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Zwicker JD, Smith D, Guerra AJ, Hitchens JR, Haug N, Vander Roest S, Lee P, Wen B, Sun D, Wang L, Keep RF, Xiang J, Carruthers VB, Larsen SD. Discovery and Optimization of Triazine Nitrile Inhibitors of Toxoplasma gondii Cathepsin L for the Potential Treatment of Chronic Toxoplasmosis in the CNS. ACS Chem Neurosci 2020; 11:2450-2463. [PMID: 32027110 DOI: 10.1021/acschemneuro.9b00674] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
With roughly 2 billion people infected, the neurotropic protozoan Toxoplasma gondii remains one of the most pervasive and infectious parasites. Toxoplasma infection is the second leading cause of death due to foodborne illness in the United States, causes severe disease in immunocompromised patients, and is correlated with several cognitive and neurological disorders. Currently, no therapies exist that are capable of eliminating the persistent infection in the central nervous system (CNS). In this study we report the identification of triazine nitrile inhibitors of Toxoplasma cathepsin L (TgCPL) from a high throughput screen and their subsequent optimization. Through rational design, we improved inhibitor potency to as low as 5 nM, identified pharmacophore features that can be exploited for isoform selectivity (up to 7-fold for TgCPL versus human isoform), and improved metabolic stability (t1/2 > 60 min in mouse liver microsomes) guided by a metabolite ID study. We demonstrated that this class of compounds is capable of crossing the blood-brain barrier in mice (1:1 brain/plasma at 2 h). Importantly, we also show for the first time that treatment of T. gondii bradyzoite cysts in vitro with triazine nitrile inhibitors reduces parasite viability with efficacy equivalent to a TgCPL genetic knockout.
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Affiliation(s)
- Jeffery D. Zwicker
- Vahlteich Medicinal Chemistry Core, College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Medicinal Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - David Smith
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Alfredo J. Guerra
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Jacob R. Hitchens
- Vahlteich Medicinal Chemistry Core, College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Medicinal Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Nicole Haug
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Steve Vander Roest
- Center for Chemical Genomics, Life Sciences Institute, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Pil Lee
- Vahlteich Medicinal Chemistry Core, College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Medicinal Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Bo Wen
- Pharmacokinetics Core, Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Duxin Sun
- Pharmacokinetics Core, Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Lu Wang
- Pharmacokinetics Core, Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Richard F. Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Jianming Xiang
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Vern B. Carruthers
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Scott D. Larsen
- Vahlteich Medicinal Chemistry Core, College of Pharmacy, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Medicinal Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States
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Burrells A, Opsteegh M, Pollock KG, Alexander CL, Chatterton J, Evans R, Walker R, McKenzie CA, Hill D, Innes EA, Katzer F. The prevalence and genotypic analysis of Toxoplasma gondii from individuals in Scotland, 2006-2012. Parasit Vectors 2016; 9:324. [PMID: 27267112 PMCID: PMC4895884 DOI: 10.1186/s13071-016-1610-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contemporary information relating to the prevalence of Toxoplasma gondii in humans is lacking for the UK population, with even less information available about the human prevalence of the parasite in Scotland. To address this, two different study groups were used to determine the prevalence and genotypes of Toxoplasma gondii in the Scottish population. METHODS The first study group included serum samples from blood donors (n = 3273) over a four-year period (2006-2009) and the second study group comprised of DNA samples extracted from human brains (n = 151) over a five-year period (2008-2012). A T. gondii IgG ELISA was performed to determine seroprevalence and available sera from individuals who had seroconverted were tested by TgERP ELISA (sporozoite specific antigen). Human brain DNA was tested for T. gondii by ITS1 PCR and positives genotyped at the SAG3 and GRA6 loci by PCR-RFLP analysis. RESULTS Seroprevalence to T. gondii from blood donors was found to be 13.2 % (95 % CI: 11.5-15.1 %). Evidence of seroconversion (n = 2) as well as reversion to sero-negative status (n = 6) was evident from blood donors who had donated within all four collection periods (n = 184). The TgERP ELISA (indicating oocyst infection) was positive for one individual. The molecular detection of T. gondii DNA from human brains indicated a prevalence of 17.9 % (95 % CI: 12.1-24.9 %), with genotyping identifying alleles for types I and III. An increase in age was associated with an increase in detection of the parasite within both study groups. CONCLUSIONS Our research provides current figures for the prevalence of T. gondii in Scotland and also shows evidence of seroreversion within the cohort of blood donors. In both study groups there was a correlation between increasing age and an increase in T. gondii prevalence, indicating that acquired infection plays an important role within the Scottish population.
