Methyltetrahydrofolate is a potent and selective agonist for kainic acid receptors

Does L-Methylfolate Supplement Methylphenidate Pharmacotherapy in Attention-Deficit/Hyperactivity Disorder?: Evidence of Lack of Benefit From a Double-Blind, Placebo-Controlled, Randomized Clinical Trial

PURPOSE/BACKGROUND

Interventions for attention-deficit/hyperactivity disorder (ADHD) may be inadequate for some patients. There is evidence that supplementation with L-methylfolate augments antidepressant agent effects and thus might also augment ADHD treatment effects by a common catecholaminergic mechanism.

METHODS

Forty-four adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of ADHD participated in a randomized, double-blind, placebo-controlled, 12-week trial of 15 mg of L-methylfolate in combination with osmotic-release oral system methylphenidate. Osmotic-release oral system methylphenidate was dose optimized over the first 6 weeks. We evaluated the effects on ADHD symptoms, self-report on the Behavior Rating Inventory of Executive Function of executive function, methylphenidate dosing, neuropsychological test measures, the Adult ADHD Self-report scale, emotional dysregulation, social adjustment, and work productivity, as well as moderating effects of body mass index, autoantibodies to folate receptors, and select genetic polymorphisms.

RESULTS

L-Methylfolate was well tolerated, with no significant effect over placebo except improvement from abnormal measures on the mean adaptive dimension of the ASR scale (χ = 4.36, P = 0.04). Methylphenidate dosing was significantly higher in individuals on L-methylfolate over time (χ = 7.35, P = 0.007). Exploratory analyses suggested that variation in a guanosine triphosphate cyclohydrolase gene predicted association with higher doses of methylphenidate (P < 0.001).

CONCLUSIONS

L-Methylfolate was associated with no change in efficacy on measures relevant to neuropsychiatric function in adults with ADHD, other than suggestion of reduced efficacy of methylphenidate. Further investigation would be required to confirm this effect and its mechanism and the genotype prediction of effects on dosing.

[A case of vitamin B12 deficiency with involuntary movements and bilateral basal ganglia lesions]

An 86-year-old woman with a one-year history of dementia was admitted to our hospital complaining of loss of appetite, hallucinations, and disturbance of consciousness. She gradually presented with chorea-like involuntary movements of the extremities. Diffusion-weighted magnetic resonance imaging (MRI) showed bilateral symmetrical hyperintense signals in the basal ganglia. The serum vitamin B12 level was below the lower detection limit of 50 pg/ml. The homocysteine level was markedly elevated at 115.8 nmol/ml. Anti-intrinsic factor and anti-parietal cell antibody tests were positive. Gastrointestinal endoscopy revealed atrophic gastritis. The patient was diagnosed with encephalopathy due to vitamin B12 deficiency caused by pernicious anemia. Involuntary movements and MRI abnormalities improved with parenteral vitamin B12 supplementation. Bilateral basal ganglia lesions are rare manifestations of adult vitamin B12 deficiency. The present case is considered valuable in identifying the pathophysiology of involuntary movement due to vitamin B12 deficiency.

Novel therapeutics for depression: L-methylfolate as a trimonoamine modulator and antidepressant-augmenting agent

Folate deficiency may increase the risk of depression and reduce the action of antidepressants. Individuals with an inherited polymorphism that reduces the efficiency of folate formation may be at high risk for folate deficiency and for major depression. Antidepressant effects have been reported when antidepressants are augmented with folic acid, folinic acid, or the centrally active L-methylfolate (known formally as (6(S)-5-methyltetrahydrofolate [MTHF]), particularly in depressed patients with folate deficiency whose major depressive episodes have failed to respond to antidepressants. The putative mechanism of action of MTHF as an augmenting agent to antidepressants is that it acts as a trimonoamine modulator (TMM), enhancing the synthesis of the three monoamines: dopamine (DA), norepinephrine (NE), and serotonin (5-HT), resulting in a boost to the efficacy of antidepressants.

Preliminary evidence for involvement of the folate gene polymorphism 19bp deletion-DHFR in occurrence of autism

Folate has long been implicated in both the metabolism of neurotransmitter molecules, and as an agonist with a direct effect upon neuronal tissue. Folates mediate transfer of one-carbon units into major biosynthetic pathways. From a developmental perspective, the most important reactions are de novo methionine and thymine synthesis, critical for DNA expression and elaboration, respectively. Dihydrofolate reductase (DHFR) is the sole enzyme responsible for maintaining the reduced state of the vitamin needed for these two pathways. Here, we report that the 19bp-deletion polymorphism of DHFR acts independently (OR 2.69, 95% CI; 1.00-7.28, p<0.05) and in concert with related folate polymorphisms as a significant risk factor for autism. Possible consequences of this are discussed in the context of the interaction between folate and the glutamatergic nervous system, an area of promising candidate genes for contributing to autism.

