Abstract
Several lines of evidence suggest that up-regulation of immune response and alterations of kynurenine pathway function are involved in pathogenesis of schizophrenia. Correlations among clinical status (using PANNS, SANS and SAPS scales) and blood levels of kynurenic acid (KYNA), 3-hydroxykynurenine (3-HK) and levels of selected immunoactive molecules, soluble interleukin-2 receptor (sIL-2R), interferon-α (IFN-α) and IL-4 were analyzed in 51 chronic schizophrenia patients during acute relapse, after four weeks of therapy and at remission. KYNA levels were significantly lower in comparison with controls (N=45) throughout the study, whereas 3-HK did not differ from controls at admission and during therapy, but increased at remission. The KYNA/3-HK ratio and IL-4 levels, but not sIL-2R and IFN-α levels, were consistently decreased in schizophrenia patients at all analyzed time points. KYNA level and KYNA/3-HK ratio measured at admission correlated negatively with the duration of illness, whereas 3-HK level correlated negatively with the improvement of SANS score at discharge. sIL-2R level before treatment was positively linked with number of relapses. In the subgroup of patients with poor response to pharmacotherapy, treated with clozapine later on, initial KYNA level and the ratio KYNA/3-HK correlated negatively with number of relapses. Positive association of sIL-2R level with number of relapses was also evident in this subgroup. Furthermore, among these patients, starting IFN-α level was negatively linked with the improvement of total PANSS score at discharge. Presented here data support the concept of disturbed kynurenine pathway function in schizophrenia and suggest that assessment of KYNA and 3-HK levels during acute relapse might be useful in prediction of response to antipsychotic therapy. Deficit of peripheral KYNA and higher 3-HK levels could be associated with more severe symptoms of schizophrenia. Further studies with larger samples size are needed to validate our results.
References
Anderson G, Maes M (2013) TRYCAT pathway, NMDA receptor hypofunction, neurodevelopment and neuroprogression. Prog Neuro-Psychopharmacol Biol Psychiatry 42:5–19
Archer T, Ricci S, Garcia D, Ricciardi MR (2014) Neurodegenerative aspects in vulnerability to schizophrenia spectrum disorders. Neurotox Res 26(4):400–413
Barak V, Barak Y, Levine J, Nisman B, Roisman I (1995) Changes in interleukin-1 beta and soluble interleukin-2 receptor levels in CSF and serum of schizophrenic patients. J Basic Clin Physiol Pharmacol 6(1):61–69
Barry S, Clarke G, Scully P, Dinan TG (2009) Kynurenine pathway in psychosis: evidence of increased tryptophan degradation. J Psychopharmacol 23(3):287–294
Cazzullo CL, Sacchetti E, Galluzzo A, Panariello A, Colombo F, Zagliani A, Clerici M (2001) Cytokine profiles in drug-naive schizophrenic patients. Schizophr Res 47(2–3):293–298
Condray R, Dougherty GG, Keshavan MS, Reddy RD, Haas GL, Montrose DM, Matson WR, McEvoy J, Kaddurah-Daouk R, Yao JK (2011) 3-Hydroxykynurenine and clinical symptoms in first-episode neuroleptic-naive patients with schizophrenia. Int J Neuropsychopharmacol 14(6):756–767
Dafny N, Prieto-Gomez B, Dong WQ, Reyes-Vazquez C (1996) Interferon modulates neuronal activity recorded from the hypothalamus, thalamus, hippocampus, amygdala and the somatosensory cortex. Brain Res 734(1–2):269–274
Davidson S, Maini MK, Wack A (2015) Disease-promoting effects of type I interferons in viral, bacterial, and coinfections. J Interf Cytokine Res 35(4):252–264
Erbağci AB, Herken H, Köylüoglu O, Yilmaz N, Tarakçioglu M (2001) Serum IL-1beta, sIL-2R, IL-6, IL-8 and TNF-alpha in schizophrenic patients, relation with symptomatology and responsiveness to risperidone treatment. Mediat Inflamm 10(3):109–115
Erhardt S, Blennow K, Nordin C, Skogh E, Lindstrom L, Engberg G (2001) Kynurenic acid levels are elevated in the cerebrospinal fluid of patients with schizophrenia. Neurosci Lett 313(1–2):96–98
Erhardt S, Schwieler L, Emanuelsson C, Geyer M (2004) Endogenous kynurenic acid disrupts prepulse inhibition. Biol Psychiatry 56(4):255–260
