GABA and Homovanillic Acid in the Plasma of Schizophrenic and Bipolar I Patients

We have determined the plasma (p) concentration of gamma-aminobutyric acid (GABA) and the dopamine metabolite homovanillic acid (HVA), and the pHVA/pGABA ratio in schizophrenic and bipolar patients. The research was undertaken in a geographic area with an ethnically homogeneous population. The HVA plasma concentrations were significantly elevated in the schizophrenic patients compared to the bipolar patients. The levels of pGABA was significantly lower in the two groups of patients compared to the control group, while the pHVA/pGABA ratio was significantly greater in the both groups of patients compared to the controls. As the levels of pHVA and pGABA are partially under genetic control it is better to compare their concentrations within an homogeneous population. The values of the ratio pHVA/pGABA are compatible with the idea of an abnormal dopamine-GABA interaction in schizophrenic and bipolar patients. The pHVA/pGABA ratio may be a good peripheral marker in psychiatric research.     

A new approach to biochemical evaluation of brain dopamine metabolism

1. Dopaminergic neurotransmission in brain is receiving increased attention because of its known involvement in Parkinson's disease and new methods for the treatment of this disorder and because of hypotheses relating several psychiatric disorders to abnormalities in brain dopaminergic systems. 2. Chemical assessment of brain dopamine metabolism has been attempted by measuring levels of its major metabolite, homovanillic acid (HVA), in cerebrospinal fluid, plasma, or urine. Because HVA is derived in part from dopamine formed in noradrenergic neurons, plasma levels and urinary excretion rates of HVA do not adequately reflect solely metabolism of brain dopamine. 3. Using debrisoquin, the peripheral contributions of HVA to plasma or urinary HVA can be diminished, but the extent of residual HVA formation in noradrenergic neurons is unknown. By measuring the levels of methoxy-hydroxyphenylglycol (MHPG) in plasma or of urinary norepinephrine metabolites (total MHPG in monkeys; the sum of total MHPG and vanillyl mandelic acid (VMA) in humans) along with HVA, it is possible to estimate the degree of impairment by debrisoquin of HVA formation from noradrenergic neuronal dopamine and thereby better assess brain dopamine metabolism. 4. This method was applied to a monkey before and after destruction of the nigrostriatal pathway by the administration of MPTP.     

The acute effects of central- and peripheral-acting dopamine antagonists on plasma HVA in schizophrenic patients

The short-term effects of fluphenazine on plasma HVA concentrations were compared with the effects of fluphenazine and concurrent administration of debrisoquin, a monoamine oxidase inhibitor which does not cross the blood brain barrier and is used to enhance the CNS contribution to circulating plasma HVA concentrations. Fluphenazine significantly increased plasma HVA with or without debrisoquin 24 hours following the initiation of treatment. Domperidone, a butyrophenone dopamine antagonist which acts only in the peripheral nervous system, failed to alter plasma HVA concentrations. These data suggest that the acute effects of neuroleptic drugs on plasma HVA concentrations are dependent upon interaction with CNS dopaminergic systems and provide additional support for the use of plasma HVA as a reflection of CNS dopamine system activity in clinical studies.     

Variability of Plasma Homovanillic Acid Over 13?Months in Patients with Schizophrenia; Relationship with the Clinical Response and the Wisconsin Card Sort Test

In the present study we have measured, on a monthly basis, the concentration of plasma homovanillic acid (pHVA) in schizophrenic patients during 13?months of their pharmacological treatment. The average pHVA values of each patient were within the range of 7.30-17.70?ng/ml and the coefficients of variation for each patient (CV %) were within the range of 13-33%. Half of the patients that showed higher pHVA CV% values also showed higher scores on the Brief Psychiatric Rating Scale at the beginning of the study, and improved more after 6?months, when compared to the remaining 50% with lower CV% values. There was no significant relationship between the scores of the Wisconsin Card Sort Test and the concentration or the CV% of the pHVA of each patient. A greater variability in the pHVA may be associated with a greater plasticity of the dopaminergic system and a better clinical response.     

Effect of MPTP-induced parkinsonism in monkeys on the urinary excretion of HVA and MHPG during debrisoquin administration

During debrisoquin administration to three monkeys there were significant reductions in excretion rates of HVA, the major dopamine metabolite, and MHPG, the major norepinephrine metabolite. Excretion rates of HVA were highly correlated to those of MHPG. The regression line relating HVA and MHPG excretion suggests that a portion of HVA (about 25%) is derived from a source independent of norepinephrine metabolites. There was a striking reduction of this portion of HVA excretion after MPTP-induced destruction of dopaminergic nigrostriatal neurons. These results support the view that the rate of HVA formation in brain dopaminergic neurons can be estimated from the relationship of urinary excretion rates of HVA and MHPG before and during debrisoquin treatment.     