Serum folate and homocysteine levels in patients with obsessive-compulsive disorder

Previous studies have shown that folate deficiency, increased homocysteine, impaired metylation have been identified in depressive disorder. Recently, growing research has resulted in the biological association between obsessive-compulsive disorder (OCD) and affective disorders. Therefore, in the present study it was evaluated whether or not folate and homocysteine levels changed. Serum folate and homocysteine concentrations were measured in 23 patients with OCD and in same number of controls. In addition, all patients were assessed by Yale-Brown Obsession Compulsion Scale (Y-BOCS). Serum folate values were significantly lower in OCD patients than in controls, while homocysteine concentrations were higher in patients compared with controls. Serum folate values were significantly and negatively related to Y-BOCS scores. Total serum homocysteine concentrations were positively correlated to Y-BOCS scores and the duration of illness. There was a trend toward a negative correlation between the concentrations of serum folate and homocysteine. In conclusion, we identified that a group of patients with OCD might have folate deficiency, higher homocysteine levels and probable impaired metylation and monoamine metabolism.

Localization of the murine reduced folate carrier as assessed by immunohistochemical analysis

The reduced folate carrier (RFC1) is a major route for the transport of folates in mammalian cells. The localization of RFC1 in murine tissues was evaluated by immunohistochemical analysis using a polyclonal antibody to the C-terminus of the carrier. There was expression of RFC1 in the brush-border membrane of the jejunum, ileum, duodenum and colon. RFC1 was localized to the basolateral membrane of the renal tubular epithelium. Carrier was detected on the plasma membrane of hepatocytes but not in bile duct epithelial cells. In the choroid plexus RFC1 was highly expressed at the apical surface. It was also expressed in axons and dendrites and on the apical membrane of cells lining the spinal canal. In spleen, RFC1 was detected only in the cells of the red pulp. These data provide insights into the role that RFC1 plays in folate delivery in a variety of tissues. In particular, the localization of carrier may elucidate the role of RFC1 in the vectorial transport of folates across epithelia. The data also indicate that in kidney tubules and choroid plexus the sites of RFC1 expression are different from what has been reported previously for the folate receptor; and while RFC1 is expressed in small intestine, folate receptor is not.

Homocysteine, folate, methylation, and monoamine metabolism in depression

OBJECTIVES

Previous studies suggest that folate deficiency may occur in up to one third of patients with severe depression, and that treatment with the vitamin may enhance recovery of the mental state. There are, however, difficulties in interpreting serum and red cell folate assays in some patients, and it has been suggested that total plasma homocysteine is a more sensitive measure of functional folate (and vitamin B12) deficiency. Other studies suggest a link between folate deficiency and impaired metabolism of serotonin, dopamine, and noradrenaline (norepinephrine), which have been implicated in mood disorders. A study of homocysteine, folate, and monoamine metabolism has, therefore, been undertaken in patients with severe depression.

METHODS

In 46 inpatients with severe DSM III depression, blood counts, serum and red cell folate, serum vitamin B12, total plasma homocysteine, and, in 28 patients, CSF folate, S-adenosylmethionine, and the monoamine neurotransmitter metabolites 5HIAA, HVA, and MHPG were examined. Two control groups comprised 18 healthy volunteers and 20 patients with neurological disorders, the second group undergoing CSF examination for diagnostic purposes.

RESULTS

Twenty four depressed patients (52%) had raised total plasma homocysteine. Depressed patients with raised total plasma homocysteine had significant lowering of serum, red cell, and CSF folate, CSF S-adenosylmethionine and all three CSF monoamine metabolites. Total plasma homocysteine was significantly negatively correlated with red cell folate in depressed patients, but not controls.

CONCLUSIONS

Utilising total plasma homocysteine as a sensitive measure of functional folate deficiency, a biological subgroup of depression with folate deficiency, impaired methylation, and monoamine neurotransmitter metabolism has been identified. Detection of this subgroup, which will not be achieved by routine blood counts, is important in view of the potential benefit of vitamin replacement.

Toxicity induced by a polyglutamated folate analog is attenuated by NAALADase inhibition

Folates have been shown to be neurotoxic and convulsive. Endogenously, folates exist in the brain in a polyglutamated form with 1-7 terminal glutamates (approx. 1 microM). The brain enzyme N-acetylated alpha-linked acidic dipeptidase (NAALADase) has been shown to remove sequentially the gamma-linked glutamates from folic acid polyglutamates. We report that, at high concentrations (300 microM-30 mM), a folic acid hexaglutamate analog is dose-dependently toxic to dissociated rat cortical cultures and that this toxicity is reversed by 2-PMPA, a potent and selective NAALADase inhibitor. These data suggest a new mechanism for folic acid toxicity.

Folate, vitamin B12, and neuropsychiatric disorders

Folate and vitamin B12 are required both in the methylation of homocysteine to methionine and in the synthesis of S-adenosylmethionine. S-adenosylmethionine is involved in numerous methylation reactions involving proteins, phospholipids, DNA, and neurotransmitter metabolism. Both folate and vitamin B12 deficiency may cause similar neurologic and psychiatric disturbances including depression, dementia, and a demyelinating myelopathy. A current theory proposes that a defect in methylation processes is central to the biochemical basis of the neuropsychiatry of these vitamin deficiencies. Folate deficiency may specifically affect central monoamine metabolism and aggravate depressive disorders. In addition, the neurotoxic effects of homocysteine may also play a role in the neurologic and psychiatric disturbances that are associated with folate and vitamin B12 deficiency.

