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Donlon J, Kumari P, Varghese SP, Bai M, Florentin OD, Frost ED, Banks J, Vadlapatla N, Kam O, Shad MU, Rahman S, Abulseoud OA, Stone TW, Koola MM. Integrative Pharmacology in the Treatment of Substance Use Disorders. J Dual Diagn 2024; 20:132-177. [PMID: 38117676 DOI: 10.1080/15504263.2023.2293854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
The detrimental physical, mental, and socioeconomic effects of substance use disorders (SUDs) have been apparent to the medical community for decades. However, it has become increasingly urgent in recent years to develop novel pharmacotherapies to treat SUDs. Currently, practitioners typically rely on monotherapy. Monotherapy has been shown to be superior to no treatment at all for most substance classes. However, many randomized controlled trials (RCTs) have revealed that monotherapy leads to poorer outcomes when compared with combination treatment in all specialties of medicine. The results of RCTs suggest that monotherapy frequently fails since multiple dysregulated pathways, enzymes, neurotransmitters, and receptors are involved in the pathophysiology of SUDs. As such, research is urgently needed to determine how various neurobiological mechanisms can be targeted by novel combination treatments to create increasingly specific yet exceedingly comprehensive approaches to SUD treatment. This article aims to review the neurobiology that integrates many pathophysiologic mechanisms and discuss integrative pharmacology developments that may ultimately improve clinical outcomes for patients with SUDs. Many neurobiological mechanisms are known to be involved in SUDs including dopaminergic, nicotinic, N-methyl-D-aspartate (NMDA), and kynurenic acid (KYNA) mechanisms. Emerging evidence indicates that KYNA, a tryptophan metabolite, modulates all these major pathophysiologic mechanisms. Therefore, achieving KYNA homeostasis by harmonizing integrative pathophysiology and pharmacology could prove to be a better therapeutic approach for SUDs. We propose KYNA-NMDA-α7nAChRcentric pathophysiology, the "conductor of the orchestra," as a novel approach to treat many SUDs concurrently. KYNA-NMDA-α7nAChR pathophysiology may be the "command center" of neuropsychiatry. To date, extant RCTs have shown equivocal findings across comparison conditions, possibly because investigators targeted single pathophysiologic mechanisms, hit wrong targets in underlying pathophysiologic mechanisms, and tested inadequate monotherapy treatment. We provide examples of potential combination treatments that simultaneously target multiple pathophysiologic mechanisms in addition to KYNA. Kynurenine pathway metabolism demonstrates the greatest potential as a target for neuropsychiatric diseases. The investigational medications with the most evidence include memantine, galantamine, and N-acetylcysteine. Future RCTs are warranted with novel combination treatments for SUDs. Multicenter RCTs with integrative pharmacology offer a promising, potentially fruitful avenue to develop novel therapeutics for the treatment of SUDs.
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Affiliation(s)
- Jack Donlon
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Pooja Kumari
- Community Living Trent Highlands, Peterborough, Canada
| | - Sajoy P Varghese
- Addiction Recovery Treatment Services, Veterans Affairs Northern California Health Care System, University of California, Davis, Sacramento, California, USA
| | - Michael Bai
- Columbia University, New York, New York, USA
| | - Ori David Florentin
- Department of Psychiatry, Westchester Medical Center, Valhalla, New York, USA
| | - Emma D Frost
- Department of Neurology, Cooper University Health Care, Camden, New Jersey, USA
| | - John Banks
- Talkiatry Mental Health Clinic, New York, New York, USA
| | - Niyathi Vadlapatla
- Thomas Jefferson High School for Science and Technology, Alexandria, Virginia, USA
| | - Olivia Kam
- Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
| | - Mujeeb U Shad
- Department of Psychiatry, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Shafiqur Rahman
- Department of Pharmaceutical Sciences, College of Pharmacy, South Dakota State University, Brookings, South Dakota, USA
| | - Osama A Abulseoud
- Department of Psychiatry and Psychology, Alix School of Medicine at Mayo Clinic, Phoenix, Arizona, USA
| | - Trevor W Stone
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Maju Mathew Koola
- Department of Psychiatry and Behavioral Health, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Guo X, Yu J, Quan C, Xiao J, Wang J, Zhang B, Hao X, Wu X, Liang J. The effect of N-methyl-D-aspartate receptor antagonists on the mismatch negativity of event-related potentials and its regulatory factors: A systematic review and meta-analysis. J Psychiatr Res 2024; 172:210-220. [PMID: 38402843 DOI: 10.1016/j.jpsychires.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/27/2024]
Abstract
This study investigates the influence of N-methyl-D-aspartate receptor (NMDAR) antagonists on the mismatch negativity (MMN) components of event-related potentials (ERPs) in healthy subjects and explores whether NMDAR antagonists have different effects on MMN components under different types of antagonists, drug dosages, and deviant stimuli. We conducted a comprehensive literature search of PubMed, EMBASE, and the Cochrane Library from inception to August 1, 2023 for studies comparing the MMN components between the NMDAR antagonist intervention group and the control group (or baseline). All statistical analyses were performed using Stata version 12.0 software. Sixteen articles were included in the systematic review: 13 articles were included in the meta-analysis of MMN amplitudes, and seven articles were included in the meta-analysis of MMN latencies. The pooled analysis showed that NMDAR antagonists reduced MMN amplitudes [SMD (95% CI) = 0.32 (0.16, 0.47), P < 0.01, I2 = 47.3%, p < 0.01] and prolonged MMN latencies [SMD (95% CI) = 0.31 (0.13, 0.49), P = 0.16, I2 = 28.3%, p < 0.01]. The type of antagonist drug regulates the effect of NMDAR antagonists on MMN amplitudes. Different antagonists, doses of antagonists, and types of deviant stimuli can also have different effects on MMN. These findings indicate a correlation between NMDAR and MMN, which may provide a foundation for the application of ERP-MMN in the early identification of NMDAR encephalitis.
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Affiliation(s)
- Xin Guo
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Jieyang Yu
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Chunhua Quan
- Central Laboratory, The Affiliated Hospital of Yanbian University, Juzi-St., No.1327, Yanji, 133000, China.
| | - Jinyu Xiao
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Jiangtao Wang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Bo Zhang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Xiaosheng Hao
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Xuemei Wu
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Jianmin Liang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
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Sehatpour P, Iosifescu DV, De Baun HM, Shope C, Mayer MR, Gangwisch J, Dias E, Sobeih T, Choo TH, Wall MM, Medalia A, Saperstein AM, Kegeles LS, Girgis RR, Carlson M, Kantrowitz JT. Dose-Dependent Augmentation of Neuroplasticity-Based Auditory Learning in Schizophrenia: A Double-Blind, Placebo-Controlled, Randomized, Target Engagement Clinical Trial of the NMDA Glutamate Receptor Agonist d-serine. Biol Psychiatry 2023; 94:164-173. [PMID: 36958998 PMCID: PMC10313776 DOI: 10.1016/j.biopsych.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients with schizophrenia show reduced NMDA glutamate receptor-dependent auditory plasticity, which is rate limiting for auditory cognitive remediation (AudRem). We evaluate the utility of behavioral and neurophysiological pharmacodynamic target engagement biomarkers, using a d-serine+AudRem combination. METHODS Forty-five participants with schizophrenia or schizoaffective disorder were randomized to 3 once-weekly AudRem visits + double-blind d-serine (80, 100, or 120 mg/kg) or placebo in 3 dose cohorts of 12 d-serine and 3 placebo-treated participants each. In AudRem, participants indicated which paired tone was higher in pitch. The primary outcome was plasticity improvement, operationalized as change in pitch threshold between AudRem tones [(test tone Hz - reference tone Hz)/reference tone Hz] between the initial plateau pitch threshold (mean of trials 20-30 of treatment visit 1) to pitch threshold at the end of visit(s). Target engagement was assessed by electroencephalography outcomes, including mismatch negativity (pitch primary). RESULTS There was a significant overall treatment effect for plasticity improvement (p = .014). Plasticity improvement was largest within the 80 and 100 mg/kg groups (p < .001, d > 0.67), while 120 mg/kg and placebo-treated participants showed nonsignificant within-group changes. Plasticity improvement was seen after a single treatment and was sustained on subsequent treatments. Target engagement was demonstrated by significantly larger mismatch negativity (p = .049, d = 1.0) for the 100 mg/kg dose versus placebo. CONCLUSIONS Our results demonstrate sufficient proof of principle for continued development of both the d-serine+AudRem combination and our target engagement methodology. The ultimate utility is dependent on the results of an ongoing larger, longer study of the combination for clinically relevant outcomes.
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Affiliation(s)
- Pejman Sehatpour
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; Nathan Kline Institute, Orangeburg, New York
| | - Dan V Iosifescu
- Nathan Kline Institute, Orangeburg, New York; Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Heloise M De Baun
- Area Psychosis, New York State Psychiatric Institute, New York, New York
| | | | - Megan R Mayer
- Area Psychosis, New York State Psychiatric Institute, New York, New York
| | - James Gangwisch
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elisa Dias
- Nathan Kline Institute, Orangeburg, New York; Psychiatry, New York University Grossman School of Medicine, New York, New York
| | | | - Tse-Hwei Choo
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Melanie M Wall
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alice Medalia
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alice M Saperstein
- Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lawrence S Kegeles
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ragy R Girgis
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marlene Carlson
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joshua T Kantrowitz
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; Nathan Kline Institute, Orangeburg, New York.
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Joshi YB, Molina JL, Braff DL, Green MF, Gur RC, Gur RE, Nuechterlein KH, Stone WS, Greenwood TA, Lazzeroni LC, Radant AD, Silverman JM, Sprock J, Sugar CA, Tsuang DW, Tsuang MT, Turetsky BI, Swerdlow NR, Light GA. Sensitivity of Schizophrenia Endophenotype Biomarkers to Anticholinergic Medication Burden. Am J Psychiatry 2023; 180:519-523. [PMID: 37038743 DOI: 10.1176/appi.ajp.20220649] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Yash B Joshi
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Juan L Molina
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - David L Braff
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Michael F Green
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Ruben C Gur
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Raquel E Gur
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Keith H Nuechterlein
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - William S Stone
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Tiffany A Greenwood
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Laura C Lazzeroni
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Allen D Radant
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Jeremy M Silverman
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Joyce Sprock
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Catherine A Sugar
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Debby W Tsuang
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Ming T Tsuang
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Bruce I Turetsky
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Neal R Swerdlow
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Gregory A Light
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
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5
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Dondé C, Kantrowitz JT, Medalia A, Saperstein AM, Balla A, Sehatpour P, Martinez A, O'Connell MN, Javitt DC. Early auditory processing dysfunction in schizophrenia: Mechanisms and implications. Neurosci Biobehav Rev 2023; 148:105098. [PMID: 36796472 PMCID: PMC10106448 DOI: 10.1016/j.neubiorev.2023.105098] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Schizophrenia is a major mental disorder that affects approximately 1% of the population worldwide. Cognitive deficits are a key feature of the disorder and a primary cause of long-term disability. Over the past decades, significant literature has accumulated demonstrating impairments in early auditory perceptual processes in schizophrenia. In this review, we first describe early auditory dysfunction in schizophrenia from both a behavioral and neurophysiological perspective and examine their interrelationship with both higher order cognitive constructs and social cognitive processes. Then, we provide insights into underlying pathological processes, especially in relationship to glutamatergic and N-methyl-D-aspartate receptor (NMDAR) dysfunction models. Finally, we discuss the utility of early auditory measures as both treatment targets for precision intervention and as translational biomarkers for etiological investigation. Altogether, this review points out the crucial role of early auditory deficits in the pathophysiology of schizophrenia, in addition to major implications for early intervention and auditory-targeted approaches.
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Affiliation(s)
- Clément Dondé
- Univ. Grenoble Alpes, F-38000 Grenoble, France; INSERM, U1216, F-38000 Grenoble, France; Psychiatry Department, CHU Grenoble Alpes, F-38000 Grenoble, France; Psychiatry Department, CH Alpes-Isère, F-38000 Saint-Egrève, France.
| | - Joshua T Kantrowitz
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States; Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, NY 10032, United States
| | - Alice M Saperstein
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, NY 10032, United States
| | - Andrea Balla
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States
| | - Pejman Sehatpour
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States; Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Antigona Martinez
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States; Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Monica N O'Connell
- Translational Neuroscience Division, Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States
| | - Daniel C Javitt
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States; Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY, United States.