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Affiliation(s)
- Alison Burrells
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, Scotland
| | - Marieke Opsteegh
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Kevin G Pollock
- Health Protection Scotland, National Services Scotland, Meridian Court, Glasgow, Scotland
| | - Claire L Alexander
- Scottish Parasite Diagnostic and Reference Laboratory, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Jean Chatterton
- Scottish Toxoplasma Reference Laboratory, Microbiology Department, Raigmore Hospital, Inverness, Scotland
| | - Roger Evans
- Scottish Toxoplasma Reference Laboratory, Microbiology Department, Raigmore Hospital, Inverness, Scotland
| | - Robert Walker
- Quintiles, Almondvale Way, Livingston, West Lothian, Scotland
| | - Chris-Anne McKenzie
- Sudden Death Brain Bank, Department of Pathology (Neuropathology) Wilkie Building Teviot Place, University of Edinburgh, Edinburgh, Scotland
| | - Dolores Hill
- USDA ARS, Northeast Area, Animal Parasitic Diseases Laboratory, Beltsville, Maryland, USA
| | - Elisabeth A Innes
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, Scotland
| | - Frank Katzer
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, Scotland.
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Sutterland AL, Fond G, Kuin A, Koeter MWJ, Lutter R, van Gool T, Yolken R, Szoke A, Leboyer M, de Haan L. Beyond the association. Toxoplasma gondii in schizophrenia, bipolar disorder, and addiction: systematic review and meta-analysis. Acta Psychiatr Scand 2015; 132:161-79. [PMID: 25877655 DOI: 10.1111/acps.12423] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To perform a meta-analysis on studies reporting prevalence of Toxoplasma gondii (T. gondii) infection in any psychiatric disorder compared with healthy controls. Our secondary objective was to analyze factors possibly moderating heterogeneity. METHOD A systematic search was performed to identify studies into T. gondii infection for all major psychiatric disorders versus healthy controls. Methodological quality, publication bias, and possible moderators were assessed. RESULTS A total of 2866 citations were retrieved and 50 studies finally included. Significant odds ratios (ORs) with IgG antibodies were found in schizophrenia (OR 1.81, P < 0.00001), bipolar disorder (OR 1.52, P = 0.02), obsessive-compulsive disorder (OR 3.4, P < 0.001), and addiction (OR 1.91, P < 0.00001), but not for major depression (OR 1.21, P = 0.28). Exploration of the association between T. gondii and schizophrenia yielded a significant effect of seropositivity before onset and serointensity, but not IgM antibodies or gender. The amplitude of the OR was influenced by region and general seroprevalence. Moderators together accounted for 56% of the observed variance in study effects. After controlling for publication bias, the adjusted OR (1.43) in schizophrenia remained significant. CONCLUSION These findings suggest that T. gondii infection is associated with several psychiatric disorders and that in schizophrenia reactivation of latent T. gondii infection may occur.