Methylfolate modulates potassium evoked neuro-secretion: evidence for a role at the pteridine cofactor level of tyrosine 3-hydroxylase

We have previously shown that 5-methyltetrahydrofolate influences neuro-secretion. The present study more precisely characterises the processes involved and considers one probable site of action. Focusing on the tyrosine-noradrenalin axis in cerebellum we showed 5-methyltetrahydrofolate causes a significant reduction in the apparent K+ evoked secretion of noradrenalin to only 12.9% of control release. Evidence supports the idea that this could actually be due to increased synthesis leading to; depletion of reserves, possibly through leakage, exocytotic inhibition via activation of presynaptic receptors or end product inhibition by noradrenalin at the pteridine cofactor level of tyrosine hydroxylase: a) concomitant decreased measurement of perfusate and intracellular tyrosine with released noradrenalin following 5-methyltetrahydrofolate treatment supports the idea of increased transmitter turn over; b) kinetic studies indicate that at saturating concentrations of tyrosine and in the presence of an inhibitor of L-DOPA decarboxylase, 5-methyltetrahydrofolate partially duplicates the rate limiting behaviour of a synthetic pteridine cofactor--DL,2-amino-4-hydroxy-6,7,dimethyltetrahydropteridine. We debate whether, in vivo, CSF 5-methyltetrahydrofolate might interact at the tetrahydrobiopterin cofactor level of tyrosine hydroxylase and other aromatic amino-acid hydroxylases.

Adenosine triphosphate deficiency: a genre of optic neuropathy

PURPOSE

To offer clinical evidence that deficiency of vitamin B12 may adversely affect the neuronal function of patients who also have the 14,484 mitochondrial DNA mutation associated with Leber's hereditary optic neuropathy (LHON).

METHODS

A case of a 27-year-old man with vitamin B12 deficiency and the 14,484 mitochondrial DNA mutation is presented and the literature on causes of some metabolic optic neuropathies reviewed.

RESULTS

Visual loss and neurologic symptoms of vitamin B12 deficiency occurred together, at a time when the level of vitamin B12 was subnormal. Vision and other sensory functions began to improve within 2 months of vitamin therapy, and normal vision eventually was restored.

CONCLUSIONS

The relatively prompt improvement and the eventual complete recovery of vision following vitamin replacement therapy suggest that the subnormal level of vitamin B12 precipitated visual loss. Given the clinical similarities of subnormal vitamin B12, LHON, and nutritional/tobacco amblyopia, deficiency of adenosine triphosphate might be a unifying etiology for several types of optic neuropathy. This energy hypothesis provides a theoretical basis for the enigmatic phenomena of centrocecal scotomata and recovery of visual function after prolonged blindness.

The chemical nature of the main central excitatory transmitter: a critical appraisal based upon release studies and synaptic vesicle localization

The chemical nature of the central transmitter responsible for fast excitatory events and other related phenomena is analysed against the historical background that has progressively clarified the structure and function of central synapses. One of the problems posed by research in this field has been whether one or more of the numerous excitatory substances endogenous to the brain is responsible for fast excitatory synaptic transmission, or if such a substance is, or was, a previously unknown one. The second question is related to the presence in the CNS of three main receptor types related to fast excitatory transmission, the so-called alpha-amino-3-hydroxy-5-methylisoxazole propionic acid, kainate and N-methyl-D-aspartate receptors. This implies the possibility that each receptor type might have its own endogenous agonist, as has sometimes been suggested. To answer such questions, an analysis was done of how different endogenous substances, including L-glutamate, L-aspartate, L-cysteate, L-homocysteate, L-cysteine sulfinate, L-homocysteine sulfinate, N-acetyl-L-aspartyl glutamate, quinolinate, L-sulfoserine, S-sulfo-L-cysteine, as well as possible unknown compounds, were able to fulfil the more important criteria for transmitter identification, namely identity of action, induced release, and presence in synaptic vesicles. The conclusion of this analysis is that glutamate is clearly the main central excitatory transmitter, because it acts on all three of the excitatory receptors, it is released by exocytosis and, above all, it is present in synaptic vesicles in a very high concentration, comparable to the estimated number of acetylcholine molecules in a quantum, i.e. 6000 molecules. Regarding a possible transmitter role for aspartate, for which a large body of evidence has been presented, it seems, when this evidence is carefully scrutinized, that it is either inconclusive, or else negative. This suggests that aspartate is not a classical central excitatory transmitter. From this analysis, it is suggested that the terms alpha-amino-3-hydroxy-5-methylisoxazole propionic acid, kainate and N-methyl-D-aspartate receptors, should be changed to that of glutamate receptors, and, more specifically, to GLUA, GLUK and GLUN receptors, respectively. When subtypes are described, a Roman numeral may be added, as in GLUNI, GLUNII, and so on.

