The role of amines in the etiology of schizophrenia

Kynurenine pathway abnormalities are state-specific but not diagnosis-specific in schizophrenia and bipolar disorder

Schizophrenia (SCZ) and bipolar disorder (BD) are associated with immunological dysfunctions that have been hypothesized to lead to clinical symptomatology in particular through kynurenine pathway abnormalities. The aim of this study was thus to investigate the impact of serum kynurenine metabolite levels on diagnosis, clinical state, symptom severity and clinical course in a large French transdiagnostic cohort of SCZ and BD patients. Four patient groups (total n = 507) were included in a cross-sectional observational study: 1) hospitalized acute bipolar patients (n = 205); 2) stable bipolar outpatients (n = 116); 3) hospitalized acute schizophrenia patients (n = 111) and 4) stable schizophrenia outpatients (n = 75), in addition to healthy controls (HC) (n = 185). The quantitative determination of serum kynurenine metabolites was performed using liquid chromatography-tandem mass spectrometry. Kynurenine levels were lower in all patients combined compared to HC while ANCOVA analyses did not reveal inter-diagnostic difference between SCZ and BD. Interestingly, hospitalized patients of both diagnostic groups combined displayed significantly lower kynurenine levels than stabilized outpatients. Psychotic symptoms were associated with lower quinaldic acid (F = 9.18, p=<.001), which is KAT-driven, whereas a longer duration of illness contributed to abnormalities in tryptophan (F = 5.41, p = .023), kynurenine (F = 16.93, p=<.001), xanthurenic acid (F = 9.34, p = .002), quinolinic acid (F = 9.18, p = .003) and picolinic acid (F = 4.15, p = .043), metabolized through the KMO-branch. These data confirm illness state rather than diagnosis to drive KP alterations in SCZ and BD. Lower levels of KP metabolites can thus be viewed as a transdiagnostic feature of SCZ and BD, independently associated with acute symptomatology and a longer duration of illness. Quinaldic acid has seldomly been investigated by previous studies and appears an important state marker in SCZ and BD. As serum samples are used in this study, it is not possible to extrapolate these findings to the brain.

Brain Versus Blood: A Systematic Review on the Concordance Between Peripheral and Central Kynurenine Pathway Measures in Psychiatric Disorders

Objective

Disturbances in the kynurenine pathway have been implicated in the pathophysiology of psychotic and mood disorders, as well as several other psychiatric illnesses. It remains uncertain however to what extent metabolite levels detectable in plasma or serum reflect brain kynurenine metabolism and other disease-specific pathophysiological changes. The primary objective of this systematic review was to investigate the concordance between peripheral and central (CSF or brain tissue) kynurenine metabolites. As secondary aims we describe their correlation with illness course, treatment response, and neuroanatomical abnormalities in psychiatric diseases.

Methods

We performed a systematic literature search until February 2021 in PubMed. We included 27 original research articles describing a correlation between peripheral and central kynurenine metabolite measures in preclinical studies and human samples from patients suffering from neuropsychiatric disorders and other conditions. We also included 32 articles reporting associations between peripheral KP markers and symptom severity, CNS pathology or treatment response in schizophrenia, bipolar disorder or major depressive disorder.

Results

For kynurenine and 3-hydroxykynurenine, moderate to strong concordance was found between peripheral and central concentrations not only in psychiatric disorders, but also in other (patho)physiological conditions. Despite discordant findings for other metabolites (mainly tryptophan and kynurenic acid), blood metabolite levels were associated with clinical symptoms and treatment response in psychiatric patients, as well as with observed neuroanatomical abnormalities and glial activity.

Conclusion

Only kynurenine and 3-hydroxykynurenine demonstrated a consistent and reliable concordance between peripheral and central measures. Evidence from psychiatric studies on kynurenine pathway concordance is scarce, and more research is needed to determine the validity of peripheral kynurenine metabolite assessment as proxy markers for CNS processes. Peripheral kynurenine and 3-hydroxykynurenine may nonetheless represent valuable predictive and prognostic biomarker candidates for psychiatric disorders.

Animal models of schizophrenia emphasizing construct validity

Achieving animal models of schizophrenia which are representative of clear aspects of the illness is critical to understanding pathophysiology and developing novel treatments for the complex syndrome. This chapter reviews the various approaches that have been used in the past to create animal models of schizophrenia, including pharmacological approaches, environmental risk conditions and schizophrenia risk genes. In addition, we present a new animal model which derives directly from human tissue and brain imaging data used to develop a human schizophrenia model. This chapter emphasizes the crucial need for construct validity and of modeling discrete elements of schizophrenia's illness presentation as the way to successful advances.