Fila-Danilow A, Kucia K, Kowalczyk M, Owczarek A, Paul-Samojedny M, Borkowska P, Suchanek R, Kowalski J (2012) Association study of interleukin-4 polymorphisms with paranoid schizophrenia in the Polish population: a critical approach. Mol Biol Rep 39(8):7941–7947
Fineberg AM, Ellman LM (2013) Inflammatory cytokines and neurological and neurocognitive alterations in the course of schizophrenia. Biol Psychiatry 73(10):951–966
Gattaz WF, Dalgalarrondo P, Schröder HC (1992) Abnormalities in serum concentrations of interleukin-2, interferon-alpha and interferon-gamma in schizophrenia not detected. Schizophr Res 6(3):237–241
Haack M, Hinze-Selch D, Fenzel T, Kraus T, Kühn M, Schuld A, Pollmächer T (1999) Plasma levels of cytokines and soluble cytokine receptors in psychiatric patients upon hospital admission: effects of confounding factors and diagnosis. J Psychiatr Res 33(5):407–418
Heyes MP, Quearry B (1988) Quantification of 3-hydroxykynurenine in brain by high-performance liquid chromatography and electrochemical detection. J Chromatogr B 428:340–344
Hilmas C, Pereira EF, Alkondon M, Rassoulpour A, Schwarcz R, Albuquerque EX (2001) The brain metabolite kynurenic acid inhibits alpha7 nicotinic receptor activity and increases non-alpha7 nicotinic receptor expression: physiopathological implications. J Neurosci 21(19):7463–7473
Hoyo-Becerra C, Schlaak JF, Hermann DM (2014) Insights from interferon-α-related depression for the pathogenesis of depression associated with inflammation. Brain Behav Immun 42:222–231
Johansson AS, Owe-Larsson B, Asp L, Kocki T, Adler M, Hetta J, Gardner R, Lundkvist GB, Urbanska EM, Karlsson H (2013) Activation of kynurenine pathway in ex vivo fibroblasts from patients with bipolar disorder or schizophrenia: cytokine challenge increases production of 3-hydroxykynurenine. J Psychiatr Res 47(11):1815–1823
Kamińska T, Wysocka A, Marmurowska-Michalowska H, Dubas-Slemp H, Kandefer-Szerszeń M (2001) Investigation of serum cytokine levels and cytokine production in whole blood cultures of paranoid schizophrenic patients. Arch Immunol Ther Exp 49(6):439–445
Katafuchi T, Take S, Hori T (1995) Roles of cytokines in the neural-immune interactions: modulation of NMDA responses by IFN-alpha. Neurobiology 3(3–4):319–327
Katila H, Cantell K, Hirvonen S, Rimón R (1989) Production of interferon-alpha and gamma by leukocytes from patients with schizophrenia. Schizophr Res 2(4–5):361–365
Katila H, Cantell C, Appelberg B, Wahlbeck K, Naukkarinen H, Rimón R (1993) Interferon-alpha as adjuvant treatment in chronic schizophrenia. Neuropsychobiology 28(4):192–196
Kim YK, Myint AM, Lee BH, Han CS, Lee HJ, Kim DJ, Leonard BE (2004) Th1, Th2 and Th3 cytokine alteration in schizophrenia. Prog Neuro-Psychopharmacol Biol Psychiatry 28(7):1129–1134
Leucht S, Davis JM, Engel RR, Kissling W, Kane JM (2009) Definitions of response and remission in schizophrenia: recommendations for their use and their presentation. Acta Psychiatr Scand Suppl. (438):7–14. Erratum in: Acta Psychiatr Scand Suppl. 124(1):82
Maes M, Meltzer HY, Bosmans E (1994) Immune-inflammatory markers in schizophrenia: comparison to normal controls and effects of clozapine. Acta Psychiatr Scand 89(5):346–351
Miller BJ, Buckley P, Seabolt W, Mellor A, Kirkpatrick B (2011) Meta-analysis of cytokine alterations in schizophrenia: clinical status and antipsychotic effects. Biol Psychiatry 70(7):663–671
Müller M, Fontana A, Zbinden G, Gähwiler BH (1993) Effects of interferons and hydrogen peroxide on CA3 pyramidal cells in rat hippocampal slice cultures. Brain Res 13; 619(1–2):157–162
Müller N, Empl M, Riedel M, Schwarz M, Ackenheil M (1997) Neuroleptic treatment increases soluble IL-2 receptors and decreases soluble IL-6 receptors in schizophrenia. Eur Arch Psych Clin Neurosci 247(6):308–313
Müller N, Weidinger E, Leitner B, Schwarz MJ (2015) The role of inflammation in schizophrenia. Front Neurosci 9:372
Murakami Y, Ishibashi T, Tomita E, Imamura Y, Tashiro T et al (2016) Depressive symptoms as a side effect of interferon-α therapy induced by induction of indoleamine 2,3-dioxygenase. Sci Rep 6:29920
Myint AM (2012) Kynurenines: from the perspective of major psychiatric disorders. FEBS J 279(8):1375–1385