Modulation of potassium evoked secretory function in rat cerebellar slices measured by real time monitoring: evidence of a possible role for methylfolate in cerebral tissue

The real time dynamics of K+ evoked neurosecretion in cerebellar slices has been monitored electrochemically. In the presence of 5-methyltetrahydrofolate a statistically significant diminution in secretory response occurs. Agonists to probe the pharmacological basis for this indicate it is not due to voltage sensitive Ca2+ channel blockade, nor does it show any similarity of effect with kainate, whose receptor is a putative binding site for 5-methyltetrahydrofolate. The method is fully validated, although no account is taken of individual molecular species. High performance liquid chromatography combined with off line microbiological assay could only detect 5-methyltetrahydrofolate in cerebrospinal fluid. We therefore discuss our findings in relation to possible cerebral roles for cerebrospinal fluid 5-methyltetrahydrofolate in the context of both membrane and transmitter related interactions.

Developmental patterns in the rat cerebellum after cis-dichlorodiammineplatinum treatment

A cytochemical study was made of some metabolic enzymes in the cerebellar neurons during postnatal ontogenesis after injection of cis-dichlorodiammineplatinum into 10-day-old rats. The profiles during development of neuron-specific enolase immunoreactivity (involved in the glycolytic pathway), dihydrofolate reductase activity (involved in the metabolism of nucleic acids and folate) and dipeptidylaminopeptidase II activity were determined in lobules V-VII of cerebellar vermis. At different developmental stages, treated rats had folia in which the morphology and cytochemical responses of Purkinje neurons were greatly affected. On postinjection day 1 (PD 11), only neuron-specific enolase immunoreactivity was changed, reactions being more intense at the basal pole, which was abnormally enlarged in several neurons. Seven days after treatment (PD 17), the dihydrofolate reductase reaction showed weakly positive cells with small grains of formazan in the perinuclear regions and dipeptidylaminopeptidase II activity, which had appeared at this time in some cells of the controls, was not observed. On PD 25 and PD 35, Purkinje cells, probably undergoing clear degeneration, were negative or very weakly positive in all the reactions. Some tracts of folia had no Purkinje cells. These results suggest that cis-dichlorodiammineplatinum affects the differentiation of Purkinje neurons and interferes first with the glycolytic enzyme and then with some enzymes of the synthetic and catabolic machinery, leading to cellular dysfunction and degeneration.

Dihydrofolate reductase activity in the Purkinje neuron populations of some non-mammalian vertebrates

The intensity and distribution of histochemically demonstrable dihydrofolate reductase (FH2-R EC 1.5.1.3.) in unfixed cryostat sections was studied in Purkinje neurons of adult vertebrates that have either simple neural circuits and cytoarchitectonics (Ictalurus nebulosus, Rana esculenta) or complex neural circuits and cytoarchitectonics (Coturnix coturnix japonica), compared with the rat as a control. The reaction was generally undetectable in Ictalurus nebulosus and in Rana esculenta; with positive reactions in only a few neurons. On the contrary, FH2-R in the Purkinje cell population of Coturnix coturnix japonica had several pattern (heterogeneity) as in the rat. These results suggest that the existence of FH2-R in Purkinje cell population may be correlated with the complexity of the neural circuits of the vertebrate's cerebellum and that the "heterogeneity" of the reaction may be related to the different functional states of the Purkinje cells within the cerebellum.

Neurotoxic action of kainic acid in the isolated toad and goldfish retina: II. Mechanism of action

The specificity and mechanism of the neurotoxic action of kainic acid (KA) was investigated by histological methods in the isolated retina of toads and goldfish. Particular attention was paid to the earliest and most sensitive response to KA in the outer plexiform layer (OPL). Of 21 compounds tested as potential mimics of KA neurotoxicity in the OPL, only the enantiomers of glutamate and aspartate mimicked KA, inducing a low-level neurotoxic effect at concentrations 5,000-10,000-fold higher than concentrations of KA giving comparable effects. Further, of 22 compounds tested as potential blockers of KA neurotoxicity in the OPL, only D-gamma-glutamylglycine, D,L-alpha-amino pimelic acid, sodium pentobarbital, D,L-alpha-amino adipic acid, L-glutamate, and L-aspartate blocked KA neurotoxicity (IC50 values of 0.1, 0.3, 0.3, 2, 5, and 15 mM, respectively). In ionic substitution experiments, KA-induced vacuolization was found to require sodium and chloride ions but not calcium ions in the extracellular medium. These findings support the hypothesis that KA combines with specific receptors in the membrane of susceptible neurons in the retinal OPL, leading to prolonged opening of membrane channels permeable to sodium and potassium ions. An accompanying equilibrating chloride influx may result in intracellular ion excess, leading to osmotic swelling and vacuolization. The membrane receptors involved in mediating the action of KA in the OPL are likely to be a class of postsynaptic or extrasynaptic glutamate receptor.

