Multiple forms of brain monoamine oxidase in schizophrenic and normal individuals

Monoamine Oxidase B (MAO-B): A Target for Rational Drug Development in Schizophrenia Using PET Imaging as an Example

Monoamine oxidase B (MAO-B) is an important high-density enzyme involved in the generation of oxidative stress and central in the catabolism of dopamine, particularly in brain subcortical regions with putative implications in the pathophysiology of schizophrenia. In this chapter, we review postmortem studies, preclinical models, and peripheral and genetic studies implicating MAO-B in psychosis. A literature search in PubMed was conducted and 64 studies were found to be eligible for systematic review. We found that MAO-B could be identified as a potential target in schizophrenia. Evidence comes mostly from studies of peripheral markers, showing reduced platelet MAO-B activity in schizophrenia, together with preclinical results from MAO-B knock-out mice resulting in a hyperdopaminergic state and behavioral disinhibition. However, whether brain MAO-B is altered in vivo in patients with schizophrenia remains unknown. We therefore review methodological studies involving MAO-B positron emission tomography (PET) radioligands used to quantify MAO-B in vivo in the human brain. Given the limitations of currently available treatments for schizophrenia, elucidating whether MAO-B could be used as a target for risk stratification or clinical staging in schizophrenia could allow for a rational search for newer antipsychotics and the development of new treatments.

Histamine metabolites in cerebrospinal fluid of patients with chronic schizophrenia: their relationships to levels of other aminergic transmitters and ratings of symptoms

Levels of the histamine metabolites, tele-methylhistamine (t-MH) and tele-methylimidazoleacetic acid (t-MIAA), and metabolites of other aminergic transmitters and of norepinephrine were measured in cerebrospinal fluid of 36 inpatients with chronic schizophrenia and eight controls. The mean t-MH level from controls was nearly identical to the levels seen previously in healthy volunteers. Compared with controls, the mean level of t-MH in the schizophrenic patients was 2.6-fold higher (p = 0.006); 21 of the patients had levels exceeding the range of controls. There was no significant difference (p > 0.05) in levels of other analytes, although the levels of t-MH correlated significantly with those of t-MIAA, homovanillic acid, 3,4-dihydroxyphenylacetic acid, norepinephrine, 3-methoxy-4-hydroxyphenylglycol and 5-hydroxyindoleacetic acid. The difference in levels of t-MH were not attributable to medication, since those taking (n = 10) or withdrawn from (n = 26) neuroleptic drugs had nearly the same mean levels of t-MH; each group had higher levels than controls (ANOVA: p < 0.05). Patients with or without tardive dyskinesia showed no significant differences in means of any analyte. Only levels of t-MH among those with schizophrenia correlated with positive symptom scores on the Psychiatric Symptom Assessment Scale (rs = 0.45, p < 0.02). The elevated levels of t-MH in cerebrospinal fluid, which represent histamine that was released and metabolized, suggest increased central histaminergic activity in patients with chronic schizophrenia.

Platelet monoamine oxidase in schizophrenia: a meta-analysis

We did a meta-analysis on all publications (English and other languages) concerned with platelet monoamine oxidase (MAO) in schizophrenia. Essentially, when patients were medicated with a neuroleptic, most studies found that schizophrenics had lower platelet MAO levels than controls. Administration of neuroleptic lowers MAO levels. MAO levels in drug-free schizophrenics were similar to controls. Only a minority of studies found drug-free schizophrenics had decreased platelet MAO levels.