Plasma homovanillic acid as an index of brain dopamine metabolism: Enhancement with debrisoquin

Plasma levels of the dopamine (DA) metabolite homovanillic acid (HVA) may be a useful measure of brain HVA production by central DA systems. Even though there is a significant peripheral contribution to plasma HVA, experimental manipulations that alter brain HVA produce parallel changes in plasma HVA levels. This study was designed to assess whether the ability of plasma HVA to reflect haloperidol induced increases in brain HVA could be strengthened by reducing the contribution to plasma HVA from peripheral sources. Debrisoquin sulfate, a monoamine oxidase inhibitor that does not enter the brain, was given in a low dose schedule to rats and lowered the peripheral contribution to plasma HVA by between 42 and 68%, resulting in a situation where between 62 and 87% of plasma HVA derived from brain. Using this dose schedule, rats pretreated with debrisoquin displayed a significant increase in plasma HVA following a lower dose of haloperidol than that required in the vehicle pretreated rats. In the debrisoquin pretreated group, a 71% increase in brain HVA was accompanied by a significant 60% increase in plasma HVA, whereas the vehicle pretreated group required a 136% increase in brain HVA to display a significant 50% increase in plasma. These findings indicate that debrisoquin pretreatment improves the reliability of plasma HVA to reflect changes in brain DA metabolism. Plasma HVA samples obtained from humans following debrisoquin may provide a clinically applicable method for assessing brain DA systems in neurologic and psychiatric illness.     

Catecholamine metabolites in human plasma as indices of brain function: Effects of debrisoquin

Metabolites of catecholamine neurotransmitters in plasma are, potentially, an easily available indicator of brain function in man. The peripheral contribution to these metabolites was lowered by debrisoquin sulfate, a monoamine oxidase inhibitor that does not enter the brain. In the monkey, it had been shown that debrisoquin decreased peripheral production of the dopamine metabolite, homovanillic acid (HVA), without changing production by brain; production of the norepinephrine metabolite, 3-methoxy-4-hydroxyphenethyleneglycol (MHPG) was decreased peripherally and in brain. Low-dose debrisoquin administration in man eliminated about 80% of the peripheral contribution to HVA and MHPG in plasma, resulting in a situation in which at least 75% of these metabolites in plasma were from the brain. Under these conditions, HVA and MHPG in plasma had a significant correlation. It could also be estimated that production of MHPG by brain was reduced 55%. Debrisoquin potentially provides a method for studying brain catecholamines through their metabolites in plasma and for treating conditions of brain noradrenergic excess.     

Effects of debrisoquin on CSF and plasma HVA concentrations in man

Data from animal studies indicate neuroleptic drugs act via their properties as antagonists of CNS dopamine (DA) receptors and this finding has led to the suggestion that alterations in CNS DA neuronal function are associated with psychotic disorders. Clinical investigations of this hypothesis, however, have been hindered by the lack of the availability of a direct and relatively easily obtained index of CNS DA neuronal activity. The work reported here was aimed at the development of such an index. Using a double blind design, human male subjects were given either placebo or debrisoquin, which is a monoamine oxidase inhibitor which does not penetrate brain. On the baseline day (no debrisoquin) and after 6 and 13 days of drug administration blood samples were obtained. In addition, for some patients CSF specimens were obtained via lumbar puncture on the baseline day and after 13 days of drug administration. It was found that debrisoquin produced a highly significant decrease in plasma homovanillic acid (HVA) concentrations whereas the concentrations of HVA in CSF were unchanged. In addition, it was found that the correlation between CSF and plasma HVA prior to debrisoquin was non-significant (r = 0.39, p = N.S., N = 10) whereas after 13 days of debrisoquin treatment the correlation was highly significant (r = 0.95, p less than .01, N = 7). These findings suggest that the administration of debrisoquin produces a situation in which plasma HVA reflects CNS HVA production, and as such debrisoquin may be a useful tool for the clinical investigator who is interested in studying relationships in human subjects between CNS DA neuronal system function and psychopathological states or other disorders which may be mediated via brain DA systems.     