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6
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Choueiry J, Blais CM, Shah D, Smith D, Fisher D, Labelle A, Knott V. An α7 nAChR approach for the baseline-dependent modulation of deviance detection in schizophrenia: A pilot study assessing the combined effect of CDP-choline and galantamine. J Psychopharmacol 2023; 37:381-395. [PMID: 36927273 PMCID: PMC10101183 DOI: 10.1177/02698811231158903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Cognitive operations including pre-attentive sensory processing are markedly impaired in patients with schizophrenia (SCZ) but evidence significant interindividual heterogeneity, which moderates treatment response with nicotinic acetylcholine receptor (nAChR) agonists. Previous studies in healthy volunteers have shown baseline-dependency effects of the α7 nAChR agonist cytidine 5'-diphosphocholine (CDP-choline) administered alone and in combination with a nicotinic allosteric modulator (galantamine) on auditory deviance detection measured with the mismatch negativity (MMN) event-related potential (ERP). AIM The objective of this pilot study was to assess the acute effect of this combined α7 nAChR-targeted treatment (CDP-choline/galantamine) on speech MMN in patients with SCZ (N = 24) stratified by baseline MMN responses into low, medium, and high baseline auditory deviance detection subgroups. METHODS Patients with a stable diagnosis of SCZ attended two randomized, double-blind, placebo-controlled and counter-balanced testing sessions where they received a placebo or a CDP-choline (500 mg) and galantamine (16 mg) treatment. MMN ERPs were recorded during the presentation of a fast multi-feature speech MMN paradigm including five speech deviants. Clinical measures were acquired before and after treatment administration. RESULTS While no main treatment effect was observed, CDP-choline/galantamine significantly increased MMN amplitudes to frequency, duration, and vowel speech deviants in low group individuals. Individuals with higher positive and negative symptom scale negative, general, and total scores expressed the greatest MMN amplitude improvement following CDP-choline/galantamine. CONCLUSIONS These baseline-dependent nicotinic effects on early auditory information processing warrant different dosage and repeated administration assessments in patients with low baseline deviance detection levels.
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Affiliation(s)
- Joëlle Choueiry
- Department of Neuroscience, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Crystal M Blais
- Institute of Cognitive Science, Carleton University, Ottawa, ON, Canada
| | - Dhrasti Shah
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Smith
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Derek Fisher
- Department of Psychology, Faculty of Social Sciences, Mount Saint Vincent University, Halifax, NS, Canada
| | - Alain Labelle
- The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Verner Knott
- Department of Neuroscience, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Institute of Cognitive Science, Carleton University, Ottawa, ON, Canada.,School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada.,The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
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7
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Kim M, Kim T, Hwang WJ, Lho SK, Moon SY, Lee TY, Kwon JS. Forecasting prognostic trajectories with mismatch negativity in early psychosis. Psychol Med 2023; 53:1489-1499. [PMID: 36315242 PMCID: PMC10009395 DOI: 10.1017/s0033291721003068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prognostic heterogeneity in early psychosis patients yields significant difficulties in determining the degree and duration of early intervention; this heterogeneity highlights the need for prognostic biomarkers. Although mismatch negativity (MMN) has been widely studied across early phases of psychotic disorders, its potential as a common prognostic biomarker in early periods, such as clinical high risk (CHR) for psychosis and first-episode psychosis (FEP), has not been fully studied. METHODS A total of 104 FEP patients, 102 CHR individuals, and 107 healthy controls (HCs) participated in baseline MMN recording. Clinical outcomes were assessed; 17 FEP patients were treatment resistant, 73 FEP patients were nonresistant, 56 CHR individuals were nonremitters (15 transitioned to a psychotic disorder), and 22 CHR subjects were remitters. Baseline MMN amplitudes were compared across clinical outcome groups and tested for utility prognostic biomarkers using binary logistic regression. RESULTS MMN amplitudes were greatest in HCs, intermediate in CHR subjects, and smallest in FEP patients. In the clinical outcome groups, MMN amplitudes were reduced from the baseline in both FEP and CHR patients with poor prognostic trajectories. Reduced baseline MMN amplitudes were a significant predictor of later treatment resistance in FEP patients [Exp(β) = 2.100, 95% confidence interval (CI) 1.104-3.993, p = 0.024] and nonremission in CHR individuals [Exp(β) = 1.898, 95% CI 1.065-3.374, p = 0.030]. CONCLUSIONS These findings suggest that MMN could be used as a common prognostic biomarker across early psychosis periods, which will aid clinical decisions for early intervention.
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Affiliation(s)
- Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Wu Jeong Hwang
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Moon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Neuropsychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
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8
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Javitt DC. Cognitive Impairment Associated with Schizophrenia: From Pathophysiology to Treatment. Annu Rev Pharmacol Toxicol 2023; 63:119-141. [PMID: 36151052 DOI: 10.1146/annurev-pharmtox-051921-093250] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cognitive impairment is a core feature of schizophrenia and a major contributor to poor functional outcomes. Methods for assessment of cognitive dysfunction in schizophrenia are now well established. In addition, there has been increasing appreciation in recent years of the additional role of social cognitive impairment in driving functional outcomes and of the contributions of sensory-level dysfunction to higher-order impairments. At the neurochemical level, acute administration of N-methyl-d-aspartate receptor (NMDAR) antagonists reproduces the pattern of neurocognitive dysfunction associated with schizophrenia, encouraging the development of treatments targeted at both NMDAR and its interactome. At the local-circuit level, an auditory neurophysiological measure, mismatch negativity, has emerged both as a veridical index of NMDAR dysfunction and excitatory/inhibitory imbalance in schizophrenia and as a critical biomarker for early-stage translational drug development. Although no compounds have yet been approved for treatment of cognitive impairment associated with schizophrenia, several candidates are showing promise in early-phase testing.
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Affiliation(s)
- Daniel C Javitt
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; .,Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
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9
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Swerdlow NR, Joshi YB, Sprock J, Talledo J, Molina JL, Delano-Wood L, Iwanaga D, Kotz JE, Huege S, Léger GC, Light GA. Preliminary Evidence that Memantine Enhances Prepulse Effects on Startle Magnitude and Latency in Patients with Alzheimer's Disease. J Alzheimers Dis 2023; 91:355-362. [PMID: 36404550 DOI: 10.3233/jad-220769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The uncompetitive NMDA antagonist, memantine (MEM), enhances prepulse inhibition of startle (PPI) across species. MEM is used to treat Alzheimer's disease (AD); conceivably, its acute impact on PPI might be used to predict a patient's sensitivity to MEM's therapeutic effects. OBJECTIVE To begin to test this possibility, we studied MEM effects on PPI and related measures in AD patients. METHODS 18 carefully screened individuals with AD (mean age = 72.8 y; M:F=9 : 9) completed double-blind order-balanced testing with MEM (placebo versus 20 mg), assessing acoustic startle magnitude, habituation, PPI, and latency. RESULTS Fifteen out of 18 participants exhibited reliable startle responses. MEM did not significantly impact startle magnitude or habituation. Compared to placebo responses, PPI was significantly increased after MEM (p < 0.04; d = 0.40); this comparison reached a large effect size for the 60 ms interval (d = 0.62), where maximal MEM effects on PPI were previously detected. Prepulses reduced peak startle latency ("latency facilitation") and this effect was amplified after MEM (p = 0.03; d = 0.41; for 60 ms intervals, d = 0.69). No effects of MEM were detected on cognition, nor were MEM effects on startle associated with cognitive or clinical measures. CONCLUSION MEM enhances prepulse effects on startle magnitude and latency in AD; these changes in PPI and latency facilitation with MEM suggest that these measures can be used to detect an AD patient's neural sensitivity to acute MEM challenge. Studies in progress will determine whether such a "biomarker" measured at the outset on treatment can predict sensitivity to MEM's therapeutic effects.
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Affiliation(s)
- Neal R Swerdlow
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Yash B Joshi
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Joyce Sprock
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Jo Talledo
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Juan L Molina
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Dylan Iwanaga
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Juliana E Kotz
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Steven Huege
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Gabriel C Léger
- Department of Neurosciences, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Gregory A Light
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
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10
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Test-retest reliability of prepulse inhibition (PPI) and PPI correlation with working memory. Acta Neuropsychiatr 2022; 34:344-353. [PMID: 35959694 DOI: 10.1017/neu.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Sensorimotor gating is experimentally operationalized by the prepulse inhibition (PPI) of the startle response (SR). Previous studies suggest high test-retest reliability of PPI and potential correlation with working memory (WM). Here, we aimed to validate and extend the test-retest reliability of PPI in healthy humans and its correlation with WM performance. METHODS We applied an acoustic startle PPI paradigm with four different prepulse intensities (64, 68, 72 and 76 dB) and two different WM tasks [n-back, change detection task (CDT)] in a group of 26 healthy adults (final sample size n = 23). To assess test-retest reliability, we performed all tests on two separate days ~27 days (range: 21-32 days) apart. RESULTS We were able to confirm high test-retest reliability of the PPI with a mean intraclass correlation (ICC) of > 0.80 and significant positive correlation of PPI with n-back but not with CDT performance. Detailed analysis showed that PPI across all prepulse intensities significantly correlated with both the 2-back and 0-back conditions, suggesting regulation by cross-conditional processes (e.g. attention). However, when removing the 0-back component from the 2-back data, we found a specific and significant correlation with WM for the 76-dB PPI condition. CONCLUSION With the present study, we were able to confirm the high test-retest reliability of the PPI in humans and could validate and expand on its correlation with WM performance.
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11
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Perry A, Hughes LE, Adams N, Naessens M, Murley AG, Rouse MA, Street D, Jones PS, Cope TE, Kocagoncu E, Rowe JB. The neurophysiological effect of NMDA-R antagonism of frontotemporal lobar degeneration is conditional on individual GABA concentration. Transl Psychiatry 2022; 12:348. [PMID: 36030249 PMCID: PMC9420128 DOI: 10.1038/s41398-022-02114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023] Open
Abstract
There is a pressing need to accelerate therapeutic strategies against the syndromes caused by frontotemporal lobar degeneration, including symptomatic treatments. One approach is for experimental medicine, coupling neurophysiological studies of the mechanisms of disease with pharmacological interventions aimed at restoring neurochemical deficits. Here we consider the role of glutamatergic deficits and their potential as targets for treatment. We performed a double-blind placebo-controlled crossover pharmaco-magnetoencephalography study in 20 people with symptomatic frontotemporal lobar degeneration (10 behavioural variant frontotemporal dementia, 10 progressive supranuclear palsy) and 19 healthy age- and gender-matched controls. Both magnetoencephalography sessions recorded a roving auditory oddball paradigm: on placebo or following 10 mg memantine, an uncompetitive NMDA-receptor antagonist. Ultra-high-field magnetic resonance spectroscopy confirmed lower concentrations of GABA in the right inferior frontal gyrus of people with frontotemporal lobar degeneration. While memantine showed a subtle effect on early-auditory processing in patients, there was no significant main effect of memantine on the magnitude of the mismatch negativity (MMN) response in the right frontotemporal cortex in patients or controls. However, the change in the right auditory cortex MMN response to memantine (vs. placebo) in patients correlated with individuals' prefrontal GABA concentration. There was no moderating effect of glutamate concentration or cortical atrophy. This proof-of-concept study demonstrates the potential for baseline dependency in the pharmacological restoration of neurotransmitter deficits to influence cognitive neurophysiology in neurodegenerative disease. With changes to multiple neurotransmitters in frontotemporal lobar degeneration, we suggest that individuals' balance of excitation and inhibition may determine drug efficacy, with implications for drug selection and patient stratification in future clinical trials.
