Commentary: The roles of folate and pteridine derivatives in neurotransmitter metabolism

Can nutrient supplements modify brain function?

Over the past 40 y, several lines of investigation have shown that the chemistry and function of both the developing and the mature brain are influenced by diet. Examples are the effect of folate deficiency on neural tube development during early gestation, the influence of essential fatty acid deficiency during gestation and postnatal life on the development of visual function in infants, and the effects of tryptophan or tyrosine intake (alone or as a constituent of dietary protein) on the production of the brain neurotransmitters derived from them (serotonin and the catecholamines, respectively). Sometimes the functional effects are clear and the underlying biochemical mechanisms are not (as with folate and essential fatty acids); in other cases (such as the amino acids tyrosine and tryptophan), the biochemical effects are well understood, whereas the effect on brain function is not. Despite the incomplete knowledge base on the effects of such nutrients, investigators, physicians, and regulatory bodies have promoted the use of these nutrients in the treatment of disease. Typically, these nutrients have been given in doses above those believed to be required for normal health; after they have been given in pure form, unanticipated adverse effects have occasionally occurred. If this pharmacologic practice is to continue, it is important from a public safety standpoint that each nutrient be examined for potential toxicities so that appropriate purity standards can be developed and the risks weighed against the benefits when considering their use.

Folic acid and psychopathology

1. The incidence of folic acid deficiency is high in patients with various psychiatric disorders including depression, dementia and schizophrenia. 2. In epileptics on anticonvulsants, folate deficiency often occurs because anticonvulsants inhibit folate absorption. In these patients folate deficiency is often associated with psychiatric symptoms. 3. In medical patients psychiatric symptoms occur more frequently, and in psychiatric patients symptoms are more severe, in those with folate deficiency than in those with normal levels. 4. Many open studies have demonstrated therapeutic effects of folate administration on psychiatric symptoms in folate deficient patients. 5. Several placebo-controlled studies have not demonstrated therapeutic effects, possibly because the doses they used (15-20 mg/day) are known to be toxic and to cause mental symptoms. 6. Two placebo-controlled studies have demonstrated beneficial effects of folic acid administration, one in patients with a syndrome of psychiatric and neuropsychological changes associated with folate deficiency and the other in patients on long-term lithium therapy. In the latter study the dose was only 0.2 mg/day. 7. Folic acid deficiency is known to lower brain S-adenosylmethionine and 5-hydroxytryptamine. S-Adenosylmethionine, which has antidepressant properties, raises brain 5-hydroxytryptamine. Thus, depression associated with folate deficiency is probably related to low brain 5HT. 8. S-Adenosylmethionine is involved in many methylation reactions, including methylation of membrane phospholipids, which influences membrane properties. This may explain the wide variety of symptoms associated with folate deficiency. 9. Because the costs and risks associated with low doses of folic acid (up to 0.5 mg/day) are small, folic acid should be given as an adjunct in the treatment of patients with unipolar or bipolar affective disorders and anorexia, epileptics on anticonvulsants, geriatric patients with mental symptoms and patients with gastrointestinal disorders who exhibit psychiatric symptoms. 10. Although the majority of the patients listed above will probably not be helped by folic acid therapy, a significant minority are likely to have folate-responsive symptoms.

Effect of folate deficiency on local cerebral glucose utilization in the rat

There is considerable debate on the role of folate in CNS function. Recent work indicates that folate deficiency may affect CNS serotonin metabolism, and clinical studies describe many consequences of such a deficiency. On the other hand some workers maintain that folate deficiency alone causes CNS abnormalities. We maintained rats, through dietary deprivation, at folate levels below 4 ng/ml for more than 6 weeks and showed that at that time both their liver and brain folate levels were significantly reduced. We then studied their local cerebral glucose utilization (LCGU) using the [14C]deoxyglucose technique. This method assesses cerebral function by measuring regional metabolic activity. We also determined LCGU in rats given the same diet but replenished with folate (folate control) and in others given free access to commercially available food (normal controls). Our results show that this degree of folate deficiency has no effect on cerebral function. This contrasts with the focal suppression of LCGU we previously reported in a model of vitamin B12 deficiency.

Melanin: the organizing molecule

The hypothesis is advanced that (neuro)melanin (in conjunction with other pigment molecules such as the isopentenoids) functions as the major organizational molecule in living systems. Melanin is depicted as an organizational "trigger" capable of using established properties such as photon-(electron)-phonon conversions, free radical-redox mechanisms, ion exchange mechanisms, and semiconductive switching capabilities to direct energy to strategic molecular systems and sensitive hierarchies of protein enzyme cascades. Melanin is held capable of regulating a wide range of molecular interactions and metabolic processes primarily through its effective control of diverse covalent modifications. To support the hypothesis, established and proposed properties of melanin are reviewed (including the possibility that (neuro)melanin is capable of self-synthesis). Two "melanocentric systems"--key molecular systems in which melanin plays a central if not controlling role--are examined: 1) the melanin-purine-pteridine (covalent modification) system and 2) the APUD (or diffuse neuroendocrine) system. Melanin's role in embryological organization and tissue repair/regeneration via sustained or direct current is considered in addition to its possible control of the major homeostatic regulatory systems--autonomic, neuroendocrine, and immunological.

Cerebrospinal fluid hydroxylase cofactor in schizophrenia

Cerebrospinal fluid levels of pterin cofactor were measured in off-medication schizophrenic patients and normal control subjects as one aspect of monoamine physiology in schizophrenia. Pterin cofactor is essential for the hydroxylation of several substances including tyrosine, the rate-limiting step in the synthesis of dopamine and norepinephrine. No significant differences were found. Platelet monoamine oxidase activity correlated significantly with pterin levels in male schizophrenic and in female control subjects.

The route and significance of endogenous synthesis of alkaloids in animals

There is now substantial evidence that several TIQs and beta-carbolines are present in vivo and increase during certain pathological conditions. It still remains to be determined, however, precisely what roles they play in endogenous functions and whether or not they are critical for the expression of these pathological conditions. Accumulating biochemical information continues to support the notion that these compounds can act as false transmitters. The exciting new findings, which will certainly receive a great deal more attention, concern the interaction of some of the beta-carbolines with the benzodiazepine receptor. Determining if a beta-carboline is an endogenous receptor ligand will attract further research interest on the theoretical and specifically clinically-directed levels. Biochemical, morphological, and behavioral data indicate that some of the condensation products can act as neurotoxins. Very few experiments have included an examination of long-term effects of exposure to one of these alkaloids, so the amount of information on this issue is limited. Chronic rather than acute administration of an alkaloid is more likely to mimic the pathological states in which these compounds are hypothesized to play a role. Biochemically, both the dopaminergic and serotonergic systems have been shown to be affected by chronic treatments with certain alkaloids. Progressive and long-term behavioral alterations also have been reported. Such changes may reflect an adaptation to an increase or decrease in activity of particular systems or a neurotoxic action.

Tobacco-alcohol amblyopia: a proposed biochemical basis for pathogenesis

Tobacco-alcohol or nutritional amblyopia is a rare disorder of decreased central vision associated with nutritional deficiencies and tobacco smoking. although folate deficiency is common in patients with tobacco-alcohol amblyopia, the role of folic acid in this disorder has been underplayed. The role of cyanide from tobacco smoke, folate and other dietary deficiencies will be reviewed. A new model of the pathogenesis of tobacco-alcohol amblyopia is proposed based on the presumptive alteration of methionine and S-adenosyl-L-methionine metabolism.