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; Nurul Nadiah Zulkifli; Khadijah Abdul Hamid; Hazlin Hashim; Syahir Mansor

doi:10.7759/cureus.43251

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)

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

Authors

Norasma Amira Binti Zainudin¹, Nurul Nadiah Zulkifli¹, Khadijah Abdul Hamid^{1

2}, Hazlin Hashim^{1

2}, Syahir Mansor^{1

2}

Affiliations

¹ Biomedical Imaging, Universiti Sains Malaysia, Penang, MYS.
² Nuclear Medicine Unit, Universiti Sains Malaysia, Penang, MYS.

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 (SUV_BW), 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.

Grants and funding

This study was funded by the Ministry of Higher Education Malaysia under the Universiti Sains Malaysia (USM) fundamental research grant scheme (FRGS/1/2019/SKK08/USM/03/4).