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Affiliation(s)
- Alistair Perry
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, UK. .,Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ, UK.
| | - Laura E. Hughes
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK ,grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Natalie Adams
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Michelle Naessens
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Alexander G. Murley
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Matthew A. Rouse
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK
| | - Duncan Street
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - P. Simon Jones
- grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Thomas E. Cope
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK ,grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Ece Kocagoncu
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK ,grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
| | - James B. Rowe
- grid.5335.00000000121885934MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF UK ,grid.5335.00000000121885934Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, CB2 0QQ UK
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12
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de la Salle S, Choueiry J, McIntosh J, Bowers H, Ilivitsky V, Knott V. N-methyl-D-aspartate receptor antagonism impairs sensory gating in the auditory cortex in response to speech stimuli. Psychopharmacology (Berl) 2022; 239:2155-2169. [PMID: 35348805 DOI: 10.1007/s00213-022-06090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
Abstract
Deficits in early auditory sensory processing in schizophrenia have been linked to N-methyl-D-aspartate receptor (NMDAR) hypofunction, but the role of NMDARs in aberrant auditory sensory gating (SG) in this disorder is unclear. This study, conducted in 22 healthy humans, examined the acute effects of a subanesthetic dose of the NMDAR antagonist ketamine on SG as measured electrophysiologically by suppression of the P50 event-related potential (ERP) to the second (S2) relative to the first (S1) of two closely paired (500 ms) identical speech stimuli. Ketamine induced impairment in SG indices at sensor (scalp)-level and at source-level in the auditory cortex (as assessed with eLORETA). Together with preliminary evidence of modest positive associations between impaired gating and dissociative symptoms elicited by ketamine, tentatively support a model of NMDAR hypofunction underlying disturbances in auditory SG in schizophrenia.
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Affiliation(s)
- Sara de la Salle
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
| | - Joelle Choueiry
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Judy McIntosh
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
| | - Hayley Bowers
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Vadim Ilivitsky
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
| | - Verner Knott
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada. .,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
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13
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Nathan PJ, Millais SB, Godwood A, Dewit O, Cross DM, Liptrot J, Ruparelia B, Jones SP, Bakker G, Maruff PT, Light GA, Brown AJH, Weir MP, Congreve M, Tasker T. A phase 1b/2a multicenter study of the safety and preliminary pharmacodynamic effects of selective muscarinic M 1 receptor agonist HTL0018318 in patients with mild-to-moderate Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12273. [PMID: 35229025 PMCID: PMC8864442 DOI: 10.1002/trc2.12273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 12/03/2022]
Abstract
Introduction This study examined the safety and pharmacodynamic effects of selective muscarinic M1 receptor orthosteric agonist HTL0018318 in 60 patients with mild‐to‐moderate Alzheimer's disease (AD) on background donepezil 10 mg/day. Methods A randomized, double‐blind, placebo‐controlled 4‐week safety study of HTL0018318 with up‐titration and maintenance phases, observing exploratory effects on electrophysiological biomarkers and cognition. Results Treatment‐emergent adverse events (TEAEs) were mild and less frequently reported during maintenance versus titration. Headache was most commonly reported (7–21%); 0 to 13% reported cholinergic TEAEs (abdominal pain, diarrhea, fatigue, nausea) and two patients discontinued due to TEAEs. At 1 to 2 hours post‐dose, HTL0018318‐related mean maximum elevations in systolic and diastolic blood pressure of 5 to 10 mmHg above placebo were observed during up‐titration but not maintenance. Postive effects of HTL0018318 were found on specific attention and memory endpoints. Discussion HTL0018318 was well tolerated in mild‐to‐moderate AD patients and showed positive effects on attention and episodic memory on top of therapeutic doses of donepezil.
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Affiliation(s)
- Pradeep J Nathan
- Heptares Therapeutics Ltd Cambridge UK.,Department of Psychiatry University of Cambridge Cambridge UK
| | | | | | | | | | | | | | | | | | | | - Gregory A Light
- Department of Psychiatry University of San Diego San Diego California USA
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14
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Yi GL, Zhu MZ, Cui HC, Yuan XR, Liu P, Tang J, Li YQ, Zhu XH. A hippocampus dependent neural circuit loop underlying the generation of auditory mismatch negativity. Neuropharmacology 2022; 206:108947. [PMID: 35026286 DOI: 10.1016/j.neuropharm.2022.108947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/11/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022]
Abstract
Extracting relevant information and transforming it into appropriate behavior, is a fundamental brain function, and requires the coordination between the sensory and cognitive systems, however, the underlying mechanisms of interplay between sensory and cognition systems remain largely unknown. Here, we developed a mouse model for mimicking human auditory mismatch negativity (MMN), a well-characterized translational biomarker for schizophrenia, and an index of early auditory information processing. We found that a subanesthetic dose of ketamine decreased the amplitude of MMN in adult mice. Using pharmacological and chemogenetic approaches, we identified an auditory cortex-entorhinal cortex-hippocampus neural circuit loop that is required for the generation of MMN. In addition, we found that inhibition of dCA1→MEC circuit impaired the auditory related fear discrimination. Moreover, we found that ketamine induced MMN deficiency by inhibition of long-range GABAergic projection from the CA1 region of the dorsal hippocampus to the medial entorhinal cortex. These results provided circuit insights for ketamine effects and early auditory information processing. As the entorhinal cortex is the interface between the neocortex and hippocampus, and the hippocampus is critical for the formation, consolidation, and retrieval of episodic memories and other cognition, our results provide a neural mechanism for the interplay between the sensory and cognition systems.
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Affiliation(s)
- Guo-Liang Yi
- Institute of Mental Health, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Min-Zhen Zhu
- Institute of Mental Health, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - He-Chen Cui
- Institute of Mental Health, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Xin-Rui Yuan
- Institute of Mental Health, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Peng Liu
- Institute of Mental Health, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Jie Tang
- Institute of Mental Health, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yuan-Qing Li
- Research Center for Brain-Computer Interface, Pazhou Lab, Guangzhou, 510330, China
| | - Xin-Hong Zhu
- Institute of Mental Health, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China; Research Center for Brain Health, Pazhou Lab, Guangzhou, 510330, China; School of Psychology, Shenzhen University, Shenzhen, 518060, China.
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15
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Swerdlow NR, Kotz JE, Joshi YB, Talledo J, Sprock J, Molina JL, Huisa B, Huege SF, Romero JA, Walsh MJ, Delano-Wood L, Light GA. Using Biomarkers to Predict Memantine Effects in Alzheimer's Disease: A Proposal and Proof-Of-Concept Demonstration. J Alzheimers Dis 2021; 84:1431-1438. [PMID: 34690144 DOI: 10.3233/jad-215029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Memantine's benefits in Alzheimer's disease (AD) are modest and heterogeneous. We tested the feasibility of using sensitivity to acute memantine challenge to predict an individual's clinical response. Eight participants completed a double-blind challenge study of memantine (placebo versus 20 mg) effects on autonomic, subjective, cognitive, and neurophysiological measures, followed by a 24-week unblinded active-dose therapeutic trial (10 mg bid). Study participation was well tolerated. Subgroups based on memantine sensitivity on specific laboratory measures differed in their clinical response to memantine, some by large effect sizes. It appears feasible to use biomarkers to predict clinical sensitivity to memantine.
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Affiliation(s)
- Neal R Swerdlow
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Juliana E Kotz
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Yash B Joshi
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Jo Talledo
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Joyce Sprock
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Juan L Molina
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Branko Huisa
- Department of Neurosciences, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Steven F Huege
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jairo Alberto Romero
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Michael J Walsh
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Gregory A Light
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
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16
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Central auditory processing deficits in schizophrenia: Effects of auditory-based cognitive training. Schizophr Res 2021; 236:135-141. [PMID: 34500174 PMCID: PMC9259506 DOI: 10.1016/j.schres.2021.07.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/23/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sensory processing abnormalities are common in schizophrenia (SZ) and impact everyday functions, such as speech perception in noisy environments. Auditory-based targeted cognitive training (TCT) is a "bottom up" cognitive remediation intervention designed to enhance the speed and accuracy of low-level auditory information processing. However, the effects of TCT on behavioral measures of central auditory processing (CAP) and the role of CAP function on verbal learning outcomes in SZ are unknown. METHODS SZ (n = 42) and healthy subjects (CTL; n = 18) underwent comprehensive clinical, neurocognitive, and auditory assessments, including tests of hearing sensitivity and speech recognition (Words-in-Noise (WIN), Quick Speech-in-Noise (SIN)). SZ patients were randomized to receive either treatment-as-usual (TAU); or 30-h of TCT + TAU using a stratified, parallel design. SZ patients repeated assessments ~10-12 weeks later. RESULTS Patients exhibited deficits in both WIN (p < 0.05, d = 0.50) and SIN (p < 0.01, d = 0.63). A treatment × time interaction on WIN (p < 0.05, d = 0.74), but not SIN discriminability, was seen in the TCT group relative to TAU. Specific enhancements in the 4-dB over background range drove gains in WIN performance. Moreover, SZ patients with greater CAP deficits experienced robust gains in verbal learning after 30-h of TCT relative to SZ patients without CAP impairment (p < 0.01, d = 1.28). CONCLUSION Findings demonstrate that intensive auditory training enhances the fidelity of auditory processing and perception, such that specific CAP deficits were 'normalized' and were predictive of gains in verbal learning after TCT. It is conceivable that patients with deficiencies in CAP measures may benefit most from TCT and other interventions targeting auditory dysfunction in SZ.
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17
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Blacker KJ, McHail DG. Time course of recovery from acute hypoxia exposure as measured by vigilance and event-related potentials. Physiol Behav 2021; 239:113508. [PMID: 34175363 DOI: 10.1016/j.physbeh.2021.113508] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 11/24/2022]
Abstract
Exposure to reduced levels of breathable oxygen is known to cause a number of deleterious effects on human performance. Previous work has demonstrated that in healthy adults, hypoxia results in decrements on a wide range of sensory, cognitive, and motor tasks. However, very little is known about the time course of recovery of cognitive functions following a hypoxic exposure. While previous studies have shown that physiological responses like heart rate and oxygen saturation rebound almost immediately, one previous study has shown a delayed recovery for response time (RT) measures following hypoxia. In the current study, we assessed the time course of neurocognitive recovery following a hypoxic exposure in healthy adults using the psychomotor vigilance task (PVT), passively elicited event-related potentials (ERPs) that assess auditory processing, and physiological measures. We also compared whether speed of recovery differed when participants were provided with 21% or 100% oxygen immediately following hypoxic exposure. Participants underwent a baseline testing session and two separate recovery sessions where they were assessed during a hypoxic exposure and at regular intervals for up to four hours post-exposure. Results demonstrated that RT, as measured by the PVT, significantly slowed during hypoxia compared to baseline and continued to be impaired until 60 min post-exposure. We assessed the mismatch negativity (MMN) and P3a ERP components in response to an auditory oddball paradigm and found a significant reduction in the amplitude of the MMN during hypoxia compared to baseline and that attenuation in amplitude persisted for up to 120 min post-exposure. Together, these results indicate that both RT and auditory processing showed a delayed recovery following hypoxia. We found no strong evidence for differential recovery speed based on recovery gas administered (21% versus 100% oxygen). These results have implications for guidance regarding return-to-duty status for military aviators following a hypoxic exposure.
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Affiliation(s)
- Kara J Blacker
- Naval Medical Research Unit-Dayton, Wright-Patterson AFB, OH, USA.
| | - Daniel G McHail
- Naval Medical Research Unit-Dayton, Wright-Patterson AFB, OH, USA.
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18
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Desai A, Benner L, Wu R, Gertsik L, Maruff P, Light GA, Uz T, Marek GJ, Zhu T. Phase 1 randomized study on the safety, tolerability, and pharmacodynamic cognitive and electrophysiological effects of a dopamine D 1 receptor positive allosteric modulator in patients with schizophrenia. Neuropsychopharmacology 2021; 46:1145-1151. [PMID: 33203954 PMCID: PMC8182805 DOI: 10.1038/s41386-020-00908-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 01/29/2023]
Abstract
ASP4345, a novel dopamine D1 receptor positive allosteric modulator, is being evaluated for the treatment of cognitive impairment associated with schizophrenia (CIAS). This phase 1 multiple ascending-dose study (NCT02720263) assessed the safety, tolerability, and pharmacodynamics of ASP4345 in patients with schizophrenia/schizoaffective disorder. Pharmacodynamic assessments were Cogstate cognitive tests and electrophysiological biomarkers, including gamma-band power and phase synchronization in response to 40-Hz auditory steady-state stimulation, as well as mismatch negativity (MMN) and P3a event-related potentials. The sample size determination was based on standard practice in assessing safety and tolerability of a new chemical entity. Data were summarized by conversion of this data into effect sizes using descriptive and inferential statistics. A total of 36 randomized patients received ASP4345 (3, 15, 50, and 150 mg; n = 9 each dose) and 12 patients received placebo. Patients in the ASP4345 group experienced 73 treatment-emergent adverse events (TEAEs) and 34 TEAEs were reported for the placebo group. The most common TEAEs were headache and somnolence and nearly all TEAEs were mild in severity. No changes in mood or self-reports of suicidal ideation/behavior were observed. Improvements in performance on cognitive tests were noted, which suggests a potential improvement in psychomotor function and visual attention. Furthermore, positive changes in neurophysiological biomarkers (auditory steady-state response [ASSR] and MMN) suggest improvement in information processing. The findings need to be confirmed in studies with a larger patient population. Nonetheless, the trends in safety and pharmacodynamic data support further clinical development of ASP4345 for the treatment of CIAS.