Effects of kainic acid and other excitotoxins in the rat superior colliculus: relations to glutamatergic afferents

In this study we have performed surgical, chemical and combined surgical/chemical lesions in order to elucidate neurotransmitter mechanisms in the superior colliculus (SC) of albino rats. Visual cortex (VC) ablation reduced high affinity (HA) uptake of D-Asp by 32% in the deafferented SC. Local injection of kainic acid (KA) into SC reduced HA D-Asp uptake selectively in the lower dose range (less than 1 nmol) by 50-60%. The GABAergic marker glutamate decarboxylase (GAD) was decreased by maximally 60% only at doses exceeding 2 nmol. Choline acetyltransferase (ChAT), however, was not affected at any of the doses administered. VC ablation provided an almost complete protection against 1 nmol KA. When KA was injected 2 days prior to VC ablation an additive effect on HA D-Asp uptake of the two lesions was observed. From these observations we infer that the notion of a glutamatergic projection from VC to SC has been strengthened. Moreover, local neurons in intermediate layers account for about 60% of the HA D-Asp uptake in SC, and these are most likely impinged upon by the glutamatergic afferents. The neurotoxic effects of KA were compared with those of some suspected endogenous excitotoxins, i.e. N-methyl tetrahydrofolic acid (Me-THF), other folates and the tryptophan metabolite quinolinic acid (QA). N-methyl tetrahydrofolic acid, Me-THF (4 and 10 nmol) reduced HA D-Asp uptake by about 50%, only when coinjected with ascorbic acid. GAD and ChAT were not affected at either of the doses. QA was about 100-fold less potent than KA on a molar basis, and the maximal reduction of GAD was similar in QA and KA injected animals, whereas the maximal reduction of HA D-Asp was only 40% after QA injection in SC. We conclude that Me-THF, QA and KA exert their neurotoxic actions by different mechanisms as judged by the behavioral, histopathological and biochemical sequelae seen after local injections of the respective substances in intermediate layers of SC and corroborate data obtained from other brain areas.

Folate induced-hypermotility response after bilateral injection into the nucleus accumbens of the rat. Possible mediation through dopaminergic mechanisms

Folic acid (FA) and certain of its reduced congeners produce excitatory effects when applied to neuronal tissue. Recent evidence has suggested that folates have other biological properties in common with the excitatory amino acids. The purpose of this study was to determine the activity of folate compounds in a system sensitive to excitatory amino acids. Bilateral injection of folic acid into the nucleus accumbens resulted in a marked increase in locomotor activity at doses of 2.5 and 5 micrograms. Larger doses resulted in behavioral responses, such as body tremor and labored breathing, which interfered with the locomotor response. Similarly, 5-formyltetrahydrofolic acid (FTHF) produced a marked hypermotility response after bilateral injection into the nucleus accumbens (2.5-25 micrograms), while dihydrofolic acid, tetrahydrofolic acid, and 5-methyltetrahydrofolic acid were ineffective. Pretreatment with reserpine (10 mg/kg, i.p.) markedly reduced the hypermotility response elicited by folic acid and FTHF as did pretreatment with haloperidol in both peripheral (0.8 mg/kg) and direct (5 micrograms) injection into the nucleus accumbens. In addition, injection of muscimol (30 ng), which depresses hypermotility induced by dopamine and amphetamine, produced a significant decrease in the hypermotility response produced by folic acid. In contrast, pretreatment with phentolamine (5 mg/kg, i.p.) or propranolol (4 mg/kg, i.p.) did not decrease folic acid or FTHF-induced responses. These results suggest that folic acid and FTHF produce an increase in locomotor activity by facilitating dopaminergic neurotransmission in the nucleus accumbens, possibly by inducing the release of dopamine from the nerve terminals. Thus, these folates have effects similar to those of the excitatory amino acids when injected into the nucleus accumbens.

[3H] kainic acid binding sites in the synaptosomal-mitochondrial (P2) fraction from goldfish brain

Binding of [3H]kainic acid to the synaptosomal-mitochondrial fraction (P2) of the goldfish brain was studied. Specific binding to this fraction represents about half of the total binding capability of the homogenate particulate material and is enriched in synaptic membranes; it is greater by about two orders of magnitude than those given for rat brain and pigeon optic tectum membranes. Association of the ligand-site complex has a time constant lower than 1 min and the same is true for the main component of the dissociation process. The binding equilibrium is apparently not affected by substances contained in the fraction material. The analysis of the dose-response data showed a main receptor population (B max = 139 pmol/mg protein) which displayed positive cooperativity (nH = 1.29). The same behaviour was shown by washed membranes from the same fraction but, in this case, the affinity for the ligand was lower (apparent affinity constants: K'D = 0.28 nM for the intact fraction and K'D = 0.38 nM for membranes). A smaller population of sites with higher affinity was also detected both in the intact fraction and in membranes. Among the substances tested as displacers of kainic acid from the synaptosomal sites, the most effective were quisqualate and L-glutamate. Folic acid and its dihydro and tetrahydro derivatives were half as potent as glutamate whereas methyltetrahydrofolic acid and folinic acid had a very weak action. The difference between these sites and those detected on rat brain membrane preparations is discussed.