Myint AM, Schwarz MJ, Verkerk R, Mueller HH, Zach J, Scharpe S et al (2011) Reversal of imbalance between kynurenic acid and 3-hydroxykynurenine by antipsychotics in medication-naive and medication-free schizophrenic patients. Brain Behav Immun 25:1576–1581
Noto C, Ota VK, Gouvea ES, Rizzo LB, Spindola LM, Honda PH, Cordeiro Q, Belangero SI, Bressan RA, Gadelha A, Maes M, Brietzke E (2014) Effects of risperidone on cytokine profile in drug-naïve first-episode psychosis. Int J Neuropsychopharmacol 18(4):pyu042
O’Brien SM, Scully P, Dinan TG (2008) Increased tumor necrosis factor-alpha concentrations with interleukin-4 concentrations in exacerbations of schizophrenia. Psychiatry Res 160(3):256–262
Oxenkrug GF (2011) Interferon-gamma-inducible kynurenines/pteridines inflammation cascade: implications for aging and aging-associated psychiatric and medical disorders. J Neural Transm 118(1):75–85
Oxenkrug G, van der Hart M, Roeser J, Summergrad P (2016) Anthranilic acid: a potential biomarker and treatment target for schizophrenia. Ann Psychiatry Ment Health 4(2):1059
Park KW, Baik HH, Jin BK (2008) Interleukin-4-induced oxidative stress via microglial NADPH oxidase contributes to the death of hippocampal neurons in vivo. Curr. Aging Sci 1:192–201
Plitman E, Nakajima S, de la Fuente-Sandoval C, Gerretsen P, Chakravarty MM, Kobylianskii J, Chung JK, Caravaggio F, Iwata Y, Remington G, Graff-Guerrero A (2014) Glutamate-mediated excitotoxicity in schizophrenia: a review. Eur Neuropsychopharmacol 24(10):1591–1605
Potvin S, Stip E, Sepehry AA, Gendron A, Bah R, Kouassi E (2008) Inflammatory cytokine alterations in schizophrenia: a systematic quantitative review. Biol Psychiatry 63(8):801–808
Schwarcz R, Rassoulpour A, Wu H-Q, Medoff D, Tamminga CA, Roberts RC (2001) Increased cortical kynurenate content in schizophrenia. Biol Psychiatry 50(7):521–530
Schwarcz R, Bruno JP, Muchowski PJ, Wu HQ (2012) Kynurenines in the mammalian brain: when physiology meets pathology. Nat Rev Neurosci 13(7):465–477
Schwarz MJ, Krönig H, Riedel M, Dehning S, Douhet A, Spellmann I, Ackenheil M, Möller HJ, Müller N (2006) IL-2 and IL-4 polymorphisms as candidate genes in schizophrenia. Eur Arch Psychiatry Clin Neurosci 256(2):72–76
Szalardy L, Zadori D, Toldi J, Fulop F, Klivenyi P, Vecsei L (2012) Manipulating kynurenic acid levels in the brain—on the edge between neuroprotection and cognitive dysfunction. Current Topics in Med Chem 12(16):1797–1806
Tourjman V, Kouassi E, Koue ME, Rocchetti M, Fortin-Fournier S, Fusar-Poli P, Potvin S (2013) Antipsychotics’ effects on blood levels of cytokines in schizophrenia: a meta-analysis. Schizophr Res 151(1–3):43–47
Turski WA, Gramsbergen JB, Traitler H, Schwarcz R (1989) Rat brain slices produce and liberate kynurenic acid upon exposure to L-kynurenine. J Neurochem 52(5):1629–1636
Upthegrove R, Manzanares-Teson N, Barnes NM (2014) Cytokine function in medication-naive first episode psychosis: a systematic review and meta-analysis. Schizophr Res 155(1–3):101–108
Urbanska EM, Kocki T, Saran T, Kleinrok Z, Turski WA (1997) Impairment of brain kynurenic acid production by glutamate metabotropic receptor agonists. Neuroreport 8:3501–3505
Urbanska EM, Chmiel-Perzyńska I, Perzyński A, Derkacz M, Owe-Larsson B (2014) Endogenous kynurenic acid and neurotoxicity. In: Kostrzewa R (ed) Handbook of neurotoxicity, 1st edn. Springer, New Jork, pp 421–453
Wilke I, Arolt V, Rothermundt M, Weitzsch C, Hornberg M, Kirchner H (1996) Investigations of cytokine production in whole blood cultures of paranoid and residual schizophrenic patients. Eur Arch Psychiatry Clin Neurosci 246(5):279–284
Acknowledgements
This study was supported by grants from Medical University in Lublin, DS 450/14, DS 450/15, DS 450/16, DS 192/14, and DS 192/15.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Szymona, K., Zdzisińska, B., Karakuła-Juchnowicz, H. et al. Correlations of Kynurenic Acid, 3-Hydroxykynurenine, sIL-2R, IFN-α, and IL-4 with Clinical Symptoms During Acute Relapse of Schizophrenia. Neurotox Res 32, 17–26 (2017). https://doi.org/10.1007/s12640-017-9714-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12640-017-9714-0