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Affiliation(s)
- Amit Desai
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA.
| | - Lauren Benner
- grid.423286.90000 0004 0507 1326Astellas Pharma Global Development, Inc., Northbrook, IL USA
| | - Ruishan Wu
- grid.423286.90000 0004 0507 1326Astellas Pharma Global Development, Inc., Northbrook, IL USA
| | - Lev Gertsik
- grid.490279.1California Clinical Trials Medical Group, Inc., Glendale, CA USA
| | | | - Gregory A. Light
- grid.266100.30000 0001 2107 4242University of California, San Diego, San Diego, CA USA
| | - Tolga Uz
- grid.423286.90000 0004 0507 1326Astellas Pharma Global Development, Inc., Northbrook, IL USA
| | - Gerard J. Marek
- grid.423286.90000 0004 0507 1326Astellas Pharma Global Development, Inc., Northbrook, IL USA
| | - Tong Zhu
- grid.423286.90000 0004 0507 1326Astellas Pharma Global Development, Inc., Northbrook, IL USA
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19
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Murphy N, Lijffijt M, Ramakrishnan N, Vo-Le B, Vo-Le B, Iqbal S, Iqbal T, O'Brien B, Smith MA, Swann AC, Mathew SJ. Does mismatch negativity have utility for NMDA receptor drug development in depression? ACTA ACUST UNITED AC 2021; 44:61-73. [PMID: 33825765 PMCID: PMC8827377 DOI: 10.1590/1516-4446-2020-1685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/13/2021] [Indexed: 11/22/2022]
Abstract
CLINICAL TRIAL REGISTRATION Rapid antidepressant effects associated with ketamine have shifted the landscape for the development of therapeutics to treat major depressive disorder (MDD) from a monoaminergic to glutamatergic model. Treatment with ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, may be effective, but has many non-glutamatergic targets, and clinical and logistical problems are potential challenges. These factors underscore the importance of manipulations of binding mechanics to produce antidepressant effects without concomitant clinical side effects. This will require identification of efficient biomarkers to monitor target engagement. The mismatch negativity (MMN) is a widely used electrophysiological signature linked to the activity of NMDA receptors (NMDAR) in humans and animals and validated in pre-clinical and clinical studies of ketamine. In this review, we explore the flexibility of the MMN and its capabilities for reliable use in drug development for NMDAR antagonists in MDD. We supplement this with findings from our own research with three distinct NMDAR antagonists. The research described illustrates that there are important distinctions between the mechanisms of NMDAR antagonism, which are further crystallized when considering the paradigm used to study the MMN. We conclude that the lack of standardized methodology currently prevents MMN from being ready for common use in drug discovery. This manuscript describes data collected from the following National Institutes of Health (NIH) and Veterans Affairs (VA) studies: AV-101, NCT03583554; lanicemine, NCT03166501; ketamine, NCT02556606.
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Affiliation(s)
- Nicholas Murphy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA
| | - Marijn Lijffijt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Nithya Ramakrishnan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Bylinda Vo-Le
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Brittany Vo-Le
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Sidra Iqbal
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Tabish Iqbal
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Brittany O'Brien
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Mark A Smith
- VistaGen Therapeutics, Inc., South San Francisco, CA, USA.,Medical College of Georgia, Augusta, GA, USA
| | - Alan C Swann
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Sanjay J Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA
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20
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Koshiyama D, Thomas ML, Miyakoshi M, Joshi YB, Molina JL, Tanaka-Koshiyama K, Sprock J, Braff DL, Swerdlow NR, Light GA. Hierarchical Pathways from Sensory Processing to Cognitive, Clinical, and Functional Impairments in Schizophrenia. Schizophr Bull 2021; 47:373-385. [PMID: 32856089 PMCID: PMC7965084 DOI: 10.1093/schbul/sbaa116] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cognitive impairment is a hallmark of schizophrenia and a robust predictor of functional outcomes. Impairments are found in all phases of the illness and are only moderately attenuated by currently approved therapeutics. Neurophysiological indices of sensory discrimination (ie, mismatch negativity (MMN) and P3a amplitudes) and gamma-band auditory steady-state response (ASSR; power and phase locking) are translational biomarkers widely used in the development of novel therapeutics for neuropsychiatric disorders. It is unclear whether laboratory-based EEG measures add explanatory power to well-established models that use only cognitive, clinical, and functional outcome measures. Moreover, it is unclear if measures of sensory discrimination and gamma-band ASSR uniquely contribute to putative causal pathways linking sensory discrimination, neurocognition, negative symptoms, and functional outcomes in schizophrenia. To answer these questions, hierarchical associations among sensory processing, neurocognition, clinical symptoms, and functional outcomes were assessed via structural equation modeling in a large sample of schizophrenia patients (n = 695) and healthy comparison subjects (n = 503). The results showed that the neurophysiologic indices of sensory discrimination and gamma-band ASSR both significantly contribute to and yield unique hierarchical, "bottom-up" effects on neurocognition, symptoms, and functioning. Measures of sensory discrimination showed direct effects on neurocognition and negative symptoms, while gamma-band ASSR had a direct effect on neurocognition in patients. Continued investigation of the neural mechanisms underlying abnormal networks of MMN/P3a and gamma-band ASSR is needed to clarify the pathophysiology of schizophrenia and the development of novel therapeutic interventions.
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Affiliation(s)
- Daisuke Koshiyama
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Michael L Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Department of Psychology, Colorado State University, Fort Collins, CO
| | - Makoto Miyakoshi
- Swartz Center for Neural Computation, University of California San Diego, La Jolla, CA
| | - Yash B Joshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA
| | - Juan L Molina
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | | | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - David L Braff
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Neal R Swerdlow
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Gregory A Light
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA
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Chamera K, Trojan E, Kotarska K, Szuster-Głuszczak M, Bryniarska N, Tylek K, Basta-Kaim A. Role of Polyinosinic:Polycytidylic Acid-Induced Maternal Immune Activation and Subsequent Immune Challenge in the Behaviour and Microglial Cell Trajectory in Adult Offspring: A Study of the Neurodevelopmental Model of Schizophrenia. Int J Mol Sci 2021; 22:ijms22041558. [PMID: 33557113 PMCID: PMC7913889 DOI: 10.3390/ijms22041558] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/22/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Multiple lines of evidence support the pathogenic role of maternal immune activation (MIA) in the occurrence of the schizophrenia-like disturbances in offspring. While in the brain the homeostatic role of neuron-microglia protein systems is well documented, the participation of the CX3CL1-CX3CR1 and CD200-CD200R dyads in the adverse impact of MIA often goes under-recognized. Therefore, in the present study, we examined the effect of MIA induced by polyinosinic:polycytidylic acid (Poly I:C) on the CX3CL1-CX3CR1 and CD200-CD200R axes, microglial trajectory (MhcII, Cd40, iNos, Il-1β, Tnf-α, Il-6, Arg1, Igf-1, Tgf-β and Il-4), and schizophrenia-like behaviour in adult male offspring of Sprague-Dawley rats. Additionally, according to the “two-hit” hypothesis of schizophrenia, we evaluated the influence of acute challenge with Poly I:C in adult prenatally MIA-exposed animals on the above parameters. In the present study, MIA evoked by Poly I:C injection in the late period of gestation led to the appearance of schizophrenia-like disturbances in adult offspring. Our results revealed the deficits manifested as a diminished number of aggressive interactions, presence of depressive-like episodes, and increase of exploratory activity, as well as a dichotomy in the sensorimotor gating in the prepulse inhibition (PPI) test expressed as two behavioural phenotypes (MIAPPI-low and MIAPPI-high). Furthermore, in the offspring rats subjected to a prenatal challenge (i.e., MIA) we noticed the lack of modulation of behavioural changes after the additional acute immune stimulus (Poly I:C) in adulthood. The important finding reported in this article is that MIA affects the expression and levels of the neuron-microglia proteins in the frontal cortex and hippocampus of adult offspring. We found that the changes in the CX3CL1-CX3CR1 axis could affect microglial trajectory, including decreased hippocampal mRNA level of MhcII and elevated cortical expression of Igf-1 in the MIAPPI-high animals and/or could cause the up-regulation of an inflammatory response (Il-6, Tnf-α, iNos) after the “second hit” in both examined brain regions and, at least in part, might differentiate behavioural disturbances in adult offspring. Consequently, the future effort to identify the biological background of these interactions in the Poly I:C-induced MIA model in Sprague-Dawley rats is desirable to unequivocally clarify this issue.
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Koshiyama D, Miyakoshi M, Thomas ML, Joshi YB, Molina JL, Tanaka-Koshiyama K, Sprock J, Braff DL, Swerdlow NR, Light GA. Unique contributions of sensory discrimination and gamma synchronization deficits to cognitive, clinical, and psychosocial functional impairments in schizophrenia. Schizophr Res 2021; 228:280-287. [PMID: 33493776 DOI: 10.1016/j.schres.2020.12.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/08/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Schizophrenia patients show widespread deficits in neurocognitive, clinical, and psychosocial functioning. Mismatch negativity (MMN) and gamma-band auditory steady-state response (ASSR) are robust translational biomarkers associated with schizophrenia and associated with cognitive dysfunction, negative symptom severity, and psychosocial disability. Although these biomarkers are conceptually linked as measures of early auditory information processing, it is unclear whether MMN and gamma-band ASSR account for shared vs. non-shared variance in cognitive, clinical, and psychosocial functioning. METHODS Multiple regression analyses with MMN, gamma-band ASSR, and clinical measures were performed in large cohorts of schizophrenia outpatients (N = 428) and healthy comparison subjects (N = 283). RESULTS Reduced MMN (d = 0.67), gamma-band ASSR (d = -0.40), and lower cognitive function were confirmed in schizophrenia patients. Regression analyses revealed that reduced MMN amplitude showed unique associations with lower verbal learning and negative symptoms, reduced gamma-band ASSR showed a unique association with working memory deficits, and both reduced MMN amplitude and reduced gamma-band ASSR showed an association with daily functioning impairment in schizophrenia patients. CONCLUSION MMN and ASSR measures are non-redundant and complementary measures of early auditory information processing that are associated with important domains of functioning. Studies are needed to clarify the neural substrates of MMN and gamma-band ASSR to improve our understanding of the pathophysiology of schizophrenia and accelerate their use in the development of novel therapeutic interventions.