Folic acid has a disinhibitory action in the rat hippocampal slice preparation

The effects of folic acid on synaptic transmission in the hippocampal slice have been studied. Application of folic acid (0.1-1 mM) increased the size of population spikes recorded extracellularly in the CAl pyramidal cell layer and caused the appearance of multiple population spikes. Intracellular recording revealed that folic acid had no consistent effect on the membrane potential, but greatly reduced the rapid chloride-mediated phase of the inhibitory postsynaptic potential (IPSP) evoked by ortho- and antidromic stimulation. The slower, potassium-mediated phase of the IPSP was usually enhanced. Furthermore, folic acid abolished spontaneous IPSPs recorded with potassium chloride-filled microelectrodes. All of these effects were quickly reversible when the drug was washed from the chamber. Finally bath-applied folic acid reduced the hyperpolarization produced by iontophoretically applied GABA. Based on these results, we conclude that folic acid produces its excitatory effects on hippocampal pyramidal cells by a disinhibitory action which involves a postsynaptic blockade of GABA responses.

Congenital folate malabsorption

A Turkish girl presented with a history of fever, diarrhoea, convulsions, recurrent infections and failure to thrive from the age of 5 months. Megaloblastic anaemia was present and profound folate deficiency was evidenced in plasma and in CSF. Treatment with oral folic acid cured the anaemia, diarrhoea and infections but failed to prevent convulsions and the appearance of mental retardation and cerebral calcifications. Loading tests with folic acid and its derivatives led to the conclusion that the folate deficiency was caused by a defect in folate transport both across the gut and the blood-brain barrier. Low plasma concentrations of methionine prompted a therapeutic trial with methionine associated with vitamin B12 and folic acid that spectacularly improved the convulsions.

An evaluation of selected brain constituents as putative excitatory neurotransmitters

Searching for the endogenous ligands of the 4 classes of excitatory amino acid receptors detected in the mammalian CNS, we have measured, using a 22Na+ efflux receptor assay, the excitatory activity of 42 brain constituents or analogs and established the receptor specificity of those substances which possess excitatory properties. Among the substances tested were methyltetrahydrofolate and N-acetylaspartylglutamate, two putative ligands of the kainate and glutamate receptors. These compounds were found to have very little or no excitatory activity, respectively. The 8 brain constituents possessing excitatory properties displayed a receptor specificity similar to either that of N-methyl-D-aspartate (e.g. quinolinate) or glutamate (e.g. cysteine sulfinate) but not of kainate or quisqualate. These results are discussed in relation with the problem of the identification of brain excitatory neurotransmitters.

Electroencephalographic, behavioral, and histopathologic features of seizures induced by intra-amygdala application of folic acid in cats

The effects of intracerebral injection of folic acid are still controversial. We studied the electroencephalographic, behavioral, and histopathologic consequences of the seizures induced by intra-amygdala administration of various doses of FA in freely moving cats. The severity of the seizures was dose-dependant. For doses of 25 and 50 nmol, single low-amplitude spikes appeared in the amygdala 15 to 20 min after injection and a typical amygdala symptomatology was observed. From doses of 100 nmol recurrent limbic seizures occurred 40 to 80 min after injection. Finally, from doses of 150 nmol secondarily generalized seizures were induced, which could be followed by death 4 to 6 h after injection. The severity of the cerebral lesions was related to both the dose and the paroxysmal manifestations. In cases with short survival time (6 h) and few seizures the pathology was restricted to a lymphocytic and glial reaction with some ischemic cells at the injected site. In cases with status epilepticus, edema and neuronal degeneration was observed in the hippocampus, amygdala, thalamic nuclei of the midline, entorhinal cortex, and cerebellum. No neuronal alteration at the injected site was observed. For longer survival times (8 days) edema was less severe, but hyperchromatic cells were still numerous. These results, compared with those of intra-amygdala administration of kainic acid, suggest that pathologic lesions induced in cats by folic acid more closely resemble those described in man after some status epilepticus.

A multidisciplinary study of folic acid neurotoxicity: interactions with kainate binding sites and relevance to the aetiology of epilepsy

Folic acid has been injected unilaterally into the amygdaloid complex of awake chronically implanted rats, or in rats under anaesthesia. Clinical, electrographic, and metabolic changes (estimated by means of the 2-deoxyglucose method) have been studied in relation to subsequently demonstrated neuropathology using Fink-Heimer and Nissl stains. The observations are compared to the corresponding effects of intra-amygdaloid application of kainic acid. Major differences were noted between the folate and the kainate induced seizure/brain damage syndrome. Thus: folate produced essentially stereotypies, alternating with myoclonic unilateral jerks of head and limbs. In contrast, limbic motor seizures which are characteristically produced by kainic acid, were extremely rare. Folate did not produce the preferential and sequential electrographic activation of limbic structures as observed after kainate. 2-Deoxyglucose autoradiography revealed an enhanced metabolic activity in the injected amygdala and in the overlying piriform and entorhinal cortices. The most conspicuous rise in labelling, however, occurred in the entire fronto-parietal cortex (ipsilaterally) up to the cingulate region, as well as in the ventral thalamic complex and the globus pallidus, i.e. in structures which are not labelled after kainate treatment. Some extent of local damage was observed 1-8 days after the injection; distant from the injection site, we found massive anoxic-ischemic type of damage in the superficial layers of the fronto-parietal cortex, a complete necrosis of the piriform lobe, and neuronal cell loss in the ventral thalamus and several extrapyramidal structures. The full range of limbic damage associated with kainate was never produced by folate. The CA3 region of the hippocampus, most susceptible to kainate, was only mildly affected by folate. These differences between kainate and folate prompted us to re-evaluate the recently reported high affinity of folates for kainic acid membrane binding sites. We found that folic acid competed only very weakly with [3H]kainic acid for binding sites on striatal, cortical, hippocampal, amygdaloid, and cerebellar membranes. It is thus concluded, that folate is not a good candidate for an endogenous kainate-like substance. We propose intracerebral injections of folic acid as a useful tool to study the vulnerability of brain structures to anoxic-ischemic conditions.