Platelet MAO activity in hallucinating and paranoid schizophrenics: a review and meta-analysis

Published studies of platelet monoamine oxidase (MAO) activity of paranoid (P) and nonparanoid (NP) schizophrenics and normal controls, and of hallucinating (H) and nonhallucinating (NH) schizophrenics and normal controls were critically reviewed, and summary analyses were conducted on the original published data. Methods of comparing results across studies are discussed. Meta-analysis of the results of 11 analyses from 9 studies, examining a total of 165 P and 152 NP schizophrenics and 985 normal controls, indicated that the typical P schizophrenic studied had platelet MAO activity lower than that of 61% of NP schizophrenics and 79% of normal controls. Meta-analysis of the results of 8 separate analyses from 6 studies comprising 130 H, 81 NH schizophrenics, and 186 normal controls indicated that the average H schizophrenic studied had platelet MAO activity lower than that of 84% of NH schizophrenics and 80% of normal controls. In comparison with normal control values, P schizophrenics had the greatest mean percentage decrease in platelet MAO activity (30%), followed by NP schizophrenics (24%), and H schizophrenics (24%). These findings could not readily be attributed to diagnostic, demographic, or methodological factors, nor to the effects of alcohol or neuroleptics.

Platelet monoamine oxidase activity and schizophrenia--a myth that refuses to die?

Platelet monoamine oxidase (MAO) activity was determined using kynuramine as a substrate in a group of schizophrenic patients (n = 107), a group of healthy individuals (n = 100), and a group of psychiatric patients who were neither schizophrenics nor alcoholics (n = 110). No significant difference emerged between the schizophrenics and the other two groups, while a significant reduction in platelet MAO activity in a group of alcoholics (n = 60) was confirmed. Breaking down the schizophrenic group according to course of illness, phenomenology (paranoid-hallucinatory or not) and drug use did not lead to a significant deviation in platelet MAO activity in any of these subgroups. It can also be demonstrated from the literature that the results reached by most research teams question the usefulness of platelet MAO activity as a genetic marker for psychiatric illness.

Elevated postmortem monoamine oxidase B activity in the caudate nucleus in Huntington's disease compared to schizophrenics and controls

Activity (Vmax) of monoamine oxidase (MAO) B in necropsy samples from the head of the caudate nucleus was 260% higher in patients dying with Huntington's disease (HD) than in controls (P less than 0.05). No differences in MAO A enzyme kinetics were found. MAO B, but not MAO A, was increased (26%) in the frontal cortex from patients dying with HD compared to control subjects. MAO A and B kinetics in caudate nucleus and frontal cortex from a group of schizophrenics did not differ from controls. Postmortem delay, the effect of neuroleptics, or nonspecific degeneration artifacts did not explain these findings. It is suggested that the increase in MAO B activity in the caudate nucleus may reflect neurochemical changes that are responsible for the choreiform movements of Huntington's disease. Lower cortical MAO B activity in the schizophrenic group may reflect the effects of neuroleptics.

Purification of human blood platelet monoamine oxidase

Monoamine oxidase B has been purified from human blood platelets 185-fold to a specific activity of 113 nmole/min/mg protein by a combination of Triton X-100 solubilization and ion exchange chromatography. A protein fraction corresponding to 58,000 Da on sodium dodecyl sulfate-polyacrylamide gel electrophoresis was identified as monoamine oxidase by its ability to bind [3H]Pargyline.

Negative symptoms and platelet monoamine oxidase activity in male schizophrenic patients

A significant positive correlation was found between negative symptoms and platelet monoamine oxidase (MAO) activity in unmedicated male, but not female, schizophrenic patients. This correlation was significant in split halves of the male patients. There was no indication that the correlation was due to either outliers or medication effects. Male schizophrenic patients with high negative symptom scores had significantly higher mean platelet MAO activity than either male normal control subjects or male schizophrenic patients with low negative symptom scores. This finding suggests that the extent of negative symptoms in a population of males could affect whether the schizophrenic subjects will be found to have platelet MAO activity which differs from that of normal control subjects. The implications of the correlation between platelet MAO activity and negative symptoms for the role of brain MAO activity and two of its substrates, dopamine and serotonin, in the etiology of negative symptoms in male schizophrenic patients are discussed.

Concentrations of 5-hydroxyindoleacetic acid and homovanillic acid in the cerebrospinal fluid of chronic therapy-resistant schizophrenics before and after hemodialysis therapy

The concentrations of the monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) have been determined by high-performance liquid chromatography in samples of lumbar cerebrospinal fluid from chronic therapy-resistant schizophrenics, both before and after either inactive or active hemodialysis for 10 weeks. A reasonable test-retest reliability was found for 5-HIAA during the inactive dialysis, but this was not found during active dialysis.