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Affiliation(s)
- Daisuke Koshiyama
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Makoto Miyakoshi
- Swartz Center for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - Michael L Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Yash B Joshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Juan L Molina
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - David L Braff
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Neal R Swerdlow
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Gregory A Light
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
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Sources of the frontocentral mismatch negativity and P3a responses in schizophrenia patients and healthy comparison subjects. Int J Psychophysiol 2021; 161:76-85. [PMID: 33453303 DOI: 10.1016/j.ijpsycho.2021.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mismatch negativity (MMN) and P3a are event-related potential measures of early auditory information processing that are increasingly used as translational biomarkers in the development of treatments for neuropsychiatric disorders. These responses are reduced in schizophrenia patients over the frontocentral scalp electrodes and are associated with important domains of cognitive and psychosocial functioning. While MMN and P3a responses are generated by a dynamic network of cortical sources distributed across the temporal and frontal brain regions, it is not clear how these sources independently contribute to MMN and P3a at the primary frontocentral scalp electrode or to abnormalities observed in schizophrenia. This study aimed to determine the independent source contributions and characterize the magnitude of impairment in source-level MMN and P3a responses in schizophrenia patients. METHODS A novel method was applied to back-project the contributions of 11 independent cortical source components to Fz, the primary scalp sensor that is used in clinical studies, in n = 589 schizophrenia patients and n = 449 healthy comparison subjects. RESULTS The groups showed comparable individual source contributions underlying both MMN and P3a responses at Fz. Source-level responses revealed an increasing magnitude of impairment in schizophrenia patients from the temporal to more frontal sources. CONCLUSIONS Schizophrenia patients have a normal architecture of source contributions that are accompanied by widespread abnormalities in source resolved mismatch and P3a responses, with more prominent deficits detected from the frontal sources. Quantification of source contributions and source-level responses accelerates clarification of the neural networks underlying MMN reduction at Fz in schizophrenia patients.
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Swerdlow NR, Bhakta SG, Talledo J, Kotz J, Roberts BZ, Clifford RE, Thomas ML, Joshi YB, Molina JL, Light GA. Memantine effects on auditory discrimination and training in schizophrenia patients. Neuropsychopharmacology 2020; 45:2180-2188. [PMID: 32961542 PMCID: PMC7784956 DOI: 10.1038/s41386-020-00865-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
The uncompetitive low-affinity NMDA receptor antagonist, memantine, acutely increases electrophysiological measures of auditory information processing in both healthy subjects (HS) and patients with schizophrenia. Memantine effects on functional measures of auditory discrimination performance and learning are not known; conceivably, beneficial effects on these measures might suggest a role for memantine in augmenting the cognitive and functional impact of auditory targeted cognitive training (TCT). Here, carefully characterized HS (n = 20) and schizophrenia patients (n = 22) were tested in measures of auditory discrimination performance (words-in-noise (WIN), quick speech-in-noise (QuickSIN), gaps-in-noise) and auditory frequency modulation learning (a component of TCT) on 2 days about a week apart, after ingesting either placebo or 20 mg memantine po, in a double-blind, within-subject cross-over random order design. Memantine modestly enhanced functional measures of auditory discrimination in both schizophrenia patients (WIN) and HS (WIN and QuickSIN), as well as auditory frequency modulation learning in schizophrenia patients. These findings converge with a growing literature showing that memantine can enhance a range of metrics of auditory function. These properties could contribute to the apparent benefits of memantine as an adjunctive treatment in schizophrenia, and suggest that memantine might augment learning and potentially clinical gains from auditory-based TCT.
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Affiliation(s)
- Neal R. Swerdlow
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Savita G. Bhakta
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Jo Talledo
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Juliana Kotz
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Benjamin Z. Roberts
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Royce Ellen Clifford
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Michael L. Thomas
- grid.47894.360000 0004 1936 8083Department of Psychology, Colorado State University, Fort Collins, CO USA
| | - Yash B. Joshi
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA USA
| | - Juan L. Molina
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Gregory A. Light
- grid.266100.30000 0001 2107 4242Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA USA
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25
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Choueiry J, Blais CM, Shah D, Smith D, Fisher D, Illivitsky V, Knott V. CDP-choline and galantamine, a personalized α7 nicotinic acetylcholine receptor targeted treatment for the modulation of speech MMN indexed deviance detection in healthy volunteers: a pilot study. Psychopharmacology (Berl) 2020; 237:3665-3687. [PMID: 32851421 DOI: 10.1007/s00213-020-05646-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
RATIONALE The combination of CDP-choline, an α7 nicotinic acetylcholine receptor (α7 nAChR) agonist, with galantamine, a positive allosteric modulator of nAChRs, is believed to counter the fast desensitization rate of the α7 nAChRs and may be of interest for schizophrenia (SCZ) patients. Beyond the positive and negative clinical symptoms, deficits in early auditory prediction-error processes are also observed in SCZ. Regularity violations activate these mechanisms that are indexed by electroencephalography-derived mismatch negativity (MMN) event-related potentials (ERPs) in response to auditory deviance. OBJECTIVES/METHODS This pilot study in thirty-three healthy humans assessed the effects of an optimized α7 nAChR strategy combining CDP-choline (500 mg) with galantamine (16 mg) on speech-elicited MMN amplitude and latency measures. The randomized, double-blinded, placebo-controlled, and counterbalanced design with a baseline stratification method allowed for assessment of individual response differences. RESULTS Increases in MMN generation mediated by the acute CDP-choline/galantamine treatment in individuals with low baseline MMN amplitude for frequency, intensity, duration, and vowel deviants were revealed. CONCLUSIONS These results, observed primarily at temporal recording sites overlying the auditory cortex, implicate α7 nAChRs in the enhancement of speech deviance detection and warrant further examination with respect to dysfunctional auditory deviance processing in individuals with SCZ.
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Affiliation(s)
- Joelle Choueiry
- Department of Neuroscience, Faculty of Medicine, University of Ottawa, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada.
- Department of Psychiatry, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada.
- Department of Psychology, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.
| | - Crystal M Blais
- Institute of Cognitive Science, Carleton University, Ottawa, ON, Canada
| | - Dhrasti Shah
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Smith
- Department of Psychiatry, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Psychology, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Derek Fisher
- Department of Psychology, Faculty of Social Sciences, Mount Saint Vincent University, Halifax, NS, Canada
| | - Vadim Illivitsky
- Department of Psychiatry, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Verner Knott
- Department of Neuroscience, Faculty of Medicine, University of Ottawa, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Department of Psychiatry, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Psychology, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
- Institute of Cognitive Science, Carleton University, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
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Kikuchi T. Is Memantine Effective as an NMDA-Receptor Antagonist in Adjunctive Therapy for Schizophrenia? Biomolecules 2020; 10:biom10081134. [PMID: 32751985 PMCID: PMC7466074 DOI: 10.3390/biom10081134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 01/07/2023] Open
Abstract
Memantine, an n-methyl-d-aspartate (NMDA) receptor antagonist approved for treating Alzheimer's disease, has a good safety profile and is increasingly being studied for possible use in a variety of non-dementia psychiatric disorders. There is an abundance of basic and clinical data that support the hypothesis that NMDA receptor hypofunction contributes to the pathophysiology of schizophrenia. However, there are numerous randomized, double-blind, placebo-controlled clinical trials showing that add-on treatment with memantine improves negative and cognitive symptoms, particularly the negative symptoms of schizophrenia, indicating that memantine as adjunctive therapy in schizophrenia helps to ameliorate negative symptoms and cognitive deficits. It remains unclear why memantine does not show undesirable central nervous system (CNS) side effects in humans unlike other NMDA receptor antagonists, such as phencyclidine and ketamine. However, the answer could lie in the fact that it would appear that memantine works as a low-affinity, fast off-rate, voltage-dependent, and uncompetitive antagonist with preferential inhibition of extrasynaptic receptors. It is reasonable to assume that the effects of memantine as adjunctive therapy on negative symptoms and cognitive deficits in schizophrenia may derive primarily, if not totally, from its NMDA receptor antagonist activity at NMDA receptors including extrasynaptic receptors in the CNS.
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Affiliation(s)
- Tetsuro Kikuchi
- New Drug Research Division, Pharmaceutical Business Division, Otsuka Pharmaceutical Co., Ltd., 463-10 Kagasuno, Kawauchi-cho, Tokushima 771-0192, Japan
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The effect of NMDA-R antagonist, MK-801, on neuronal mismatch along the rat auditory thalamocortical pathway. Sci Rep 2020; 10:12391. [PMID: 32709861 PMCID: PMC7381643 DOI: 10.1038/s41598-020-68837-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022] Open
Abstract
Efficient sensory processing requires that the brain maximize its response to unexpected stimuli, while suppressing responsivity to expected events. Mismatch negativity (MMN) is an auditory event-related potential that occurs when a regular pattern is interrupted by an event that violates the expected properties of the pattern. According to the predictive coding framework there are two mechanisms underlying the MMN: repetition suppression and prediction error. MMN has been found to be reduced in individuals with schizophrenia, an effect believed to be underpinned by glutamate N-methyl-d-aspartate receptor (NMDA-R) dysfunction. In the current study, we aimed to test how the NMDA-R antagonist, MK-801 in the anaesthetized rat, affected repetition suppression and prediction error processes along the auditory thalamocortical pathway. We found that low-dose systemic administration of MK-801 differentially affect thalamocortical responses, namely, increasing thalamic repetition suppression and cortical prediction error. Results demonstrate an enhancement of neuronal mismatch, also confirmed by large scale-responses. Furthermore, MK-801 produces faster and stronger dynamics of adaptation along the thalamocortical hierarchy. Clearly more research is required to understand how NMDA-R antagonism and dosage affects processes contributing to MMN. Nonetheless, because a low dose of an NMDA-R antagonist increased neuronal mismatch, the outcome has implications for schizophrenia treatment.
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Maternal Immune Activation Sensitizes Male Offspring Rats to Lipopolysaccharide-Induced Microglial Deficits Involving the Dysfunction of CD200-CD200R and CX3CL1-CX3CR1 Systems. Cells 2020; 9:cells9071676. [PMID: 32664639 PMCID: PMC7407118 DOI: 10.3390/cells9071676] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
Early life challenges resulting from maternal immune activation (MIA) may exert persistent effects on the offspring, including the development of psychiatric disorders, such as schizophrenia. Recent evidence has suggested that the adverse effects of MIA may be mediated by neuron-microglia crosstalk, particularly CX3CL1-CX3CR1 and CD200-CD200R dyads. Therefore, the present study assessed the behavioural parameters resembling schizophrenia-like symptoms in the adult male offspring of Sprague-Dawley rats that were exposed to MIA and to an additional acute lipopolysaccharide (LPS) challenge in adulthood, according to the "two-hit" hypothesis of schizophrenia. Simultaneously, we aimed to clarify the role of the CX3CL1-CX3CR1 and CD200-CD200R axes and microglial reactivity in the brains of adult offspring subjected to MIA and the "second hit" wit LPS. In the present study, MIA generated a range of behavioural changes in the adult male offspring, including increased exploratory activity and anxiety-like behaviours. The most intriguing finding was observed in the prepulse inhibition (PPI) test, where the deficit in the sensorimotor gating was age-dependent and present only in part of the rats. We were able to distinguish the occurrence of two groups: responsive and non-responsive (without the deficit). Concurrently, based on the results of the biochemical studies, MIA disrupted mainly the CD200-CD200R system, while the changes of the CX3CL1-CX3CR1 axis were less evident in the frontal cortex of adult non-responsive offspring. MIA markedly affected the immune regulators of the CD200-CD200R pathway as we observed an increase in cortical IL-6 release in the responsive group and IL-4 in the non-responsive offspring. Importantly, the "second hit" generated disturbances at the behavioural and biochemical levels mostly in the non-responsive adult animals. Those offspring were characterized both by disturbed PPI and "priming" microglia. Altogether, the exposure to MIA altered the immunomodulatory mechanisms, including the CD200-CD200R axis, in the brain and sensitized animals to subsequent immunological challenges, leading to the manifestation of schizophrenia-like alterations.
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Abnormal Effective Connectivity Underlying Auditory Mismatch Negativity Impairments in Schizophrenia. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:1028-1039. [PMID: 32830097 DOI: 10.1016/j.bpsc.2020.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Auditory mismatch negativity (MMN) is a translatable event-related potential biomarker, and its reduction in schizophrenia is associated with the severity of clinical symptoms. While MMN recorded at the scalp is generated by a distributed network of temporofrontal neural sources, the primary contributing sources and the dynamic interactions among sources underlying MMN impairments in schizophrenia have not been previously characterized. METHODS A novel data-driven analytic framework was applied to large cohorts of healthy comparison subjects (n = 449) and patients with schizophrenia (n = 589) to identify the independent contributing sources of MMN, characterize the patterns of effective connectivity underlying reduced MMN in patients, and explore the clinical significance of these abnormal source dynamics in schizophrenia. RESULTS A network of 11 independent contributing sources underlying MMN distributed across temporofrontal cortices was identified. Orderly shifts in peak source activity were detected in a steplike manner, starting at temporal structures and progressing across frontal brain regions. MMN reduction in patients was predominantly associated with reduced contributions from 3 frontal midline sources: orbitofrontal, anterior cingulate, and middle cingulate cortices. Patients showed increased connectivity from temporal to prefrontal regions in conjunction with decreased cross-hemispheric connectivity to prefrontal regions. The decreased connectivity strength of precentral to prefrontal regions in patients with schizophrenia was associated with greater severity of negative symptoms. CONCLUSIONS Alterations in the dynamic interactions among temporofrontal sources underlie MMN abnormalities in schizophrenia. These results advance our understanding of the neural substrates and temporal dynamics of normal and impaired information processing with novel applications for translatable biomarkers of neuropsychiatric disorders.