Acidic amino acid binding sites in mammalian neuronal membranes: their characteristics and relationship to synaptic receptors

This review summarizes studies designed to label and characterize mammalian synaptic receptors for glutamate, aspartate and related acidic amino acids using in vitro ligand binding techniques. The binding properties of the 3 major ligands employed--L-[3H]glutamate, L-[3H]aspartate and [3H]kainate--are described in terms of their kinetics, the influence of ions, pharmacology, molecular nature, localization and physiological/pharmacological function. In addition, the binding characteristics are described of some new radioligands--[3H]AMPA, L-[3H]cysteine sulphinate, L-[35S]cysteate, D-[3H]aspartate, D,L-[3H]APB, D-[3H]APV and D,L-[3H]APH. Special emphasis is placed on recent findings which allow a unification of the existing binding data, and detailed comparisons are made between binding site characteristics and the known properties of the physiological/pharmacological receptors for acidic amino acids. Through these considerations, a binding site classification is suggested which differentiates 5 different sites. Four of the binding site subtypes are proposed to correspond to the individual receptor classes identified in electrophysiological experiments; thus, A1 = NMDA receptors; A2 = quisqualate receptors; A3 = kainate receptors; A4 = L-APB receptors; the fifth site is proposed to be the recognition site for a Na+-dependent acidic amino acid membrane transport process. An evaluation of investigations designed to elucidate regulatory mechanisms at acidic amino acid binding sites is made; hypotheses such as the Ca2+-activated protease hypothesis of long-term potentiation are assessed in terms of the new binding site/receptor classification scheme, and experiments are suggested which will clarify and expand this exciting area in the future.

Responses of solitary retinal horizontal cells to L-glutamate and kainic acid are antagonized by D-aspartate

Solitary horizontal cells dissociated from goldfish retinas depolarized when exposed to micromolar doses of either L-glutamate or kainic acid. The responses to both of these agonists were antagonized by D-aspartate, and unaffected by L-aspartate, L-glutamic acid diethyl ester and folic acid. the results of the present study thus suggest that L-glutamate and kainic acid may produce depolarizations of horizontal cells by interacting with pharmacologically similar membrane receptors.

Effects of folic and kainic acids on synaptic responses of hippocampal neurones

The actions of the neurotoxic amino acids folate and kainate have been compared on ortho-and antidromic responses evoked in CA1, CA3 and the dentate gyrus of slices of rat hippocampus maintained in vitro. Both in CA1 and the dentate gyrus superfusion of these acids caused an increase in amplitude of the population spike discharging from an excitatory postsynaptic potential which either remained unaffected or was reduced. In the CA3 region kainate and folate had broadly similar actions to enhance the probability of cell firing to synaptic excitation, and also caused epileptiform discharges to occur spontaneously or in response to electrical stimulation. Spontaneous and evoked population bursts in CA3 did not persist in low calcium/high magnesium medium indicating their dependence on intact synaptic transmission; spontaneously occurring bursts in CA1 were eliminated with the latter treatment or when the axonal connections between it and CA3 were cut. Following folate superfusion the commissural-evoked response in CA3 showed large and variable shifts of the latency which were dependent on the stimulus intensity and its timing after a spontaneous population discharge. Although all of the effects of folate were reproduced by bicuculline, no evidence for a decreased recurrent inhibition in CA1 was obtained although this was observed with kainate. The finding that folate and kainate produced their effects in the absence of a detectable effect on the antidromic population spike suggests a mechanism of action other than neuronal depolarization. The implications of these data for the neurotoxic mechanism(s) and the receptor homologies of folate and kainate are discussed.