Plasma-free homovanillic acid: within- and across-day stability in children and adults with Tourette's syndrome

Within- and across-day stability of plasma-free homovanillic acid (pHVA) was assessed in children and adults with Tourette's syndrome. A diurnal fall in pHVA was observed in 13 of 15 subjects. There was a small but significant (p less than .0001) decrease (8%) in mean morning pHVA levels obtained just 20 minutes apart (8:30 A.M. and 8:50 A.M.). A substantial and significant (p less than .001) mean decrease in pHVA (25%) was observed when samples obtained between 8:00 and 8:30 A.M. were compared with samples obtained at 12:00 noon. Changes in pHVA levels observed during the afternoon (between 12:00 noon and 4:00 P.M.) were small, nondirectional, and nonsignificant. Repeated measurement of morning pHVA in the same individual after 24 or more hours revealed marked increases or decreases in many individuals, suggesting that morning pHVA is not a stable measure. The results of this and previous studies suggest that pHVA obtained at 12:00 noon or later in the day may be a more reliable measure of centrally produced HVA. Further studies are needed regarding the stability of pHVA over time.     

Hyperprolactinemia in hepatic encephalopathy may result from impaired central dopaminergic neurotransmission

Ten patients with liver disease and hepatic encephalopathy (HE) and eight normal controls were studied. Five of the 10 HE patients had hyperprolactinemia. The administration of L-dopa produced a decrease of serum prolactin in all. Prior administration of Carbidopa, a peripheral decarboxylase inhibitor, did not change the prolactin suppression by L-dopa in the normal controls or in the patients with normal baseline prolactin levels. In the hyperprolactinemic group, Carbidopa significantly inhibited the response to L-dopa. Impaired central neurotransmission, at least involving the hypothalamic-pituitary dopaminergic system, may underlie the hyperprolactinemia in HE.     

Plasma Homovanillic Acid and Prolactin in Huntington’s Disease

Dopaminergic activity is expected to be altered in patients with Huntington’s disease (HD) and be related to factors like duration and severity of illness or patients’ specific symptomatology like dementia, depression, or psychotic features. We assessed plasma homovanillic acid (pHVA) and plasma prolactin (pPRL), two correlates of dopaminergic activity, in 116 subjects with CAG repeats expansion in the HD gene, 26 presymptomatic (18 females) and 90 with overt symptomatology (43 females). Patients were evaluated using the Unified HD Rating Scale and the Total Functional Capacity Scale. Presence of dementia, depression, and psychotic features were also assessed. The age range of the patients was 22–83 years, duration of illness from 0.5 to 27 years, and CAG repeat number from 34 to 66. A group of 60 age and sex matched healthy subjects served as control group. Plasma PRL in subjects at risk and in neuroleptic-free patients, evaluated separately for males and females, did not differ from controls. Plasma HVA levels did not differ from controls in the group of presymptomatic subjects, but were significantly higher in the patients group. This increase was positively associated mainly with severity of illness and functional capacity of the patients, and not with presence of depression or dementia. Plasma HVA levels may be proven to be a peripheral index of disease progression. Reducing dopaminergic activity may have not only symptomatic, but also neuroprotective effects in HD.     

Systemic administration of neuregulin-1β1 protects dopaminergic neurons in a mouse model of Parkinson's disease

Neuregulin-1 (Nrg1) is genetically linked to schizophrenia, a disease caused by neurodevelopmental imbalance in dopaminergic function. The Nrg1 receptor ErbB4 is abundantly expressed on midbrain dopaminergic neurons. Nrg1 has been shown to penetrate blood-brain barrier, and peripherally administered Nrg1 activates ErbB4 and leads to a persistent hyperdopaminergic state in neonatal mice. These data prompted us to study the effect of peripheral administration of Nrg1 in the context of Parkinson's disease, a neurodegenerative disorder affecting the dopaminergic system in the adult brain. We observed that systemic injections of the extracellular domain of Nrg1β(1) (Nrg1β(1)-ECD) increased dopamine levels in the substantia nigra and striatum of adult mice. Nrg1β(1)-ECD injections also significantly protected the mouse nigrostriatal dopaminergic system morphologically and functionally against 6-hydroxydopamine-induced toxicity in vivo. Moreover, Nrg1β(1)-ECD also protected human dopaminergic neurons in vitro against 6-hydroxydopamine. In conclusion, we have identified Nrg1β(1)-ECD as a neurotrophic factor for adult mouse and human midbrain dopaminergic neurons with peripheral administratability, warranting further investigation as therapeutic option for Parkinson's disease patients.     