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Molina JL, Voytek B, Thomas ML, Joshi YB, Bhakta SG, Talledo JA, Swerdlow NR, Light GA. Memantine Effects on Electroencephalographic Measures of Putative Excitatory/Inhibitory Balance in Schizophrenia. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:562-568. [PMID: 32340927 PMCID: PMC7286803 DOI: 10.1016/j.bpsc.2020.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Abnormalities in cortical excitation and inhibition (E/I) balance are thought to underlie sensory and information processing deficits in schizophrenia. Deficits in early auditory information processing mediate both neurocognitive and functional impairment and appear to be normalized by acute pharmacologic challenge with the NMDA antagonist memantine (MEM). METHODS Thirty-six subjects with a diagnosis of schizophrenia and 31 healthy control subjects underwent electroencephalographic recordings. Subjects ingested either placebo or MEM (10 or 20 mg) in a double-blind, within-subject, crossover, randomized design. The aperiodic, 1/f-like scaling property of the neural power spectra, which is thought to index relative E/I balance, was estimated using a robust linear regression algorithm. RESULTS Patients with schizophrenia had greater aperiodic components compared with healthy control subjects (p < .01, d = 0.64), which was normalized after 20 mg MEM. Analysis revealed a significant dose × diagnosis interaction (p < .0001, d = 0.82). Furthermore, the MEM effect (change in aperiodic component in MEM vs. placebo conditions) was associated with baseline attention and vigilance (r = .54, p < .05) and MEM-induced enhancements in gamma power (r = -.60, p < .01). CONCLUSIONS Findings confirmed E/I balance abnormalities in schizophrenia that were normalized with acute MEM administration and suggest that neurocognitive profiles may predict treatment response based on E/I sensitivity. These data provide proof-of-concept evidence for the utility of E/I balance indices as metrics of acute pharmacologic sensitivity for central nervous system therapeutics.
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Affiliation(s)
- Juan L Molina
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Bradley Voytek
- Department of Cognitive Sciences, Halicioğlu Data Science Institute, and Neurosciences Graduate Program, University of California, San Diego, La Jolla, California
| | - Michael L Thomas
- Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Psychology, Colorado State University, Fort Collins, Colorado
| | - Yash B Joshi
- Department of Psychiatry, University of California, San Diego, La Jolla, California; VA Desert Pacific Mental Illness Research, Education and Clinical Center, VA San Diego Healthcare System, San Diego, California
| | - Savita G Bhakta
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Jo A Talledo
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Neal R Swerdlow
- Department of Psychiatry, University of California, San Diego, La Jolla, California.
| | - Gregory A Light
- Department of Psychiatry, University of California, San Diego, La Jolla, California; VA Desert Pacific Mental Illness Research, Education and Clinical Center, VA San Diego Healthcare System, San Diego, California
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Light GA, Joshi YB, Molina JL, Bhakta SG, Nungaray JA, Cardoso L, Kotz JE, Thomas ML, Swerdlow NR. Neurophysiological biomarkers for schizophrenia therapeutics. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Jalewa J, Todd J, Michie PT, Hodgson DM, Harms L. Do rat auditory event related potentials exhibit human mismatch negativity attributes related to predictive coding? Hear Res 2020; 399:107992. [PMID: 32571607 DOI: 10.1016/j.heares.2020.107992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023]
Abstract
Rodent models play a significant role in understanding disease mechanisms and the screening of new treatments. With regard to psychiatric disorders such as schizophrenia, however, it is difficult to replicate the human symptoms in rodents because these symptoms are often either 'uniquely human' or are only conveyed via self-report. There is a growing interest in rodent mismatch responses (MMRs) as a translatable 'biomarker' for disorders such as schizophrenia. In this review, we will summarize the attributes of human MMN, and discuss the scope of exploring the attributes of human MMN in rodents. Here, we examine how reliably MMRs that are measured in rats mimic human attributes, and present original data examining whether manipulations of stimulus conditions known to modulate human MMN, do the same for rat MMRs. Using surgically-implanted epidural electroencephalographic electrodes and wireless telemetry in freely-moving rats, we observed human-like modulations of MMRs, namely that larger MMRs were elicited to unexpected (deviant) stimuli that a) had a larger change in pitch compared to the expected (standard) stimulus, b) were less frequently presented (lower probability), and c) had no jitter (stable stimulus onset asynchrony) compared to high jitter. Overall, these findings contribute to the mounting evidence for rat MMRs as a good analogue of human MMN, bolstering the development of a novel approach in future to validate the preclinical models based on a translatable biomarker, MMN.
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Affiliation(s)
- Jaishree Jalewa
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Juanita Todd
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Patricia T Michie
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Deborah M Hodgson
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Lauren Harms
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia.
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Harms L, Parras GG, Michie PT, Malmierca MS. The Role of Glutamate Neurotransmission in Mismatch Negativity (MMN), A Measure of Auditory Synaptic Plasticity and Change-detection. Neuroscience 2020; 456:106-113. [PMID: 32045628 DOI: 10.1016/j.neuroscience.2020.01.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
Mismatch negativity (MMN) is an electrophysiological signature that occurs in response to unexpected stimuli. It is often referred to as a measure of memory-based change detection, because the elicitation of a prediction error response relies on the formation of a prediction, which in turn, is dependent upon intact memory of previous auditory stimulation. As such, the MMN is altered in conditions in which memory is affected, such as Alzheimer's disease, schizophrenia and healthy aging. The most prominent pharmacological finding for MMN strengthens the link between MMN and synaptic plasticity, as glutamate N-methyl-d-aspartate receptor (NMDA-R) antagonists reduce the MMN response. However, recent data has begun to demonstrate that the link between NMDA-R function and MMN is not as clear as once thought, with low dose and low affinity NMDA-R antagonists observed to facilitate MMN.
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Affiliation(s)
- Lauren Harms
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Australia; Hunter Medical Research Institute, University of Newcastle, Australia; Centre for Brain and Mental Health Research, University of Newcastle, Australia.
| | - Gloria G Parras
- Cognitive and Auditory Neuroscience Laboratory, Institute of Neuroscience of León (INCYL), Salamanca, Spain; The Salamanca Institute for Biomedical Research (IBSAL), Salamanca, Spain
| | - Patricia T Michie
- Hunter Medical Research Institute, University of Newcastle, Australia; Centre for Brain and Mental Health Research, University of Newcastle, Australia; School of Psychology, University of Newcastle, Australia
| | - Manuel S Malmierca
- Cognitive and Auditory Neuroscience Laboratory, Institute of Neuroscience of León (INCYL), Salamanca, Spain; The Salamanca Institute for Biomedical Research (IBSAL), Salamanca, Spain; Department of Cell Biology and Pathology, Faculty of Medicine, University of Salamanca, Salamanca, Spain.
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Seech TR, Funke ME, Sharp RF, Light GA, Blacker KJ. Impaired Sensory Processing During Low-Oxygen Exposure: A Noninvasive Approach to Detecting Changes in Cognitive States. Front Psychiatry 2020; 11:12. [PMID: 32082202 PMCID: PMC7006237 DOI: 10.3389/fpsyt.2020.00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/07/2020] [Indexed: 12/23/2022] Open
Abstract
The ability to detect novelty in our environment is a critical sensory function. A reliable set of event-related potentials (ERP), known as the auditory deviance response (ADR), are elicited in the absence of directed attention and indexes functionally relevant networks. The ADR consists of three peaks: mismatch negativity (MMN), P3a, and reorienting negativity (RON) that are sequentially evoked in response to unattended changes in repetitive background stimulation. While previous studies have established the ADR's sensitivity to a range of pharmacologic and nonpharmacologic interventions and are leading candidate biomarkers of perturbations of the central nervous system (CNS), here we sought to determine if ADR peaks are sensitive to decreases in breathable oxygen. Participants performed a visuomotor tracking task while EEG was recorded during two 27-min sessions. The two sessions differed in the amount of environmental oxygen available: 10.6% O2 (hypoxia) versus 20.4% O2 (normoxia). ERPs were measured while a series of identical, or "standard," tones combined with occasional "oddball," tones, were presented. MMN, P3a, and RON were assessed in response to the oddball compared to the standard stimuli. Behavioral impairment during hypoxia was demonstrated by a deficit in tracking performance compared to the normoxia condition. Whereas no changes were detected in the MMN or RON, the amplitude of the P3a component was significantly reduced during hypoxia compared to normoxia, within the first 9 min of exposure. To our knowledge, this is the first study to demonstrate the effect of low oxygen exposure on passively elicited neural measures of early sensory processing. This study demonstrates that passively elicited EEG measures, reflecting preattentive auditory processing, are disrupted by acute hypoxia. Results have implications for the development of biomarkers for the noninvasive assessment of CNS perturbations.
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Affiliation(s)
- Todd R Seech
- Warfighter Effectiveness Research Center, U.S. Air Force Academy, Colorado Springs, CO, United States
| | - Matthew E Funke
- Naval Medical Research Unit-Dayton, Wright-Patterson AFB, Dayton, OH, United States
| | - Richard F Sharp
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Gregory A Light
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States.,VISN-22 Mental Illness, Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, United States
| | - Kara J Blacker
- Naval Medical Research Unit-Dayton, Wright-Patterson AFB, Dayton, OH, United States.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
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de la Garrigue N, Glasser J, Sehatpour P, Iosifescu DV, Dias E, Carlson M, Shope C, Sobeih T, Choo TH, Wall MM, Kegeles LS, Gangwisch J, Mayer M, Brazis S, De Baun HM, Wolfer S, Bermudez D, Arnold M, Rette D, Meftah AM, Conant M, Lieberman JA, Kantrowitz JT. Grant Report on d-Serine Augmentation of Neuroplasticity-Based Auditory Learning in Schizophrenia †. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2020; 5:e200018. [PMID: 32856005 PMCID: PMC7448686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We report on the rationale and design of an ongoing NIMH sponsored R61-R33 project in schizophrenia/schizoaffective disorder. This project studies augmenting the efficacy of auditory neuroplasticity cognitive remediation (AudRem) with d-serine, an N-methyl-d-aspartate-type glutamate receptor (NMDAR) glycine-site agonist. We operationalize improved (smaller) thresholds in pitch (frequency) between successive auditory stimuli after AudRem as improved plasticity, and mismatch negativity (MMN) and auditory θ as measures of functional target engagement of both NMDAR agonism and plasticity. Previous studies showed that AudRem alone produces significant, but small cognitive improvements, while d-serine alone improves symptoms and MMN. However, the strongest results for plasticity outcomes (improved pitch thresholds, auditory MMN and θ) were found when combining d-serine and AudRem. AudRem improvements correlated with reading and other auditory cognitive tasks, suggesting plasticity improvements are predictive of functionally relevant outcomes. While d-serine appears to be efficacious for acute AudRem enhancement, the optimal dose remains an open question, as does the ability of combined d-serine + AudRem to produce sustained improvement. In the ongoing R61, 45 schizophrenia patients will be randomized to receive three placebo-controlled, double-blind d-serine + AudRem sessions across three separate 15 subject dose cohorts (80/100/120 mg/kg). Successful completion of the R61 is defined by ≥moderate effect size changes in target engagement and correlation with function, without safety issues. During the three-year R33, we will assess the sustained effects of d-serine + AudRem. In addition to testing a potentially viable treatment, this project will develop a methodology to assess the efficacy of novel NMDAR modulators, using d-serine as a "gold-standard".
