Treatment of cognitive deficits associated with schizophrenia: potential role of catechol-O-methyltransferase inhibitors

Molecules of madness

My professional life over five decades meandered from a high school ambition to be a psychiatrist and understand the "mind" to biochemical studies of neurotransmitters and drugs. Hopefully, the tale of my quirky impatient curiosity about "too many" different areas will be useful for young scientists embarking on their own careers.

Introduction: genes, cognition and neuropsychiatry

Numerous genes modulate dopamine and consequently prefrontal cortical function. Some of these genes - notably catechol-O-methyltransferase - have been shown to impact a variety of core cognitive processes that are dependent upon the prefrontal cortex. This demonstration that a single functional polymorphism can contribute so dramatically to individual differences heralds a new era for neuropsychiatry. Although enormous detail remains to be discovered about these various genes that regulate neurotransmitters, how they interact and how they affect brain systems, there is much excitement and promise regarding new neuropsychopharmacological possibilities. However, this new research program is magnitudes more complex than any enterprise embarked on hitherto and requires the development, validation and deployment of novel behavioural and neurophysiological phenotypes in order to unravel the pathologies within neural functional systems. This research foundation is essential if these genetic breakthroughs are to be translated to successful clinical agents.

A hotspot of inactivation: The A22S and V108M polymorphisms individually destabilize the active site structure of catechol O-methyltransferase

Human catechol O-methyltransferase (COMT) contains three common polymorphisms (A22S, A52T, and V108M), two of which (A22S and V108M) render the protein susceptible to deactivation by temperature or oxidation. We have performed multiple molecular dynamics simulations of the wild-type, A22S, A52T, and V108M COMT proteins to explore the structural consequences of these mutations. In total, we have amassed more than 1.4 micros of simulation time, representing the largest set of simulations detailing the effects of polymorphisms on a protein system to date. The A52T mutation had no significant effect on COMT structure in accord with experiment, thereby serving as a good negative control for the simulation set. Residues 22 (alpha2) and 108 (alpha5) interact with each other throughout the simulations and are located in a polymorphic hotspot approximately 20 A from the active site. Introduction of either the larger Ser (22) or Met (108) tightens this interaction, pulling alpha2 and alpha5 toward each other and away from the protein core. The V108M polymorphism rearranges active-site residues in alpha5, beta3, and alpha6, increasing the S-adenosylmethionine site solvent exposure. The A22S mutation reorients alpha2, moving critical catechol-binding residues away from the substrate-binding pocket. The A22S and V108M polymorphisms evolved independently in Northern European and Asian populations. While the decreased activities of both A22S and V108M COMT are associated with an increased risk for schizophrenia, the V108M-induced destabilization is also linked with improved cognitive function. These results suggest that polymorphisms within this hotspot may have evolved to regulate COMT activity and that heterozygosity for either mutation may be advantageous.

Genes, cognition and brain through a COMT lens

Various genes are known to modulate the delicate balance of dopamine in prefrontal cortex and influence cortical information processing. Catechol-O-methyltransferase (COMT) on chromosome 22q11 is the most widely studied of these genes. Val158Met, a common, functional variant in the coding sequence that increases or decreases the enzymatic activity of the gene has been shown to impact the efficiency of prefrontally-mediated cognition, specifically executive functioning, working memory, fluid intelligence and attentional control. We review the rapidly evolving literature exploring the association between COMT genotype and cognitive performance, and illustrate how this polymorphism has served a pivotal role in characterizing various interacting dimensions of complexity in the relationship between genes and cognition. We review how Val158Met has been used to help develop and validate behavioral and neurophysiological phenotypes, as a critical tool in dissecting overlapping neural functional systems and exploring interactions within and between genes, and in exploring how gene effects on cognition are modulated by environmental, demographic and developmental factors. Despite the impressive range of findings, the COMT story is also a bracing reminder of how much work remains to translate this knowledge into practical clinical applications.