Impact of growth hormone administration on other hormonal axes

Growth hormone regulates several other hormonal systems and vice versa. The present review focusses on the effect of GH administration in adults on selected hormonal systems. Growth hormone treatment has been linked to development of central hypothyroidism in hypopituitary children. We now know that GH enhances the extra-thyroidal conversion of T(4) to T(3). Lowering of T(4) during GH treatment therefore reflects biochemical unmasking of subclinical central hypothyroidism. In normal adults GH administration does not affect the pituitary-gonadal axis. There is, however, evidence to suggest that GH substitution in hypopituitary adults enhances peripheral actions of sex steroids (males) and stimulates gonadal function (females). Both increased, unchanged and reduced basal and ACTH stimulated glucocorticoid levels have been reported during GH treatment. Several groups have recorded reduced levels of cortisol binding globulin with unchanged free cortisol concentrations. Regular assessment of thyroid and glucocorticoid status during GH substitution in GH-deficient patients is recommended.     

Is the treatment with psychostimulants in children and adolescents with attention deficit hyperactivity disorder harmful for the dopaminergic system?

A major concern regarding psychostimulant medication (amphetamine and methylphenidate) in the treatment of children and adolescents with attention deficit/hyperactivity disorder (ADHD) are the potential adverse effects to the developing brain, particularly in regard to dopaminergic brain function. The present review focuses on the pharmacology of these psychostimulants, their mode of action in the human brain and their potential neurotoxic effects to the developing brain in animals, particularly concerning DA brain function. The potential clinical significance of these findings for the treatment of ADHD in children and adolescents is discussed. Studies on sensitization to psychostimulants’ rewarding effects, which is a process expected to increase the risk of substance abuse in humans, are not included. The available findings in non-human primates support the notion that the administration of amphetamine and methylphenidate with procedures simulating clinical treatment conditions does not lead to long-term adverse effects in regard to development, neurobiology or behaviour as related to the central dopaminergic system.     

Evidence for a dopaminergic involvement in the inhibitory effect of alpha human natriuretic peptide on prolactin in man

Recently, it has been suggested that Atrial Natriuretic Peptides (ANP), as well as peripheral hormones, may have a role as central neurotransmitters or neuromodulators, and in humans it has been observed that alpha human ANP inhibits prolactin secretion. In this study, on 12 normal adult males, we evaluated the effects of ANP on the prolactin release induced by TRH and by the dopaminergic blocker sulpiride. Alpha-hANP administration was followed by a significant fall of prolactin plasma levels but did not influence TRH-induced prolactin response. Nevertheless, sulpiride-induced prolactin secretion was significantly lower after Alpha-hANP administration than after placebo pre-treatment (p values ranging between 0.01 and 0.001). Our results suggest that in man Alpha-hANP has no direct influence on lactotrope cells in inhibiting prolactin secretion, but seems to involve activation of the hypothalamic dopaminergic system.     

Brain glucose and insulin: effects on food intake and brain biogenic amines of rainbow trout

The effects of central (intracerebroventricular, 9 g fish^–1) and peripheral (intraperitoneal, 4 mg kg^–1) administration of bovine insulin, as well as the effect of hyperglycemia (oral administration of 1 g glucose fish^–1) and brain glucodeprivation (intracerebroventricular administration of 2-deoxy-D-glucose) on food intake and levels of brain (telencephalon, preoptic area, and hypothalamus) biogenic amines (serotonin, dopamine, noradrenaline and their metabolites 5-hydroxyindoleacetic acid, and dihydroxyphenylacetic acid) were assessed on rainbow trout (Oncorhynchus mykiss). Treatment with insulin inhibited food intake after 26 or 52 h of administration, central or peripheral, respectively. This effect was still apparent after 74 h of central treatment. When assessing changes in the levels of biogenic amines after 26 h of central insulin administration, there was a significant increase in the levels of 5-hydroxyindoleacetic acid, and in the ratio of dihydroxyphenylacetic acid/dopamine of insulin-treated fish, in telencephalon and hypothalamus, respectively. These results suggest that peripherally administered insulin is involved in a feedback regulatory loop with food intake and body weight. Moreover, at least part of the effects of insulin could be mediated by hypothalamic dopaminergic activity. The strong hyperglycemia induced by oral administration of glucose did not induce significant changes either on food intake (control versus treated), or in brain levels of biogenic amines. The intracerebroventricular administration of 2-deoxy-D-glucose induced an increase in food intake without altering plasma glucose levels, suggesting that fish brain possesses a control system for detecting hypoglycemia in plasma and therefore keep brain glucose levels high enough for brain function.Abbreviations 2-DG 2 Deoxy-D-glucose - 5-HIAA 5-Hydroxyindoleacetic acid - 5-HT 5-Hydroxytryptamine or serotonin - DA Dopamine - DOPAC Dihydroxyphenylacetic acid - EDTA Ethylenediaminetetraacetic acid - FI Food intake - HPLC High pressure liquid chromatography - icv Intracerebroventricular - i.p. Intraperitoneal - MS 222 3-Aminobenzoic acid ethyl esther methanesulfonate salt - NA Noradrenaline     