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Affiliation(s)
| | - Juliana Glasser
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Pejman Sehatpour
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA,Nathan Kline Institute, Orangeburg, NY 10962, USA
| | - Dan V. Iosifescu
- Nathan Kline Institute, Orangeburg, NY 10962, USA,NYU Langone Medical Center, New York, NY 10016, USA
| | - Elisa Dias
- Nathan Kline Institute, Orangeburg, NY 10962, USA,NYU Langone Medical Center, New York, NY 10016, USA
| | - Marlene Carlson
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | | | - Tarek Sobeih
- Nathan Kline Institute, Orangeburg, NY 10962, USA
| | - Tse-Hwei Choo
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Melanie M. Wall
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Lawrence S. Kegeles
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - James Gangwisch
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Megan Mayer
- New York State Psychiatric Institute, New York, NY 10032, USA
| | | | | | | | - Dalton Bermudez
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Molly Arnold
- Nathan Kline Institute, Orangeburg, NY 10962, USA
| | | | - Amir M. Meftah
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Melissa Conant
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Jeffrey A. Lieberman
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Joshua T. Kantrowitz
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA,Nathan Kline Institute, Orangeburg, NY 10962, USA,Correspondence: Joshua T. Kantrowitz, ; Tel.: +1-646-774-6738
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Lijffijt M, Green CE, Balderston N, Iqbal T, Atkinson M, Vo-Le B, Vo-Le B, O’Brien B, Grillon C, Swann AC, Mathew SJ. A Proof-of-Mechanism Study to Test Effects of the NMDA Receptor Antagonist Lanicemine on Behavioral Sensitization in Individuals With Symptoms of PTSD. Front Psychiatry 2019; 10:846. [PMID: 31920733 PMCID: PMC6923195 DOI: 10.3389/fpsyt.2019.00846] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Individuals with post-traumatic stress disorder (PTSD) have a heightened sensitivity to subsequent stressors, addictive drugs, and symptom recurrence, a form of behavioral sensitization. N-methyl-D-aspartate receptors (NMDARs) are involved in the establishment and activation of sensitized behavior. Objective: We describe a protocol of a randomized placebo-controlled Phase 1b proof-of-mechanism trial to examine target engagement, safety, tolerability, and possible efficacy of the NMDAR antagonist lanicemine in individuals with symptoms of PTSD (Clinician Administered PTSD Scale [CAPS-5] score ≥ 25) and evidence of behavioral sensitization measured as enhanced anxiety-potentiated startle (APS; T-score ≥ 2.8). Methods: Subjects (n = 24; age range 21-65) receive three 60-min intravenous infusions of placebo or 100 mg lanicemine over 5 non-consecutive days. Primary endpoint is change in APS from pre-treatment baseline to after the third infusion. NMDAR engagement is probed with resting state EEG gamma band power, 40 Hz auditory steady state response, the mismatch negativity amplitude, and P50 sensory gating. Change in CAPS-5 scores is an exploratory clinical endpoint. Bayesian statistical methods will evaluate endpoints to determine suitability of this agent for further study. Conclusion: In contrast to traditional early-phase trials that use symptom severity to track treatment efficacy, this study tracks engagement of the study drug on expression of behavioral sensitization, a functional mechanism likely to cut across disorders. This experimental therapeutics design is consistent with recent NIMH-industry collaborative studies, and could serve as a template for testing novel pharmacological agents in psychiatry. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03166501.
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Affiliation(s)
- Marijn Lijffijt
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Charles E. Green
- Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Pediatrics - Center for Evidence Based Medicine, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nicholas Balderston
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Tabish Iqbal
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Megan Atkinson
- Department of Anesthesiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, United States
| | - Brittany Vo-Le
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Bylinda Vo-Le
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Brittany O’Brien
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Christian Grillon
- Department of Pediatrics - Center for Evidence Based Medicine, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Alan C. Swann
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Sanjay J. Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
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Swerdlow NR, Bhakta SG, Talledo J, Benster L, Kotz J, Lavadia M, Light GA. Lessons learned by giving amphetamine to antipsychotic-medicated schizophrenia patients. Neuropsychopharmacology 2019; 44:2277-2284. [PMID: 31445502 PMCID: PMC6897898 DOI: 10.1038/s41386-019-0495-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/29/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022]
Abstract
Experimental Medicine studies in psychiatric populations test specific, mechanistic hypotheses related to the biology of mental illness, by combining well-characterized neurobiological probes and laboratory-based measures of behavioral performance and neurobiology. However, scientific inquiry through the acute administration of psychoactive drugs to patients with serious mental illness raises important ethical issues. These issues arise in studies in which the psychostimulant, amphetamine, is used as an Experimental Medicine probe in patients with schizophrenia. In this study, we summarize relevant aspects of our experience with acute, laboratory-based challenges of amphetamine in schizophrenia patients. Schizophrenia patients participated in one or more Experimental Medicine studies involving limited doses of amphetamine with clinical monitoring, over a 4-year period. Acute (within hours of ingestion; collective n = 53), subacute (three active doses over 4 weeks; n = 28), and long-term (mean = 17 months after ingestion; n = 19) effects of amphetamine ingestion were assessed. In antipsychotic (AP)-medicated schizophrenia patients, amphetamine was associated with no detrimental subjective, autonomic, or functional changes. Symptoms assessed acutely, subacutely, or long term were either unchanged or diminished. No adverse acute, subacute, or long-term consequences from the Experimental Medicine use of amphetamine in antipsychotic-medicated schizophrenia patients were detected. These findings do not address the safety or effectiveness of the use of amphetamine in unmedicated patients, or as an adjunctive treatment for schizophrenia. Indeed, it is important to distinguish evidence-based risks of symptom exacerbation in an Experimental Medicine setting vs. risks associated with long-term, daily clinical use or even misuse of amphetamine.
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Affiliation(s)
- Neal R Swerdlow
- Department of Psychiatry, 0804, University of California, San Diego, La Jolla, CA, 92093, USA.
| | - Savita G Bhakta
- Department of Psychiatry, 0804, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Jo Talledo
- Department of Psychiatry, 0804, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Lindsay Benster
- Department of Psychiatry, 0804, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Juliana Kotz
- Department of Psychiatry, 0804, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Maria Lavadia
- Department of Psychiatry, 0804, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Gregory A Light
- Department of Psychiatry, 0804, University of California, San Diego, La Jolla, CA, 92093, USA
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
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Tada M, Kirihara K, Mizutani S, Uka T, Kunii N, Koshiyama D, Fujioka M, Usui K, Nagai T, Araki T, Kasai K. Mismatch negativity (MMN) as a tool for translational investigations into early psychosis: A review. Int J Psychophysiol 2019; 145:5-14. [DOI: 10.1016/j.ijpsycho.2019.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/09/2019] [Accepted: 02/25/2019] [Indexed: 12/14/2022]
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Hochberger WC, Joshi YB, Zhang W, Thomas ML, Braff DL, Swerdlow NR, Light GA. Decomposing the constituent oscillatory dynamics underlying mismatch negativity generation in schizophrenia: Distinct relationships to clinical and cognitive functioning. Int J Psychophysiol 2019; 145:23-29. [PMID: 30586570 PMCID: PMC7261144 DOI: 10.1016/j.ijpsycho.2018.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/04/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022]
Abstract
Abnormalities in early auditory information processing (EAIP) contribute to higher-order deficits in cognition and psychosocial functioning in schizophrenia. A passive auditory oddball paradigm is commonly used to evoke event-related potential (ERP) measures of EAIP reflecting auditory sensory registration and deviance detection, including mismatch negativity (MMN) and P3a responses. MMN and P3a have been extensively studied in healthy subjects and neuropsychiatric patient populations and are increasingly used as translational biomarkers in the development of novel therapeutics. Despite widespread use, relatively few studies have examined the constituent oscillatory elements and the extent to which sensory registration and deviance detection represent distinct or intercorrelated processes. This study aimed to determine the factor structure and clinical correlates of these oscillatory measures in schizophrenia patients (n = 706) and healthy comparison subjects (n = 615) who underwent clinical, cognitive, and functional characterization and EEG testing via their participation in the Consortium of Genomics in Schizophrenia (COGS-2) study. Results revealed significant deficits in theta-band (4-7 Hz) evoked power and phase locking in patients. Exploratory factor analyses of both ERP and oscillatory measures revealed two dissociable factors reflecting sensory registration and deviance detection. While each factor shared a significant correlation with social cognition, the deviance detection factor had a unique relationship to multiple cognitive and clinical domains. Results support the continued advancement of functionally relevant oscillatory measures underlying EAIP in the development of precognitive therapeutics.
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Affiliation(s)
- W C Hochberger
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States of America; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
| | - Y B Joshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
| | - W Zhang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
| | - M L Thomas
- Colorado State University, Department of Psychology, Fort Collins, CO, United States of America
| | - D L Braff
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
| | - N R Swerdlow
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
| | - G A Light
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States of America; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America.
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41
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Zhand N, Attwood DG, Harvey PD. Glutamate modulators for treatment of schizophrenia. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.pmip.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
PURPOSE OF REVIEW The objective of this article is to highlight the potential role of the galantamine-memantine combination as a novel antioxidant treatment for schizophrenia. RECENT FINDINGS In addition to the well-known mechanisms of action of galantamine and memantine, these medications also have antioxidant activity. Furthermore, an interplay exists between oxidative stress, inflammation (redox-inflammatory hypothesis), and kynurenine pathway metabolites. Also, there is an interaction between brain-derived neurotrophic factor and oxidative stress in schizophrenia. Oxidative stress may be associated with positive, cognitive, and negative symptoms and impairments in white matter integrity in schizophrenia. The antipsychotic-galantamine-memantine combination may provide a novel strategy in schizophrenia to treat positive, cognitive, and negative symptoms. SUMMARY A "single antioxidant" may be inadequate to counteract the complex cascade of oxidative stress. The galantamine-memantine combination as "double antioxidants" is promising. Hence, randomized controlled trials are warranted with the antipsychotic-galantamine-memantine combination with oxidative stress and antioxidant biomarkers in schizophrenia.
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Guercio GD, Thomas ME, Cisneros-Franco JM, Voss P, Panizzutti R, de Villers-Sidani E. Improving cognitive training for schizophrenia using neuroplasticity enhancers: Lessons from decades of basic and clinical research. Schizophr Res 2019; 207:80-92. [PMID: 29730045 DOI: 10.1016/j.schres.2018.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 01/29/2023]
Abstract
Mounting evidence indicates that schizophrenia is a disorder that stems from maladaptive plasticity within neural circuits and produces broad cognitive deficits leading to loss of autonomy. A large number of studies have identified abnormalities spanning many neurotransmitter systems in schizophrenia, and as a result, a variety of drugs have been developed to attempt to treat these abnormalities and enhance cognition. Unfortunately, positive results have been limited so far. This may be in part because the scope of abnormalities in the schizophrenic brain requires a treatment capable of engaging many different neurotransmitter systems. One approach to achieving this kind of treatment has been to use neuroplasticity-based computerized cognitive training programs to stimulate the formation of more adaptive circuits. Although the number of studies implementing this approach has increased exponentially in recent years, effect sizes for cognitive gains have been modest and adherence to treatment remains an important challenge in many studies, as patients are often required to train for 40 h or more. In the present paper, we argue that cognitive training protocols will benefit from the addition of cognitive enhancers to produce more robust and longer lasting targeted neuroplasticity. Indeed, recent data from animal studies have provided support for combining plasticity-enhancing drugs with tailored behavioral training paradigms to restore normal function within dysfunctioning neural circuits. The advantages and challenges of applying this approach to patients with schizophrenia will be discussed.
