) of any medication that has a significant potential to affect mental functioning (e.g. benzodiazepines, antidepressants, neuroleptics etc.)
  • Any intake of recreational drugs in the last 3 months (e.g. marijuana, ecstasy etc.)
  • Harmful alcohol use in the last 6 months (harmful alcohol use established based on self-reported work-related or social problems due to alcohol use or other's feedback to the participant that s/he should cut down)
  • History of allergic reactions to relevant substances (reboxetine, rivastigmine)
  • Previous participation in a study using the same or similar tasks
  • In the researcher's or study medic's opinion participation in the study could be harmful or severely distressing to the participant (e.g. intolerance of side effects) or the participant is not able to follow instructions or complete study tasks
Contacts and Locations

Locations
Layout table for location information
United Kingdom
Dept of Psychiatry, University of Oxford
Oxford, Oxfordshire, United Kingdom, OX3 7JX
Sponsors and Collaborators
University of Oxford
Tracking Information
First Submitted Date  ICMJE May 10, 2019
First Posted Date  ICMJE May 21, 2019
Last Update Posted Date June 16, 2020
Actual Study Start Date  ICMJE June 1, 2019
Actual Primary Completion Date June 1, 2020   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: May 16, 2019)
Change in learning rates [ Time Frame: 2 hours after dosing (NB outcome is the change from the baseline measure to this time point) ]
Learning rates from negative and positive outcomes received in a reinforcement learning task
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: May 16, 2019)
  • Pupil size [ Time Frame: 2 hours after dosing (NB outcome is the change from the baseline measure to this time point) ]
    High temporal resolution pupil size measurement during a reinforcement learning task
  • Affective processing [ Time Frame: 2 hours after dose ]
    Response accuracy in the Facial Emotion Recognition Task (FERT).
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Noradrenaline, Acetylcholine and Dynamic Learning in Healthy Humans
Official Title  ICMJE Noradrenaline, Acetylcholine and Dynamic Learning in Healthy Humans
Brief Summary The aim of this study is to characterize the role of central norepinephrine and acetylcholine on reward and emotion related information processing in healthy volunteers using behavioural tasks and pupillometry (with eye tracking equipment). The pharmacological compounds used in the study (reboxetine and rivastigmine) are used as tools to manipulate these systems rather than to treat patients. The aim of the study is not to study the clinical effects, pharmacodynamics, adverse reactions, absorption, distribution, metabolism or excretion of the drugs. Further, the population studied is non-clinical, the drugs are not administered in a therapeutic dosing regimen (only a single dose of study drug will be administered) and the investigators do not measure clinically significant outcomes.
Detailed Description

Background: Previous research has shown that human learners are able to encode the probabilities of positive and negative outcomes in parallel, and adjust their learning behaviour to the information content of positive and negative outcomes (Pulcu and Browning 2017). In reinforcement learning tasks, the volatility (also known as unexpected uncertainty arising when the environment changes suddenly) of outcomes directly influences how informative the outcomes are perceived to be (Behrens, Woolrich et al. 2007). Previous studies consistently shown that human participants use a higher learning rate while learning from outcomes with high volatility (Behrens, Woolrich et al. 2007, Browning, Behrens et al. 2015, Pulcu and Browning 2017). Another source of uncertainty is expected uncertainty, which arises from naturally varying outcomes (e.g. day to day changes in temperature). Different sources of uncertainty in the environment are argued to be associated with the activity of different neurotransmitter systems in the human brain (Yu and Dayan, 2005)(Angela and Dayan 2005). For example, outcome volatility (unexpected uncertainty) is thought to be associated with the activity of the central norepinephrine (NE) system, whereas outcome variation (expected uncertainty) has been linked to the cholinergic (ACY) system.

Studies using pupillometry (a non-invasive way of inferring central norepinephrine activity in the human brain) showed that pupil size is associated with the volatility of outcomes during reinforcement learning tasks (Browning, Behrens et al. 2015, Pulcu and Browning 2017). However, pupil size can also be influenced by the activity of other neurotransmitters including acetylcholine limiting the degree to which these results can be attributed to the NE system. Further, previous human studies have been associational in nature and thus the causal role of the NE and ACY systems in human learning under uncertainty have yet to be tested. The current study will address this knowledge gap by investigating how administering a single dose of the norepinephrine reuptake inhibitor reboxetine or cholinesterase inhibitor rivastigmine influence choice behaviour and pupillary correlates of human reinforcement learning.