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Affiliation(s)
- A L Sutterland
- Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - G Fond
- AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Translationnelle, Université Paris Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France
| | - A Kuin
- Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - M W J Koeter
- Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - R Lutter
- Departments of Experimental Immunology and Respiratory Medicine, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - T van Gool
- Department of Parasitology, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - R Yolken
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Szoke
- AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Translationnelle, Université Paris Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France
| | - M Leboyer
- AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Translationnelle, Université Paris Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France
| | - L de Haan
- Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands
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Abstract
INTRODUCTION A number of different infections are associated with acute psychosis. However, relationships between infections and acute psychosis in patients with schizophrenia have not been extensively explored. Exposure to Toxoplasma gondii is a replicated risk factor for schizophrenia. Previous studies have focused on T. gondii IgG antibodies, which are a marker of lifetime exposure, whereas IgM antibodies are a marker of acute/recent exposure, persistent infection, or reinfection. We performed a meta-analysis of T. gondii IgM antibodies and acute psychosis, to further investigate whether infections may be associated with relapse in schizophrenia. METHODS We identified articles by systematic searches of PubMed, PsycINFO, and ISI databases. We included studies, in English, of serum T. gondii IgM antibodies in patients with acute psychosis and controls. RESULTS Sixteen independent samples (2353 patients and 1707 controls) met inclusion criteria. Data were pooled using a random effects model. There was a significant increase in risk of positive T. gondii IgM antibodies in acute psychosis compared with controls (7.6% vs 5.7%, OR = 1.68, 95% CI = 1.23-2.27, P = .001). The association was stronger for patients with chronic schizophrenia (8.7% vs 4.6%, OR = 2.54, 95% CI = 1.63-3.96, P < .001) than first-episode psychosis. In meta-regression analyses, age, sex, and publication year were unrelated to the association; however, there was a significant association with geographic region. DISCUSSION An increased seroprevalence of T. gondii IgM in patients with acute psychosis complements and extends previous findings, suggesting that infections may be relevant to the etiopathophysiology of relapse in some patients with schizophrenia.
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Affiliation(s)
- Joel M Monroe
- Department of Psychiatry and Health Behavior, Georgia Regents University, Augusta, GA
| | - Peter F Buckley
- Medical College of Georgia, Georgia Regents University, Augusta, GA
| | - Brian J Miller
- Department of Psychiatry and Health Behavior, Georgia Regents University, Augusta, GA;
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Fond G, Boyer L, Gaman A, Laouamri H, Attiba D, Richard JR, Delavest M, Houenou J, Le Corvoisier P, Charron D, Krishnamoorthy R, Oliveira J, Tamouza R, Yolken R, Dickerson F, Leboyer M, Hamdani N. Treatment with anti-toxoplasmic activity (TATA) for toxoplasma positive patients with bipolar disorders or schizophrenia: a cross-sectional study. J Psychiatr Res 2015; 63:58-64. [PMID: 25769398 DOI: 10.1016/j.jpsychires.2015.02.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/04/2015] [Accepted: 02/16/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The association between Toxoplasma gondii seropositivity and respectively Bipolar Disorder (BD) and Schizophrenia/Schizoaffective disorder (SZ) is one of the most studied link between one pathogen and psychiatric disorders. The aim of the present study was thus to retrospectively determine if the administration of an antipsychotic and/or a mood stabilizer having known in vitro Anti-Toxoplasmic Activity (TATA+) was associated with a better clinical outcome in a population of 152 BD or 114 SZ patients and seropositive for T. gondii infection compared to patients receiving a treatment without anti-toxoplasmic activity (TATA-). METHODS This multicenter study was conducted in an academic public hospital during a 3-years period between 2009 and 2011. All consecutive inpatients and outpatients with SZ or BD diagnosis with a stable treatment for more than 4 weeks were recruited. socio-demographic and clinical characteristics measured with validated scales as well as a serological status for toxoplasmic infection were included. Treatments were classified according to their in vitro antitoxoplasmic activity. A multivariate model was used to determine the clinical characteristics that were significantly different between patients receiving a treatment with no antitoxoplasmic activity compared to others. RESULTS BD patients with positive serum antibodies against T. gondii presented more lifetime depressive episodes (p = 0.048) after adjustment for age, sex and sociodemographic characteristics when treated by drug having no anti-toxo activity, compared to patients having received drugs with anti-toxo activity. A significant difference was not found in BD toxonegative patients and in SZ toxopositive or toxonegative patients. CONCLUSIONS It seems to be of importance to consider prescribing a drug with a clear anti-toxoplasmic activity (TATA+) for BD patients seropositive to T. gondii, in particular valproate that was found as the mood stabilizer with the highest antitoxoplasmic activity. Prospective randomized controlled trials are warranted to confirm this preliminary data.