Monoamine oxidase activities in human brain microvessels

Microvessels can be easily isolated from human brain samples obtained at autopsy. Human frontal cortex MAO type A and B activities are similar in microvessel and microvessel-free preparations. In microvessels, enzyme activities and the ratio of MAO type A to type B vary among the areas studied and could selectively regulate the passage of certain amines though the blood vessel wall.

Monoamine oxidase-A and -B activities in the brain stem of schizophrenics and non-schizophrenic psychotics

In the pons of autopsy cases who had suffered from chronic schizophrenic or nonschizophrenic psychoses, an increased activity of monoamine oxidase -B but not -A was found, as compared with age-matched controls. Consequently, the ratio of the activities of MAO-B : MAO-A was elevated in the cases of psychosis. There was no significant difference in enzyme activities between schizophrenic and nonschizophrenic psychoses. Lobotomy appeared not to influence the monoamine oxidase activity. Increased ratios of the activities of MAO-B : MAO-A in various brain parts of chronic schizophrenics in comparison with age-matched controls was found in the previously published data of Eckert et al (1980) and Schwartz et al. (1974) but not Crow et al. (1979). The mechanism underlying the change in enzyme activities is unclear. There seems to exist an association between an increased monoamine oxidase-B activity and degenerative processes in the brain resulting in loss of neuronal activity. The change observed may be linked either to pathological processes associated with chronic psychosis or to long-term treatment with neuroleptic drugs.

Human platelet monoamine oxidase activity in health and disease: a review

The most readily available source of monoamine oxidase in man is the platelet, although only the B form of the enzyme is represented in this site. Platelet activity is higher in women than in men. The enzyme activity is generally stable and is partly under genetic control. There is some evidence that individuals with low activity have a higher psychiatric morbidity than those with high activity. Despite some negative studies, the consensus of publication dealing with schizophrenia, migraine, and alcoholism find that mean platelet monoamine oxidase activity in the patient group is lower than in the controls. Values are raised in unipolar depression. Technical differences, or patient or control group heterogeneity, might well account for the absence of unanimity in the literature. A considerable degree of overlap between patient and control values, whatever the clinical diagnosis, appears to be the standard finding. Apart from these neuropsychiatric disturbances, platelet monoamine oxidase activity is raised in megaloblastic anaemia and reduced in iron deficiency anaemia. Although altered enzyme activity values may be linked to abnormal platelet populations in some of the haematological disorders discussed, in general the causes of abnormal platelet monoamine oxidase activity are unknown.

MAO activity and EEG sleep in primary depression

Platelet monoamine oxidase (MAO) activity and electroencephalographic (EEG) sleep measures were examined in 56 drug-free hospitalized patients with primary depression as defined by the Research Diagnostic Criteria. The group included 35 females and 21 males with a mean age of 42.6 +/- 1.4 years. Platelet MAO and EEG sleep data were compared for the group as a whole and separately for the unipolar, bipolar, male, and female subgroups. No significant relationships could be demonstrated for the entire group or for the unipolar, male, or female subgroups. However, an inverse relationship between MAO activity and REM sleep percent was noted in the bipolar subgroup (p < 0.02). While changes in REM sleep have been relatively firmly established in primary depression, the relationship of MAO to depression and to REM sleep remains unclear.

Monoacylcadaverines in the blood of schizophrenic patients

Concentrations of cadaverine, monoacetylcadaverine and monopropionylcadaverine in the blood of schizophrenic and nonschizophrenic subjects were measured. Two groups, one from the U.S.A. the other from Japan, were tested. Monoacetylcadaverine and monopropionylcadaverine were found elevated in the blood of some schizophrenic patients in comparison with those in controls in each group. Their increase could be caused by a reduced monoamine oxidase activity or by an increased acylation in schizophrenic patients.

