The majority of schizophrenia patients fail to achieve premorbid status and functional outcomes (e.g. employment, interpersonal relationships, independent living) are very poor, despite effective psychosis symptom reduction with antipsychotic medications. Cognitive impairments are broad and persistent and underlie the functional deficits of the illness. To date, however, there have been no characteristics identified in schizophrenia that provide good predictors for treatment targets of cognitive and functional deficits. Glutamate dysfunction may significantly contribute to the cognitive and functional deficits in schizophrenia. The proposed research is centered around the pathophysiological model of N-methyl-D-aspartate receptor (NMDAR) hypofunction of schizophrenia. This dysfunction produces damage to the dendritic portion of neurons, which leads to chronic cognitive and functional disabilities. Patients who have lower glutamate levels may manifest with broad cognitive impairment and greater social disabilities. Our short-term goal is to characterize the relationship between glutamate, cognition, and functional outcomes in schizophrenia. The documentation of these relationships is essential for us to achieve our long-term goal: to create a model that will allow the selection of specific patients that will be good candidates for glutamatergic modulation drug treatments. The proposed project will use a novel method, proton echo planar spectroscopic imaging (PEPSI) at 3 Tesla, to study glutamate concentrations in distinct cortical gray and white matter regions in schizophrenia. We will also measure N-acetylaspartate compounds (NAAc, a marker of neuronal viability), myoinositol (Ins, a glial marker) and GABA (the major inhibitory neurotransmitter). PEPSI is advantageous over other spectroscopy techniques because it provides superior spatial resolution (1cc voxels), with greater brain coverage (over 130 voxels), and very fast acquisition (under 10 min). To examine neurometabolism across different stages of the illness, 200 subjects with schizophrenia will be equally recruited into two groups: short illness duration (d10 yrs) and long duration (>10 yrs). Symptoms, side-effects, cognitive and social function will be assessed. A group of 200 healthy volunteers, matched in age, gender and parental socioeconomic status to the schizophrenia groups, will also be studied. This project will address four specific pressing issues: 1) The in-vivo examination of the relationship between glutamate, cognition, negative symptoms and social function in schizophrenia. 2) The evaluation of cortical pathology suggestive of dendritic damage (reduced gray matter NAAc), early in the illness. 3) The examination of a compensatory glial up-regulation (increased Ins) in older schizophrenia subjects. 4) The assessment of GABAergic dysfunction in schizophrenia. Documentation that reduced glutamate is a robust correlate of cognition in schizophrenia would support the use of glutamate enhancing agents to optimize cognitive function in vulnerable patients. As 3 Tesla scanners become widely available for standard of care, spectroscopy with PEPSI, may contribute to the identification of such individuals. This application presents extensive pilot data addressing all four of these issues.

Public Health Relevance

There is a need to develop effective treatments for cognitive impairment in schizophrenia. Glutamate dysfunction may underlie some of these impairments. We have developed a new technique, proton echo planar spectroscopic imaging, to measure brain glutamate. We propose to use this technique to examine the relationships between glutamate, cognition and social disability in schizophrenia. This is an essential step towards being able to select groups of patients whom may benefit from drugs that modulate glutamate function.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH084898-02
Application #
7882657
Study Section
Neural Basis of Psychopathology, Addictions and Sleep Disorders Study Section (NPAS)
Program Officer
Meinecke, Douglas L
Project Start
2009-07-01
Project End
2014-03-31
Budget Start
2010-04-01
Budget End
2011-03-31
Support Year
2
Fiscal Year
2010
Total Cost
$341,317
Indirect Cost
Name
University of New Mexico Health Sciences Center
Department
Psychiatry
Type
Schools of Medicine
DUNS #
829868723
City
Albuquerque
State
NM
Country
United States
Zip Code
87131
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Bustillo, Juan R; Chen, Hongji; Jones, Thomas et al. (2014) Increased glutamine in patients undergoing long-term treatment for schizophrenia: a proton magnetic resonance spectroscopy study at 3 T. JAMA Psychiatry 71:265-72
Bustillo, Juan; Galloway, Matthew P; Ghoddoussi, Farhad et al. (2012) Medial-frontal cortex hypometabolism in chronic phencyclidine exposed rats assessed by high resolution magic angle spin 11.7 T proton magnetic resonance spectroscopy. Neurochem Int 61:128-31
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Bustillo, Juan R; Chen, Hongji; Gasparovic, Charles et al. (2011) Glutamate as a marker of cognitive function in schizophrenia: a proton spectroscopic imaging study at 4 Tesla. Biol Psychiatry 69:19-27

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