Functional magnetic resonance in psychiatry

Neuroimaging is a powerful tool for the study of the neurobiological changes in psychiatric disorders. Functional magnetic resonance imaging (MRI) is a noninvasive method that assesses cortical activation by measuring changes in the local concentration of deoxyhemoglobin, which is paramagnetic and therefore can be detected using MRI. This method has been referred to as blood oxygen level-dependent imaging. This article discusses the application of functional MRI techniques, with emphasis on blood oxygen level-dependent imaging, to the study of psychiatric diseases. The first part of the article provides an overview of the contribution of functional MRI research to the current understanding of mood disorders, schizophrenia, and substance abuse. The last part reviews recent advances and highlights future directions for the use of the functional MRI technique for psychiatric research.

Using the MATRICS to guide development of a preclinical cognitive test battery for research in schizophrenia

Cognitive deficits in schizophrenia are among the core symptoms of the disease, correlate with functional outcome, and are not well treated with current antipsychotic therapies. In order to bring together academic, industrial, and governmental bodies to address this great 'unmet therapeutic need', the NIMH sponsored the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. Through careful factor analysis and consensus of expert opinion, MATRICS identified seven domains of cognition that are deficient in schizophrenia (attention/vigilance, working memory, reasoning and problem solving, processing speed, visual learning and memory, verbal learning and memory, and social cognition) and recommended a specific neuropsychological test battery to probe these domains. In order to move the field forward and outline an approach for translational research, there is a need for a "preclinical MATRICS" to develop a rodent test battery that is appropriate for drug development. In this review, we outline such an approach and review current rodent tasks that target these seven domains of cognition. The rodent tasks are discussed in terms of their validity for probing each cognitive domain as well as a brief overview of the pharmacology and manipulations relevant to schizophrenia for each task.

Tolcapone enhances food-evoked dopamine efflux and executive memory processes mediated by the rat prefrontal cortex

BACKGROUND AND RATIONALE

Genetic variations in catechol-O-methyl transferase (COMT) or administration of COMT inhibitors have a robust impact on cognition and executive function in humans. The COMT enzyme breaks down extracellular dopamine (DA) and has a particularly important role in the prefrontal cortex (PFC) where DA transporters are sparse. As such, the beneficial cognitive effects of the COMT inhibitor tolcapone are postulated to be the result of increased bioavailability of DA in the PFC. Furthermore, it has been shown previously that COMT inhibitors increase pharmacologically evoked DA but do not affect basal levels in the PFC.

OBJECTIVES

The current study characterized the ability of tolcapone to increase DA release in response to behaviorally salient stimuli and improve performance of the delayed spatial win-shift (DSWSh) task.

RESULTS AND CONCLUSIONS

Tolcapone enhanced PFC DA efflux associated with the anticipation and consumption of food when compared to saline controls. Chronic and acute treatment with tolcapone also reduced the number of errors committed during acquisition of the DSWSh. However, no dissociable effects were observed in experiments designed to selectively assay encoding or recall in well-trained animals, as both experiments showed improvement with tolcapone treatment. Taken together, these data suggest a generalized positive influence on cognition. Furthermore, these data support the conclusion of Apud and Weinberger (CNS Drugs 21:535-557, 2007) that agents which selectively potentiate PFC DA release may confer cognitive enhancement without the unwanted side effects produced by drugs that increase basal DA levels in cortical and subcortical brain regions.

Improvement of prepulse inhibition and executive function by the COMT inhibitor tolcapone depends on COMT Val158Met polymorphism

Recent evidence suggests that prepulse inhibition (PPI) levels relate to executive function possibly by a prefrontal cortex (PFC) dopamine (DA) link. We explored the effects of enhanced PFC DA signaling by the nonstimulant catechol-O-methyltransferase (COMT) inhibitor tolcapone, on PPI and working memory of subjects homozygous for the Val (low PFC DA) and the Met (high PFC DA) alleles of the COMT Val158Met polymorphism. Twelve Val/Val and eleven Met/Met healthy male subjects entered the study. Tolcapone 200 mg was administered in two weekly sessions, according to a balanced, crossover, double-blind, placebo-controlled design. PPI was assessed with 5 dB and 15 dB above background prepulses, at 30-, 60-, and 120 ms prepulse-pulse intervals. Subjects also underwent the n-back and the letter-number sequencing (LNS) tasks. PPI was lower in the Val/Val compared to the Met/Met group in the placebo condition. Tolcapone increased PPI significantly in the Val/Val group and tended to have the opposite effect in the Met/Met group. Baseline startle was not affected by tolcapone in the Val/Val group but it was slightly increased in the Met/Met group. Tolcapone improved performance in the n-back and LNS tasks only in the Val/Val group. Enhancement of PFC DA signaling with tolcapone improves both PPI and working memory in a COMT Val158Met genotype-specific manner. These results suggest that early information processing and working memory may both depend on PFC DA signaling, and that they may both relate to PFC DA levels according to an inverted U-shaped curve function.