A critique of the dopamine hypothesis of schizophrenia and psychosis

The dopamine hypothesis of schizophrenia and psychosis originated from observations of the dopamine-blocking actions of early neuroleptic drugs. These results support the dopamine hypothesis, however, only on the assumption that the drugs act by reversing an underlying disease mechanism (or part of it). An alternative explanation is that the drugs work by inducing a state of neurological suppression that reduces the intensity of symptoms. Although stimulant drugs are known to induce episodes of psychosis, the mechanism for stimulant-induced psychosis has not been clarified, and stimulants are known to affect many neurotransmitters other than dopamine. Recent imaging studies suggest that there may be increased dopamine release in response to amphetamine administration compared to controls. Some studies indicate increased uptake of L-dopa in parts of the striatum, but some do not. The potential confounding effects of factors associated with dopamine release--such as movement, arousal, attention, stress, and smoking--have rarely been examined, and prior medication use may also have influenced results in some studies. Comparable research on other psychiatric conditions associated with increased arousal, stress, and physical activity is sparse. Research on dopamine concentrations in postmortem brain tissue, on homovanillic acid concentrations, and on dopamine receptors has been negative or inconclusive. Therefore, the idea that the symptoms of psychosis or schizophrenia are caused by the overactivity of dopamine is not supported by current evidence.

Association of catechol-O-methyltransferase variants with loudness dependence of auditory evoked potentials

OBJECTIVE

The loudness dependence of auditory evoked potentials (LDAEP) provides a measure of the central serotonergic activity. As dopamine transporter availabilities also correlate with LDAEP, a dopaminergic influence is probable. The enzyme catechol-O-methyltransferase (COMT) is involved in the inactivation of synaptic dopamine. The aim of this study was to investigate the relationship between genetic variants of the COMT gene influencing synaptic dopamine levels and the LDAEP.

METHODS

Rs737865 in intron 1, rs4680 coding for a Val158Met substitution and rs165599 in the 3' region were investigated in 95 carefully selected healthy subjects of German descent (41 males, 54 females). The LDAEP was calculated as a linear regression slope with stimulus intensity as independent and N1/P2-amplitude as dependent variables.

RESULTS

Single marker analysis showed weak associations for two single nucleotide polymorphisms (SNPs) (rs737865: CC vs. T allele carrier; rs4680: G-allele carrier vs. AA homozygotes). A-G (rs4680-rs165599) was associated with lower LDAEP scores. Accordingly, haplotype analysis with all SNPs (rs737865-rs4680-rs165599) showed that the T-A-G haplotype was associated with lower scores.

CONCLUSIONS

These findings support the hypothesis that the LDAEP is also influenced by dopaminergic transmission. However, replications of these very preliminary but potentially important findings in independent samples are needed.

Trace amine-associated receptor 1-Family archetype or iconoclast?

Interest has recently been rekindled in receptors that are activated by low molecular weight, noncatecholic, biogenic amines that are typically found as trace constituents of various vertebrate and invertebrate tissues and fluids. The timing of this resurgent focus on receptors activated by the "trace amines" (TA) beta-phenylethylamine (PEA), tyramine (TYR), octopamine (OCT), synephrine (SYN), and tryptamine (TRYP) is the direct result of 2 publications that appeared in 2001 describing the cloning of a novel G protein-coupled receptor (GPCR) referred to by their discoverers Borowsky et al. as TA1 and Bunzow et al. as TA receptor 1 (TAR1). When heterologously expressed in Xenopus laevis oocytes and various eukaryotic cell lines, recombinant rodent and human TAR dose-dependently couple to the stimulation of adenosine 3',5'-monophosphate (cAMP) production. Structure-activity profiling based on this functional response has revealed that in addition to the TA, other biologically active compounds containing a 2-carbon aliphatic side chain linking an amino group to at least 1 benzene ring are potent and efficacious TA receptor agonists with amphetamine (AMPH), methamphetamine, 3-iodothyronamine, thyronamine, and dopamine (DA) among the most notable. Almost 100 years after the search for TAR began, numerous TA1/TAR1-related sequences, now called TA-associated receptors (TAAR), have been identified in the genome of every species of vertebrate examined to date. Consequently, even though heterologously expressed TAAR1 fits the pharmacological criteria established for a bona fide TAR, a major challenge for those working in the field is to discern the in vivo pharmacology and physiology of each purported member of this extended family of GPCR. Only then will it be possible to establish whether TAAR1 is the family archetype or an iconoclast.

Dynamics of tyrosine hydroxylase mediated regulation of dopamine synthesis

Tyrosine hydroxylase's catalysis of tyrosine to dihydroxyphenylalanine (DOPA) is the highly regulated, rate-limiting step catalyzing the synthesis of the catecholamine neurotransmitter dopamine. Phosphorylation, cofactor-mediated regulation, and the cell's redox status, have been shown to regulate the enzyme's activity. This paper incorporates these regulatory mechanisms into an integrated dynamic model that is capable of demonstrating relative rates of dopamine synthesis under various physiological conditions. Most of the kinetic equations and substrate parameters used in the model correspond with published experimental data, while a few which were not available in literature have been optimized based on explicit assumptions. This kinetic pathway model permits a comparison of the relative regulatory contributions made by variations in substrate, phosphorylation, and redox status on enzymatic activity and permits predictions of potential disease states. For example, the model correctly predicts the recent observation that individuals with haemochromatosis and having excessive iron accumulation are at increased risk for acquiring Parkinsonism, a defect in neuronal dopamine synthesis (Bartzokis et al., 2004; Costello et al., 2004). Alpha synuclein mediated regulation of tyrosine hydroxylase has also been incorporated in the model, allowing an insight into the overexpression and aggregation of alpha synuclein in Parkinson's disease.

