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. 2023 Aug 10;15(8):e43251.
doi: 10.7759/cureus.43251. eCollection 2023 Aug.

A Pilot Study of the Striatal Dopamine Transporter Levels in Kratom-Dependent and Normal Subjects Using 99mTc-TRODAT-1 Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT)

Norasma Amira Binti Zainudin  1 , Nurul Nadiah Zulkifli  1 , Khadijah Abdul Hamid  1   2 , Hazlin Hashim  1   2 , Syahir Mansor  1   2
Affiliations

A Pilot Study of the Striatal Dopamine Transporter Levels in Kratom-Dependent and Normal Subjects Using 99mTc-TRODAT-1 Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT)

Norasma Amira Binti Zainudin et al. Cureus. .

Abstract

Objective: The study aims to elucidate the effects of kratom addiction on dopamine transporter (DAT) using [2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo[3.2.1]oct-2-yl]methyl](2-mercaptoethyl)amino]ethyl]amino]ethanethiolato(3-)-N2,N20,S2,S20]oxo-[1R-(exo-exo)]-[99mTc] technetium (99mTc-TRODAT-1) brain single photon emission computed tomography-computed tomography (SPECT-CT) in kratom-dependent and healthy subjects.

Materials and methods: We recruited 12 kratom-dependent subjects and 13 healthy men to participate in this study. Addiction, craving, depression, and cognitive scores were assessed. All subjects received a single bolus injection of 99mTc-TRODAT-1 with 914.1 MBq ± 65.5 of activity (mean ± SD). The brain SPECT-CT images were reconstructed using 3D ordered subset expectation maximization (3D-OSEM) along with attenuation correction (AC), scatter correction (SC), and resolution recovery (RR) with an iteration number of four and a subset of 10. The Cohen's Kappa interrater-reliability between two raters, the standardized uptake value of body weight (SUVBW), and the asymmetrical index percentage (AI%) were evaluated.

Results: Kappa statistics showed a fine agreement of abnormal 99mTc-TRODAT-1 uptake in the striatum region for the kratom-dependent group with the κ value of 0.69 (p = 0.0001), and the percentage of agreement for rater 1 and rater 2 was 56% and 64%, respectively. There was a reduction in average SUV in kratom-dependent subjects compared to healthy control subjects in the left caudate and left striatum (0.938 vs. 1.251, p = 0.014, and 1.055 vs. 1.29, p = 0.036, respectively). There was a significant difference in the AI% of the caudate region between the kratom-dependent group and the normal group (33% vs. 14%, p = 0.019).

Conclusion: Our findings signify that kratom addiction, may cause a change in DAT level and the results can be confirmed using 99mTc-TRODAT-1 SPECT-CT.

Keywords: 99mtc-trodat-1; addiction; dopamine transporter (dat); kratom; spect/ct.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The DSM-V, HAM-A, MMSE, and PHQ scores for kratom-dependent and healthy control subjects
DSM-V: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; HAM-A: Hamilton Anxiety Rating Scale; MMSE: Mini-Mental State Examination; PHQ: Patient Health Questionnaire-9. The star (*) symbols represent the outlier data points within the group
Figure 2
Figure 2. The SUVBW images overlay on the MRI of one of the normal subjects (top row) versus one of the kratom-dependent subjects (bottom row) for axial, coronal, and sagittal slices. Kratom-dependent subjects consumed the kratom for 21 years of duration. Images were reconstructed using 4i10s (Butterworth filter frequency of 0.4 and an order of 10) for image display. Red arrows represent the striatum region for normal subjects and kratom-dependent subjects, respectively.
SUVBW: standardized uptake value of body weight
Figure 3
Figure 3. The SUVBW for kratom-dependent and healthy control subjects for right caudate (A), left caudate (B), right putamen (C), and left putamen (D)
SUVBW: standardized uptake value of body weight
Figure 4
Figure 4. The SUV trend for a healthy control subject for the whole striatum (A), the SUV trend for a kratom-dependent subject for the whole striatum (B), the left striatum (C), and the right striatum (D); the dotted lines show 95% of the confidence interval.
Figure 5
Figure 5. The asymmetrical index percentage (%) for kratom-dependent and healthy control subjects for caudate (A), putamen (B), and striatum (C)
Figure 6
Figure 6. The asymmetrical index trendline for kratom-dependent and healthy control subjects for caudate (A) and putamen (B); the dotted lines show 95% of the confidence interval.
See this image and copyright information in PMC

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