Does COMT val158met affect behavioral phenotypes: yes, no, maybe?

The COMT gene functional polymorphism val(158)met is one of the most intensively studied variants in psychiatric genetics. Due to small effect size and various methodological issues, its role in various psychiatric disorders and behavioral traits has still not been unequivocally established. In this issue of Neuropsychopharmacology, several studies are presented supporting a role for COMT as a factor in cocaine addiction, brain reward activation, response to tolcapone, distractibility in ADHD, and fMRI bold response. The studies make important contributions to the growing literature that aim to establish an effect of this functional variant on behavioral phenotypes and treatment response.

The forthcoming revision of the diagnostic and classificatory system: perspectives based on the European psychiatric tradition

Europe has a rich tradition in psychopathology and psychiatric classification. This could be helpful developing new classification systems like ICD-11 and DSM-V. Some examples of this are described and further discussed, such as the categorical vs. the syndromatological approach, the relevance of hierarchical rules for the delineation of nosological entities, the antagonistic tradition of unitarian vs. splitting approaches and the relevance of a differentiated psychopathological description. Finally, the conclusion is that a too radical change of the classificatory system, e.g. in the direction of a purely symptomatical/dimensional systematic, or a totally new classification based on modern new biological findings, might be problematic and premature.

Systematic of psychiatric disorders between categorical and dimensional approaches: Kraepelin's dichotomy and beyond

This paper describes basic principles of systematics for psychiatric disorders such as the categorical and dimensional approach. It summarises validity aspects of the traditional psychiatric nosology and syndromatology. The importance and limitations of the dichotomy of schizophrenia and affective disorders, first suggested by Kraepelin, is reviewed in the light of results from modern research in the field of classification, follow-up and neurobiological studies, especially neurochemical, neurogenetic and neuroimaging studies. Current developments towards DSM-V and ICD-11 are critically reflected. The conclusion is reached that there might be insufficient data to establish a new systematics of psychoses. Therefore it might be premature to leave the Kraepelinian dichotomy totally although it has to be modified in the light of new research.

Neuroimaging and molecular genetics of schizophrenia: pathophysiological advances and therapeutic potential

There is impressive evidence for the involvement of several genetic risk factors in the aetiopathogenesis of schizophrenia. Most of these genes impact on neuropharmacological systems. Examining their relationship with brain imaging indices is arguably the best currently available method of examining these effects in vivo. In a sample of young, initially healthy people at high genetic risk of schizophrenia brain structure was measured with structural magnetic resonance imaging (sMRI) and brain function was indexed with neuropsychological tests and functional MRI. Regular detailed clinical assessments established whether subjects had developed psychotic symptoms and/or schizophrenia itself. The Catechol-O-Methyl Transferase (COMT) Val allele increased the risk of schizophrenia in this cohort in a dose-dependent manner. Subjects with this allele had reduced grey matter density in anterior cingulate cortex and increased fMRI activation in lateral prefrontal cortex and anterior and posterior cingulate. The risk allele in the Neuregulin 1 (NRG1) promoter region, on the other hand, was associated with the development of psychotic symptoms, decreased premorbid IQ and decreased activation of pre-frontal and temporal lobe regions. The NRG1 gene appears to be a risk factor for an extended or intermediate phenotype, while the COMT Val allele, which decreases the rate at which cortical dopamine is degraded compared to the Met allele, is associated with an increased risk of schizophrenia in subjects at increased familial risk. We provide examples of how these advances in our knowledge could lead to the development of new treatments for psychosis.