Antagonism of the hypermotility response induced by excitatory amino acids in the rat nucleus accumbens

Several compounds have been shown to antagonize the excitation of single neurons produced by excitatory amino acids. This study was designed to determine the effectiveness of these compounds in antagonizing the hypermotility response to excitatory amino acids after intra-accumbens administration. Of the putative antagonists tested, D-aminoadipic acid, diaminopimelic acid and glutamic acid diethyl ester all showed significant inhibitory effects on excitatory amino acid-induced hypermotility while 2-amino-5-phosphonovaleric acid, gamma-D-glutamylglycine, 2-amino-4-phosphonobutyric acid and cis-2,3-piperidine dicarboxylic acid were ineffective. D-Aminoadipic acid decreased N-methyl-aspartic acid-induced hypermotility while having no significant effect on the hypermotility responses induced by kainic or quisqualic acids. Diaminopimelic acid markedly decreased N-methyl-aspartic acid- and kainic acid-induced hypermotility but was totally ineffective on quisqualic acid-induced hypermotility. In contrast to D-aminoadipic acid, glutamic acid diethyl ester antagonized the increase in motility produced by kainic and quisqualic acids but not that produced by N-methyl-aspartic acid. The above data suggests that N-methyl-aspartic acid and quisqualic acid may produce their motor effects through the activation of two different receptors in the nucleus accumbens while kainic acid may mediate its hypermotility response through both N-methyl-aspartic acid and quisqualic acid receptors. However, a third receptor type activated solely by kainic acid cannot be excluded at this time.

The ionic mechanisms associated with the excitatory response of kainate, L-glutamate, quisqualate, ibotenate, AMPA and methyltetrahydrofolate on leech Retzius cells

Intracellular recordings were made from Retzius cells from segmental ganglia of the leech, Hirudo medicinalis. The ionic mechanisms of the following compounds were examined: L-glutamate, ibotenate, quisqualate, AMPA, kainate, methyltetrahydrofolate and carbachol. All these compounds depolarise and excite Retzius cells. In sodium-free Ringer, the responses to L-glutamate, kainate, ibotenate and AMPA were greatly reduced, the response to quisqualate was reduced, the response to methyltetrahydrofolate was normal while the response to carbachol was abolished. In sodium-free high calcium Ringer the responses to L-glutamate, ibotenate and carbachol were absent, the responses to quisqualate and AMPA greatly reduced, the responses to methyltetrahydrofolate and kainate were normal. The methyltetrahydrofolate and kainate responses in sodium-free high calcium Ringer were greatly reduced on addition of cobalt. All the responses are associated with an increase in conductance, the increase being the largest in the case of kainate. It is concluded that the response to L-glutamate, ibotenate and carbachol are dependent on sodium, the responses to quisqualate and AMPA are mainly sodium dependent, possibly with a small calcium component. The kainate response in normal Ringer is largely sodium dependent but in sodium-free Ringer calcium can completely substitute for sodium. The methyltetrahydrofolate response appears to be sodium independent but at least partly calcium dependent. These studies provide further evidence that L-glutamate and ibotenate act on a common receptor on leech Retzius cells while kainate acts on a separate receptor which can activate a calcium ionophore. It is probable that methyltetrahydrofolate acts on a different ionophore system to kainate. N-Methyl-D-aspartate has no agonist activity on any of these receptors.

Are convulsant and toxic properties of folates of the kainate type?

Intra-amygdaloid injections of folic acid (FA) in rats induce behavioural, metabolic (assessed using the 2-deoxyglucose method) and neuropathological changes which, however, differ considerably from those produced by kainic acid (KA). Thus FA, in contrast to KA, does not readily induce limbic motor seizures, fails to activate the entire limbic system and does not readily reproduce the local and distant damage induced by KA, notably in the Ammon's horn of the hippocampus. The results argue against the hypothesis that KA acts at folate receptors to induce its limbic epileptic/brain damage syndrome.

Interaction of phenytoin and folate in the rat

The interactions between folate and phenytoin were studied in the rat using a model in which constant, nontoxic, and continuously protective levels of phenytoin were maintained. After 10 days of treatment with phenytoin, liver folate concentration was decreased while brain, plasma, and adrenal folate concentrations remained unaffected. Oral folate supplementation (20 mg/kg) increased folate concentrations in all tissues examined in phenytoin-treated animals, but had no effect on phenytoin levels. Folate supplementation did, however, increase the recovery time after maximal electroshock seizures in phenytoin-treated rats, but did not influence phenytoin's ability to protect against tonic hindlimb extension. Oral folate supplementation in animals not treated with phenytoin also significantly increased folate concentrations in all tissues examined except brain.

Dose-dependent effects of intravitreal kainic acid on specific cell types in chicken retina

In chicken retina, approximately two thirds of the bipolar cells and most amacrine cells are destroyed after intravitreal injection of from 20 to 60 nmoles of kainic acid. These cells, plus horizontal cells are destroyed after intravitreal injections of 120 nmoles of kainic acid. One third of the bipolar cells, Müller glial cells, photoreceptors and ganglion cells seem to be much more resistant. The resistance of the ganglion cells to intravitreal kainic acid is unusual and is not found in mammalian retinas. Dopaminergic amacrine cells may also be resistant to kainic acid. It is suggested that kainic acid interacts directly with bipolar cells and horizontal cells, depolarising the bipolar cells and horizontal cells and thereby killing them, while hyperpolarizing the ON-bipolar cells. The possibility that amacrine cell death may be an indirect result of kainic acid's effects on bipolar cells is discussed. Whatever the precise way in which kainic acid causes cell death, the technique of causing lesions is useful for defining the localization of retinal and particularly amacrine cell transmitter systems.