The Dopamine System and the Pathophysiology of Schizophrenia: A Basic Science Perspective

The dopamine system has been a subject of intense investigation due to its role in a number of normal functions and its disruption in pathological conditions. Thus, the dopamine system has been shown to play a major role in cognitive, affective, and motor functions, and its disruption has been proposed to underlie the pathophysiology of several major psychiatric and neurological disorders, including schizophrenia, Parkinson's disease, drug abuse, and attention deficit/hyperactivity disorder. Although these studies have continued to define the basic functional principles of the dopamine system in the mammalian brain, we are still at the initial stages in unraveling the complex role of this transmitter system in regulating behavioral processes. Accumulating evidence suggests that dopamine modulates excitatory and inhibitory neurotransmission, and moreover affects synaptic plasticity induced within the circuits of its target brain regions. It is this role in synaptic plasticity that has associated the dopamine system with aspects of cognitive function involving learning and memory. In this chapter, we summarize recent findings relevant to the role of the dopamine system in psychiatric disorders at cellular, anatomical, and functional levels. In particular, we will focus on the regulation of dopamine neuron activity states and how this impacts dopamine release in cortical and subcortical systems, and the physiological and behavioral impact of dopamine receptor stimulation in the postsynaptic targets of these neurons. A brief summary of recent findings regarding the development and maturation of DA system and how this relates to the pathophysiology of psychiatric disorders are given, and finally models of dopamine system disruption in schizophrenia and how therapeutic approaches impact on dopamine system dynamics is presented.

Cerebral decarboxylation of meta- and para-tyrosine

The decarboxylase inhibitor DL-alpha-monofluoromethyldopa reduces, in a dose dependent manner, the concentration of striatal p-tyramine in the mouse. Homovanillic acid is also significantly reduced. Conversely, this treatment increases the m-tyramine concentration. Administration of m-tyrosine produces large increases in m-tyramine and a slight decrease in p-tyramine; these changes are potentiated in the presence of the decarboxylase inhibitor. Such data along with other recently published results permit the conclusion that m-tyramine arises from phenylalanine via m-tyrosine and that p-tyramine arises by decarboxylation of p-tyrosine. Both these reactions are closely related to the activity of tyrosine hydroxylase and the availability of appropriate substrates.

Plasma levels of phenylacetic acid, m- and p-hydroxyphenylacetic acid, and platelet monoamine oxidase activity in schizophrenic and other patients

Blood from chronic schizophrenic patients in two hospitals (A and B) and from institutional and noninstitutional controls was analyzed for platelet monoamine oxidase (MAO) activity toward three different substrates (tryptamine, phenylethylamine, and p-tyramine) and for plasma levels of conjugated and unconjugated phenylacetic acid (PAA) and m- and p-hydroxyphenylacetic acids (mHPA and pHPA). Compared to the controls, schizophrenic patients were found to have significantly reduced MAO activity. Although significant differences were found between unconjugated PAA (reduced) in Hospital B, conjugated pHPA (increased) in Hospital A, and conjugated PAA (increased) in Hospitals A and B and noninstitutional controls, the most consistent significant finding was a reduced unconjugated mHPA in both groups of schizophrenic patients compared with both control groups.

Trace amines and mental disorders

In this brief review it will be possible to mention only superficially the bioclinical, behavioral, neurochemical, neuropharmacological and neurophysiological evidence to support the view that some of the trace amines [meta- and paratyramine (m-TA, p-TA), beta-phenylethylamine (PE) and tryptamine (T)] may play a significant role in the propagation of nervous impulses and perhaps be involved in the etiology of certain mental disorders. More detailed comments will be found in some recent papers and reviews (Axelrod et al., 1976; Boulton, 1974, 1976, 1978, 1979; Boulton and Baker, 1975; Boulton and Juorio, 1979, Faurbye, 1968; Mosnaim and Wolfe, 1978, Sandler and Reynolds, 1976; Wyatt et al., 1977).

Tail pinch-induced eating, gnawing and licking behavior in rats: dependence on the nigrostriatal dopamine system

Mild-tail-pinch induces a syndrome of eating, gnawing and licking behavior in rats in the presence of food. Detailed behavioral, pharmacological and biochemical analyses of this phenomenon resulted in the following conclusions. (1) This is an unusually reliable phenomenon, demonstrable in each of more than 200 animals tested. (2) Eating is by far the predominant response to tail-pinch. (3) Tail-pinch behavior is critically dependent on the nigrostriatal dopamine system. (4) There are striking pharmacological parallels between tail-pinch behavior and schizophrenia.