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Affiliation(s)
- G D Guercio
- Biomedical Sciences Institute, Federal University of Rio de Janeiro, RJ, Brazil; Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
| | - M E Thomas
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - J M Cisneros-Franco
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - P Voss
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - R Panizzutti
- Biomedical Sciences Institute, Federal University of Rio de Janeiro, RJ, Brazil
| | - E de Villers-Sidani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
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Kantrowitz JT. N-methyl-d-aspartate-type glutamate receptor modulators and related medications for the enhancement of auditory system plasticity in schizophrenia. Schizophr Res 2019; 207:70-79. [PMID: 29459050 DOI: 10.1016/j.schres.2018.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 12/14/2022]
Abstract
Deficits in N-methyl-d-aspartate-type (NMDAR) function contribute to cognitive deficits in schizophrenia, particularly dysfunction in neuroplasticity, defined as reduced learning during training on exercises that place implicit, increasing demands on early sensory (auditory and visual) information processing. Auditory mismatch negativity (MMN) can be both a target engagement biomarker for the NMDAR and a proxy measure of neurophysiological plasticity. This review covers the evidence for using NMDAR modulator and related compounds for enhancement of cognition, with a particular focus on early auditory processing/plasticity. Compounds covered include glycine site agonists, glycine and system A-type transporter inhibitors, d-amino acid oxidase inhibitors, memantine and nicotinic alpha-7 acetylcholine receptor agonists. As opposed to daily treatment studies focusing on schizophrenia in general, intermittent, non-daily treatment combining NMDAR modulators with neuroplasticity-based paradigms, using MMN as target-engagement biomarkers show promise as treatments to both remediate plasticity deficits and overall functional deficits.
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Affiliation(s)
- Joshua T Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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Choueiry J, Blais CM, Shah D, Smith D, Fisher D, Labelle A, Knott V. Combining CDP-choline and galantamine, an optimized α7 nicotinic strategy, to ameliorate sensory gating to speech stimuli in schizophrenia. Int J Psychophysiol 2019; 145:70-82. [PMID: 30790597 DOI: 10.1016/j.ijpsycho.2019.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/04/2019] [Accepted: 02/12/2019] [Indexed: 11/18/2022]
Abstract
Neural α7 nicotinic acetylcholine receptor (nAChR) expression and functioning deficits have been extensively associated with cognitive and early sensory gating (SG) impairments in schizophrenia (SCZ) patients and their relatives. SG, the suppression of irrelevant and redundant stimuli, is measured in a conditioning-testing (S1-S2) paradigm eliciting electroencephalography-derived P50 event-related potentials (ERPs), the S2 amplitudes of which are typically suppressed relative to S1. Despite extensive reports of nicotine-related improvements and several decades of research, an efficient nicotinic treatment has yet to be approved for SCZ. Following reports of SG improvements in low P50 suppressing SCZ patients and healthy participants with the α7 agonist, CDP-choline, this pilot study examined the combined modulatory effect of CDP-choline (500 mg) and galantamine (16 mg), a nAChR positive allosteric modulator and acetylcholinesterase inhibitor, on SG to speech stimuli in twenty-four SCZ patients in a randomized, double-blind and placebo-controlled design. As expected, in low P50 suppressors CDP-choline/galantamine (vs. Placebo) improved rP50 and dP50 scores by increasing inhibitory mechanisms as reflected by S2P50 amplitude reductions. Results also suggest a moderating role for auditory verbal hallucinations in treatment response. These preliminary findings provide supportive evidence for the involvement of α7 nAChR activity in speech gating in SCZ and support additional trials, examining different dose combinations and repeated doses of this optimized and personalized targeted α7 cholinergic treatment for SG dysfunction in subgroups of SCZ patients.
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Affiliation(s)
- Joelle Choueiry
- Department of Neuroscience, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Crystal M Blais
- Institute of Cognitive Science, Carleton University, Ottawa, ON, Canada
| | - Dhrasti Shah
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Smith
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Derek Fisher
- Department of Psychology, Faculty of Social Sciences, Mount Saint Vincent University, Halifax, NS, Canada
| | - Alain Labelle
- The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Verner Knott
- Department of Neuroscience, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institute of Cognitive Science, Carleton University, Ottawa, ON, Canada; School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada; Department of Psychology, Faculty of Social Sciences, Mount Saint Vincent University, Halifax, NS, Canada; The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada; University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.
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Nonlinear dynamics underlying sensory processing dysfunction in schizophrenia. Proc Natl Acad Sci U S A 2019; 116:3847-3852. [PMID: 30808768 DOI: 10.1073/pnas.1810572116] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Natural systems, including the brain, often seem chaotic, since they are typically driven by complex nonlinear dynamical processes. Disruption in the fluid coordination of multiple brain regions contributes to impairments in information processing and the constellation of symptoms observed in neuropsychiatric disorders. Schizophrenia (SZ), one of the most debilitating mental illnesses, is thought to arise, in part, from such a network dysfunction, leading to impaired auditory information processing as well as cognitive and psychosocial deficits. Current approaches to neurophysiologic biomarker analyses predominantly rely on linear methods and may, therefore, fail to capture the wealth of information contained in whole EEG signals, including nonlinear dynamics. In this study, delay differential analysis (DDA), a nonlinear method based on embedding theory from theoretical physics, was applied to EEG recordings from 877 SZ patients and 753 nonpsychiatric comparison subjects (NCSs) who underwent mismatch negativity (MMN) testing via their participation in the Consortium on the Genetics of Schizophrenia (COGS-2) study. DDA revealed significant nonlinear dynamical architecture related to auditory information processing in both groups. Importantly, significant DDA changes preceded those observed with traditional linear methods. Marked abnormalities in both linear and nonlinear features were detected in SZ patients. These results illustrate the benefits of nonlinear analysis of brain signals and underscore the need for future studies to investigate the relationship between DDA features and pathophysiology of information processing.
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Koola MM. Potential Role of Antipsychotic-Galantamine-Memantine Combination in the Treatment of Positive, Cognitive, and Negative Symptoms of Schizophrenia. MOLECULAR NEUROPSYCHIATRY 2018; 4:134-148. [PMID: 30643787 PMCID: PMC6323397 DOI: 10.1159/000494495] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022]
Abstract
Schizophrenia is, in part, a cognitive illness. There are no approved medications for cognitive impairments associated with schizophrenia (CIAS) and primary negative symptoms. Cholinergic and glutamatergic systems, alpha-7 nicotinic acetylcholine (α-7nACh) and N-methyl-D-aspartate (NMDA) receptors, kynurenic acid (KYNA), and mismatch negativity have been implicated in the pathophysiology of CIAS and negative symptoms. Galantamine is an acetylcholinesterase inhibitor that is also a positive allosteric modulator at the α4β2 and α7nACh receptors. Memantine is a noncompetitive NMDA receptor antagonist. Galantamine and memantine alone and in combination were effective for cognition in animals and people with Alzheimer's disease. The objective of this article is to critically dissect the published randomized controlled trials with galantamine and memantine for CIAS to highlight the efficacy signal. These studies may have failed to detect a clinically meaningful efficacy signal due to limitations, methodological issues, and possible medication nonadherence. There is evidence from a small open-label study that the galantamine-memantine combination may be effective for CIAS with kynurenine pathway metabolites as biomarkers to detect the severity of cognitive impairments. Given that there are no available treatments for cognitive impairments and primary negative symptoms in schizophrenia, testing of this "five-pronged strategy" (quintuple hypotheses: dopamine, nicotinic-cholinergic, glutamatergic/NMDA, GABA, and KYNA) is a "low-risk high-gain" approach that could be a major breakthrough in the field. The galantamine-memantine combination has the potential to treat positive, cognitive, and negative symptoms, and targeting the quintuple hypotheses concurrently may lead to a major scientific advancement - from antipsychotic treatment to antischizophrenia treatment.
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Affiliation(s)
- Maju Mathew Koola
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Kızıltan ME, Leba LK, Gündüz A, Pazarcı N, Özkara Ç, Yeni N. Does Valproic Acid/Na Valproate Suppress Auditory Startle Reflex in Patients With Epilepsy? Clin EEG Neurosci 2018; 49:407-413. [PMID: 29262725 DOI: 10.1177/1550059417747155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Auditory startle response (ASR) was normal in juvenile myoclonic epilepsy whereas it was suppressed in progressive myoclonic epilepsy. However, both groups were using valproic acid/Na valproate (VPA) in different doses. Therefore, we aimed to analyze whether VPA has an impact on ASR in a cohort of epilepsy. For this purpose, we included patients with epilepsy and analyzed ASR in patients who were using VPA. PATIENTS AND METHOD We included 51 consecutive patients who had epilepsy and were using VPA between January 2014 and January 2016. Two control groups of 37 epilepsy patients using other antiepileptic drugs (AEDs) and of 25 healthy subjects were also constituted. All participants underwent investigations of ASR and startle response to somatosensory inputs (SSS) under similar conditions. RESULTS An analysis of patients using VPA, not using VPA and healthy subjects revealed significantly longer latency and lower probability of orbicularis oculi (O.oc) and sternocleidomastoid responses after auditory stimulation, decreased total ASR probability and longer latency of O.oc response after somatosensory stimulation in patient groups compared with healthy subjects. Multivariate analysis showed type of AED had a role in the generation of abnormalities. VPA, carbamazepine, and multiple AED use caused suppression of ASR. Total ASR probability was decreased or O.oc latency got longer with longer duration of VPA use whereas serum VPA level at the time of investigation did not correlate with total ASR probability. DISCUSSION Both ASR and SSS are suppressed by the effect of VPA, especially in patients using for a long period and in patients using other AEDs with VPA. Given the fact that VPA leads to long-standing synaptic changes of dopaminergic transmission, abnormalities of this network may be the more likely cause.
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Affiliation(s)
- Meral E Kızıltan
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Leyla Köse Leba
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayşegül Gündüz
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nevin Pazarcı
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Çiğdem Özkara
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Naz Yeni
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
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Koola MM. Attenuated Mismatch Negativity in Attenuated Psychosis Syndrome Predicts Psychosis: Can Galantamine-Memantine Combination Prevent Psychosis? MOLECULAR NEUROPSYCHIATRY 2018; 4:71-74. [PMID: 30397594 PMCID: PMC6206967 DOI: 10.1159/000488797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/26/2018] [Indexed: 12/13/2022]
Abstract
Although first proposed in 1987, early diagnosis and intervention of psychotic disorders has only recently become a priority in the field. The interest in clinical high risk (CHR) for psychosis skyrocketed after attenuated psychosis syndrome (APS) was added to the DSM-5. There is evidence that in individuals with APS, attenuated mismatch negativity (MMN: functioning of the auditory sensory memory system) is a robust biomarker that can predict transition to psychosis. The underlying pathophysiological mechanism of MMN is via the interaction of N-methyl-D-aspartate (NMDA) and alpha-7 nicotinic acetylcholine (α-7nACh) receptors. Galantamine is an acetylcholinesterase inhibitor and a positive allosteric modulator of the α-7nACh receptors. Memantine is an NMDA receptor antagonist. Memantine has been shown to enhance MMN in people with schizophrenia. Although no studies with galantamine have measured MMN, encenicline, an α-7 nicotinic partial agonist, increased MMN in people with schizophrenia. MMN has been suggested as a potential biomarker with the galantamine-memantine combination for the treatment of neuropsychiatric disorders. Hence, the galantamine-memantine combination may enhance MMN, thereby preventing CHR to psychosis. With no treatments available, randomized controlled trials are warranted with the galantamine-memantine combination to delay or prevent conversion to psychosis in individuals with CHR.
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Affiliation(s)
- Maju Mathew Koola
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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50
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Room to move: Plasticity in early auditory information processing and auditory learning in schizophrenia revealed by acute pharmacological challenge. Schizophr Res 2018; 199:285-291. [PMID: 29627173 PMCID: PMC6151271 DOI: 10.1016/j.schres.2018.03.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 11/23/2022]
Abstract
Many patients with chronic psychotic disorders including schizophrenia (SZ) maintain meaningful levels of plasticity (i.e., capacity for change) within neurocognition-relevant brain mechanisms, as evidenced by gains in neurocognition and function after interventions such as targeted cognitive training. However, like many clinical features of these disorders, therapeutic responses in SZ are heterogeneous, and prospectively identifying treatment-sensitive individuals and individualized treatment modalities remains an unmet challenge. We propose that available plasticity in neurocognition-relevant brain mechanisms in individual SZ patients can be detected by gains in laboratory measures of early auditory information processing (EAIP) and auditory learning after a single challenge-dose of a pharmacologic agent; here, we present supportive data for this strategy with the non-competitive NMDA antagonist, memantine, and the psychostimulant, amphetamine. We describe a novel therapeutic model where this "challenge dose" strategy is used to prospectively identify a sensitive cohort of patients, and in these patients, a therapeutic response is elicited by pairing drug-enhanced EAIP and auditory learning with auditory-based targeted cognitive training.
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