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Affiliation(s)
- Guillaume Fond
- INSERM U955, Équipe de Psychiatrie Translationnelle, Université Paris-Est Créteil, DHU Pe-psy, Pôle de psychiatrie des hôpitaux universitaire H Mondor, Créteil, France; Fondation FondaMental Fondation de coopération scientifique en santé mentale, France.
| | - Laurent Boyer
- Fondation FondaMental Fondation de coopération scientifique en santé mentale, France; Pôle psychiatrie universitaire, CHU Sainte-Marguerite, F-13274 Marseille cedex 09, France
| | - Alexandru Gaman
- Fondation FondaMental Fondation de coopération scientifique en santé mentale, France
| | - Hakim Laouamri
- Fondation FondaMental Fondation de coopération scientifique en santé mentale, France
| | - Dodji Attiba
- Fondation FondaMental Fondation de coopération scientifique en santé mentale, France
| | - Jean-Romain Richard
- INSERM U955, Équipe de Psychiatrie Translationnelle, Université Paris-Est Créteil, DHU Pe-psy, Pôle de psychiatrie des hôpitaux universitaire H Mondor, Créteil, France; Fondation FondaMental Fondation de coopération scientifique en santé mentale, France
| | - Marine Delavest
- Fondation FondaMental Fondation de coopération scientifique en santé mentale, France; AP-HP, Université Paris Diderot, Service de Psychiatrie, Hôpital Lariboisiere Fernand Widal, Paris, F-75010, France
| | - Josselin Houenou
- INSERM U955, Équipe de Psychiatrie Translationnelle, Université Paris-Est Créteil, DHU Pe-psy, Pôle de psychiatrie des hôpitaux universitaire H Mondor, Créteil, France; Fondation FondaMental Fondation de coopération scientifique en santé mentale, France; CEA Saclay, Neurospin, Gif-Sur-Yvette, France
| | | | - Dominique Charron
- CIC 006 Henri Mondor INSERM & Plateforme de Ressources Biologiques, Université Paris Est Créteil, AP-HP, France
| | | | - José Oliveira
- Fondation FondaMental Fondation de coopération scientifique en santé mentale, France; Jean Dausset Laboratory & INSERM, UMRS 940, Hôpital Saint Louis, Paris, France
| | - Ryad Tamouza
- Jean Dausset Laboratory & INSERM, UMRS 940, Hôpital Saint Louis, Paris, France
| | - Robert Yolken
- Stanley Laboratory of Developmental Neurovirology, Johns Hopkins University Medical Center, Baltimore, MD, USA; Stanley Research Program, Sheppard Pratt, Baltimore, MD, USA
| | - Faith Dickerson
- Stanley Research Program, Sheppard Pratt, Baltimore, MD, USA
| | - Marion Leboyer
- INSERM U955, Équipe de Psychiatrie Translationnelle, Université Paris-Est Créteil, DHU Pe-psy, Pôle de psychiatrie des hôpitaux universitaire H Mondor, Créteil, France; Fondation FondaMental Fondation de coopération scientifique en santé mentale, France
| | - Nora Hamdani
- INSERM U955, Équipe de Psychiatrie Translationnelle, Université Paris-Est Créteil, DHU Pe-psy, Pôle de psychiatrie des hôpitaux universitaire H Mondor, Créteil, France; Fondation FondaMental Fondation de coopération scientifique en santé mentale, France
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Association between latent toxoplasmosis and psychiatric disorders in HIV-infected subjects. J Acquir Immune Defic Syndr 2015; 68:e8-9. [PMID: 25296099 DOI: 10.1097/qai.0000000000000384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fond G, Macgregor A, Tamouza R, Hamdani N, Meary A, Leboyer M, Dubremetz JF. Comparative analysis of anti-toxoplasmic activity of antipsychotic drugs and valproate. Eur Arch Psychiatry Clin Neurosci 2014; 264:179-83. [PMID: 23771405 DOI: 10.1007/s00406-013-0413-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/20/2013] [Indexed: 12/20/2022]
Abstract