Properties of monoamine oxidase (MAO) in human blood platelets, plasma, lymphocytes and granulocytes

The properties of monoamine oxidase in plasma, platelets, lymphocytes and granulocytes have been studied using cells prepared from a single small (about 20 ml) sample of blood. The three substrates, 5-hydroxytryptamine, tyramine and benzylamine, have been used to obtain a more complete picture of blood monoamine oxidase than was previously possible. Measurement of Michaelis constants, use of selective inhibitors, and activity against the three substrates distinguished three types of activity. The monoamine oxidases in platelets and lymphocytes are very similar, being most active with tyramine or benzylamine as substrate and inhibited by low concentrations of deprenil. The enzymes in plasma and granulocytes are similar in their relatively high activity against 5-hydroxytryptamine and in their inhibition by semicarbazide and cuprizone with tyramine or benzylamine as substrates. They differ in their affinities for 5-hydroxytryptamine and their activity against tyramine. The activity in platelets, plasma, lymphocytes and granulocytes has been measured in a group of 15 normal subjects using three substrates.

Suicide attempts, platelet monoamine oxidase and the average evoked response

The relationship between suicides and suicide attempts and two biological measures, platelet monoamine oxidase levels (MAO) and average evoked response (AER) augmenting, was examined in 79 off-medication psychiatric patients and in 68 college student volunteers chosen from the upper and lower deciles of MAO activity levels. In the patient sample, male individuals with low MAO and AER augmenting, a pattern previously associated with bipolar affective disorders, showed a significantly increased incidence of suicide attempts in comparison with either non-augmenting low MAO or high MAO patients. Within the normal volunteer group, all male low MAO probands with a family history of suicide or suicide attempts were AER augmenters themselves. Four completed suicides were found among relatives of low MAO probands where as no high MAO proband had a relative who committed suicide. These findings suggest that the combination of low platelet MAO activity and AER augmenting may be associated with a possible genetic vulnerability to psychiatric disorders.

Differential distribution of type A and B monoamine oxidase in neuronal tissues

Various neuronal tissues of the albino rabbit were assayed for type A and type B monoamine oxidase, using norepinephrine and 2-phenylethylamine as substrates, respectively. There was an apparent positive correlation between the sympathetic character of peripheral nerves and the presence of type A monoamine oxidase activity. Type A enzyme activity was 15 fold higher in the superior cervical ganglion than in the vagus nerve. Type B activity was more uniformly distributed.

Evidence for a single catalytic binding site on human brain type B monoamine oxidase

The tricyclic antidepressant drug, amitriptyline, inhibited the B form of human brain mitochondrial monoamine oxidase (MAO) under normal atmospheric conditions in a noncompetitive manner when phenylethylamine (PEA) was used as substrate and competitively when benzylamine (BzNH2) was employed as substrate. In addition, it was also found that PEA and BzNH2 inhibited each other's degradation noncompetitively. Similar results have previously been reported with human platelet MAO. These data suggest that the catalytic binding sites for PEA and BzNH2 on the B form of human brain MAO may be different. Attempts were made to further distinguish these catalytic binding sites on the brain oxidase using the irreversible MAO inhibitors, pargyline and clorgyline. Though these drugs have considerably different affinities for the B form of the oxidase, the degree to which either compound inhibited PEA or BzNH2 deamination was essentially identical. When incubations were performed at elevated oxygen concentrations PEA and BzNH2 became mutually competitive inhibitors of each other's metabolism. Also at the higher levels of oxygen, amitriptyline inhibition of PEA deamination approached a competitive fashion. These results suggest that PEA and BzNH2 share a common catalytic binding site on the B form of MAO and, in addition, bind to an inhibitory site on the reduced form of the oxidase. Accordingly, the data indicate that amitriptyline also binds to both the oxidized and reduced forms of this human brain oxidase.

Does phenylethylamine cause schizophrenia?

The model psychosis associated with amphetamine overdosage is known to bear a close resemblance to acute paranoid schizophrenia. Amphetamine is chemically similar to the endogenous sympathomimetic amine, phenylethylamine, which possess many of its pharmacological properties. It is suggested that some cases of schizophrenia may be associated with an abnormal phenylethylamine response, either from increased concentrations of the amine or from abnormal receptor sensitivity to it.