Effects of oral L-tyrosine administration on CSF tyrosine and homovanillic acid levels in patients with Parkinson's disease

To determine whether 1-tyrosine administration can enhance dopamine synthesis in humans as it does in rats, we measured levels of tyrosine and the major dopamine metabolite, homovanillic acid, in lumbar spinal fluids of 23 patients with Parkinson's disease before and during ingestion of 100 mg/kg/day of tyrosine. Nine patients took 100 mg/kg/day of probenecid in six divided doses for 24 hours prior to each spinal tap; 14 patients did not receive probenecid. L-tyrosine administration significantly increased CSF tyrosine levels in both groups of patients (p less than .01) and significantly increased homovanillic acid levels in the group of patients pretreated with probenecid (p less than .02). These data indicate that l-tyrosine administration can increase dopamine turnover in patients with disorders in which physicians wish to enhance dopaminergic neurotransmission.     

Penetration of DGAVP (Org 5667) across the blood-brain barrier in human subjects

To assess the penetration of desglycinamide-arginine-vasopressin (DGAVP, Org 5667) to the central nervous system, levels of DGAVP were measured in the lumbar CSF after peripheral administration. DGAVP (2 mg) was administered intranasally to 37 patients and CSF samples were collected from these patients 5 to 240 minutes later. Detectable levels of DGAVP in CSF could be found 5 minutes after administration, but levels declined rapidly during the next 90 minutes. The DGAVP levels in CSF correlated with plasma levels of DGAVP (r=0.586, p less than 0.001). According to these results, DGAVP may gain access to the central nervous system and may induce central effects.     

Disturbed prolactin responses to dopamine-related substances in patients with acromegaly and hyperprolactinemia

We undertook this study, because conflicting data were reported about the dopaminergic regulation of prolactin (PRL) secretion in patients with acromegaly and hyperprolactinemia. In order to clarify the dopaminergic regulation of PRL secretion in patients with acromegaly and hyperprolactinemia, the effects of nomifensine, a central dopamine agonist, FK 33-824, a centrally antidopaminergically acting agent, and domperidone, a peripheral dopamine antagonist, on plasma PRL in these patients were studied. The results were compared with those observed in normal subjects and hyperprolactinemic patients, with or without a pituitary tumor. Nomifensine did not lower the PRL levels and FK 33-824 did not raise the PRL levels in acromegalic patients. In hyperprolactinemic patients, nomifensine did not lower the PRL levels and FK 33-824 failed to raise the PRL levels. Domperidone did not increase PRL in about a third of acromegalic patients, while TRH increased PRL in the all normoprolactinemic acromegalic patients. These results suggest that in acromegalic patients there may be a disturbance in dopamine related neurotransmission and that such disorders also seem to be present in patients with hyperprolactinemia, with or without a pituitary tumor.     

Various aspects of dopaminergic function in patients with prolactin-secreting hypophyseal adenoma

Controversial data have been published in these last years on the dopaminergic tonus of tubero infundibular (TIDA) neurons in hyperprolactinemic subjects. Some authors retain that L-Dopa (LD) stimulation test after pretreatment with Carbidopa (CD), a dopa decarboxylase inhibitor substance, may reveal the presence of a central Dopamine (DA) defect in patient with prolactinoma. To elucidate the reason of so different activity of DA central tonus in subjects with prolactinoma, the effects of Nomifensine (NOM), an indirect DA agonist, DOM, Carbidopa/L-Dopa (CD/LD) and LD, were studied in 26 prolactinoma patients, (basal Prl levels 50 to 280 ng/ml). The patients (24-39 years) were characterized by secondary amenorrhea with sella turcica enlargement at hypocicloidal polytomography. The NOM administration resulted unable to reduce Prl plasma levels in all the patients. On the basis of Prl response to CD/LD administration the patients were subdivided in two groups: group A, which showed a significant decrease of Prl plasma levels and group B, who did not show any significant change. LD test induced a significant Prl decrease in all patients with more evident response in these of group A. DOM administration induced a Prl rise in patients of group A, but failed to change significantly Prl levels in group B subjects. These results confirming the high validity of NOM inhibiting test in the diagnosis of tumoural hyperprolactinemic states, reveal contradictory responses to CD/LD, LD and DOM, with sustain the existence of 2 sub-group of Prolactinomas: with or without a maintained DA central tonus supporting the possibility of different etiopathogenetical factors in inducing a tumoural hyperprolactinemic states.