Recent studies have shown a strong link between Toxoplasma gondii infection and psychiatric disorders, especially schizophrenia and bipolar disorders (odd ratio ≈2.7 for each disorder). Antipsychotic drugs and mood stabilizers may have anti-toxoplasmic activity that potentially may be associated with better effectiveness in these disorders, but previous results have been few in number and conflicting. We therefore sought to determine which daily prescribed antipsychotics and mood stabilizer have the best anti-toxoplasmic activity during the development phase of the parasite. In the present study, we examined the effects of commonly used antipsychotic drugs (amisulpride, cyamemazine, fluphenazine, haloperidol, levomepromazine, loxapine, olanzapine, risperidone and tiapride) and one mood-stabilizing agent (valproate) on toxoplasmic activity. We replicated that fluphenazine has a high anti-toxoplasmic activity, but it does not seem to be a phenothiazine-specific class effect: indeed, we found that another first-generation antipsychotic, zuclopenthixol, has a high anti-toxoplasmic activity. Valproate, tiapride and amisulpride have no anti-toxoplasmic activity on parasite growth, and the other antipsychotic drugs showed low or intermediate anti-toxoplasmic activity. As it is not possible to know the intracellular concentrations of antipsychotics in the brain, further clinical studies are warranted to determine whether these in vitro findings have potential implications in treatment of toxo-positive patients with schizophrenia. These findings may be potentially relevant for the choice of the first-line antipsychotic drug or mood stabilizer in previously infected patients.
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Affiliation(s)
- Guillaume Fond
- Fondation FondaMental Fondation de Coopération Scientifique en Santé Mentale, Eq Psychiatrie Génétique, INSERM U955, DHU Pepsy, Pôle de Psychiatrie du Groupe des Hôpitaux Universitaires de Mondor, Université Paris Est-Créteil, 94000, Créteil, France,
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Evaluation of kynurenine pathway metabolism in Toxoplasma gondii-infected mice: implications for schizophrenia. Schizophr Res 2014; 152:261-7. [PMID: 24345671 PMCID: PMC3922412 DOI: 10.1016/j.schres.2013.11.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/07/2013] [Accepted: 11/10/2013] [Indexed: 10/25/2022]
Abstract
Toxoplasma gondii, an intracellular protozoan parasite, is a major cause of opportunistic infectious disease affecting the brain and has been linked to an increased incidence of schizophrenia. In murine hosts, infection with T. gondii stimulates tryptophan degradation along the kynurenine pathway (KP), which contains several neuroactive metabolites, including 3-hydroxykynurenine (3-HK), quinolinic acid (QUIN) and kynurenic acid (KYNA). As these endogenous compounds may provide a mechanistic connection between T. gondii and the pathophysiology of schizophrenia, we measured KP metabolites in both the brain and periphery of T. gondii-treated C57BL/6 mice 8 and 28 days post-infection. Infected mice showed early decreases in the levels of tryptophan in the brain and serum, but not in the liver. These reductions were associated with elevated levels of kynurenine, KYNA, 3-HK and QUIN in the brain. In quantitative terms, the most significant increases in these KP metabolites were observed in the brain at 28 days post-infection. Notably, the anti-parasitic drugs pyrimethamine and sulfadiazine, a standard treatment of toxoplasmosis, significantly reduced 3-HK and KYNA levels in the brain of infected mice when applied between 28 and 56 days post-infection. In summary, T. gondii infection, probably by activating microglia and astrocytes, enhances the production of KP metabolites in the brain. However, during the first two months after infection, the KP changes in these mice do not reliably duplicate abnormalities seen in the brain of individuals with schizophrenia.
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