Study Structure: All participants will be recruited via the recruitment pipeline described below. The randomisation procedure used will treat participants as if 2 parallel studies were running: a reboxetine vs. placebo and a rivastigmine vs. placebo study. Researchers will assign participants to either the reboxetine or rivastigmine arm (NB researchers will not be blind to this allocation although participants will be). Both studies will randomise participants in a 1:1 ratio, stratified by gender, to either the active drug or placebo (NB both researchers and participants will remain blind to this allocation). This will result in an overall group size for the reboxetine:rivastigmine:placebo groups of 30:30:60 (with participants randomised to placebo being specifically associated with the reboxetine or rivastigmine group). The rationale for this approach is that, while study procedures are identical for all participants, the investigators are addressing 2 separate questions in this study (the effect of NE manipulation and the effect of ACY manipulation on learning) which are more straightforwardly assessed using two, separate, placebo controlled comparisons rather than a larger three group study.

Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:
Three group parallel design
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Masking Description:
Overencapsulated drug/placebo capsule used. Investigator and participant blind to allocation. Randomisation schedule drawn up by independent researcher and kept in locked cabinet.
Primary Purpose: Basic Science
Condition  ICMJE Healthy
Intervention  ICMJE
  • Drug: Reboxetine
    Single dose used to increase central norepinepherine
  • Drug: Rivastigmine
    Single dose to increase central acetylcholine
  • Drug: Placebo oral tablet
    Single dose as control condition
Study Arms  ICMJE
  • Experimental: Reboxetine
    Single dose of 4mg
    Intervention: Drug: Reboxetine
  • Experimental: Rivastigmine
    Single dose of 3mg
    Intervention: Drug: Rivastigmine
  • Placebo Comparator: Placebo
    Single dose of placebo
    Intervention: Drug: Placebo oral tablet
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: June 15, 2020)
107
Original Estimated Enrollment  ICMJE
 (submitted: May 16, 2019)
120
Actual Study Completion Date  ICMJE June 1, 2020
Actual Primary Completion Date June 1, 2020   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Male or female
  • Age: 18 to 45 years
  • Good physical and mental health
  • Participant is willing and able to give informed consent for participation in the study
  • Sufficient knowledge of English language to understand and complete study tasks
  • Willingness to refrain from driving, cycling, or operating heavy machinery on the day of the study

Exclusion Criteria:

  • Current or past psychiatric disorder (e.g. depression, bipolar disorder etc.)
  • BMI outside of range 187.5 and 2530
  • Any severe medical condition not stabilized at the time of the experiment that, in the opinion of the study medic, would compromise the safety or conduct of the study including significant hypertension (diastolic pressure > 100mmHg) or bradycardia (pulse less than 50 bpm).
  • Any history of seizures, glaucoma or pancreatitis
  • Lactose intolerance
  • Any current or past physical illness that has the potential to significantly affect mental functioning (e.g. epilepsy, hypothyroidism, Parkinson's disease, multiple sclerosis etc.)
  • Pregnant, or lactating woman
  • Sexually active woman who does not use any medically accepted method of contraception
  • Current or previous intake (last month) of any medication that has a significant potential to affect mental functioning (e.g. benzodiazepines, antidepressants, neuroleptics etc.)
  • Any intake of recreational drugs in the last 3 months (e.g. marijuana, ecstasy etc.)
  • Harmful alcohol use in the last 6 months (harmful alcohol use established based on self-reported work-related or social problems due to alcohol use or other's feedback to the participant that s/he should cut down)
  • History of allergic reactions to relevant substances (reboxetine, rivastigmine)
  • Previous participation in a study using the same or similar tasks
  • In the researcher's or study medic's opinion participation in the study could be harmful or severely distressing to the participant (e.g. intolerance of side effects) or the participant is not able to follow instructions or complete study tasks
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 45 Years   (Adult)
Accepts Healthy Volunteers  ICMJE Yes
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United Kingdom
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03957174
Other Study ID Numbers  ICMJE R62807/RE001
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: Yes
Plan Description: Annonymised data and study protocol will be made available to researchers who contact the PI
Supporting Materials: Study Protocol
Supporting Materials: Analytic Code
Time Frame: After completion of data analysis, and then indefinitely.
Access Criteria: Researchers who contact the PI with a valid interest in the data (as assessed by the PI)
Responsible Party University of Oxford
Study Sponsor  ICMJE University of Oxford
Collaborators  ICMJE Not Provided
Investigators  ICMJE Not Provided
PRS Account University of Oxford
Verification Date March 2020

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP