Effect of Clozapine and Other Antipsychotics on the Level of Platelet-Associated Autoantibodies in Children with Schizophrenia: A Longitudinal Follow-Up Study.

BACKGROUND: Previous studies have demonstrated significantly higher blood titers of platelet-associated autoantibodies (PAA) in adult schizophrenia patients compared to normal healthy subjects. In addition, young adult schizophrenia patients at their early stages of the disorder displayed higher PAA titers than older patients with longer duration of the disorder. AIM: To assess longitudinally the blood titers of PAA in inpatients with childhood-onset schizophrenia at admission, after short- and long-term follow-up, and the correlation of these titers with the response to clozapine and other antipsychotic treatments. METHODS: Thirty children, age range of 6-12 (mean ± SD: 9.6 ± 1.5 years), with DSM-IV TR schizophrenia in active psychotic state were assessed 3 times: at baseline, after short-term (8-17 weeks; n = 26) and after long-term follow-up (33-170 weeks; n = 19). The blood titers of PAA were analyzed using ELISA and expressed by a linear optical density (OD) scale. A test recording >1.4 OD units was predefined as the positive cutoff value. RESULTS: On long-term follow-up, 9 out of the 17 children who were PAA-positive at baseline became PAA-negative: 7 already after 2 months of clozapine treatment and 2 following 3 years of risperidone treatment. Eight children remained PAA-positive during the entire study period. There was no significant correlation between the clinical improvement (as assessed by change in the Positive and Negative Syndrome Scale score) and the alteration in PAA levels (n = 19, r = -0.4, p = 0.088). CONCLUSIONS: High rates of positive PAA in COS patients may indicate an active autoimmune process in early-onset schizophrenia. It is concluded that PAA may serve as a biomarker for the diagnosis of COS, but does not predict the response to treatment. A transition to a PAA-negative status does not indicate an improvement in psychosis. © 2015 S. Karger AG, Basel.

High circulatory titer of platelet-associated autoantibodies in childhood onset schizophrenia and its diagnostic implications.

BACKGROUND: It has been suggested that the etiology of schizophrenia, in a distinct group of patients, originates from an autoimmune reaction against platelets. Previous studies have demonstrated significantly higher blood titers of platelet-associated autoantibodies (PAA) in adult schizophrenia patients as compared to normal healthy subjects. In addition, young adult schizophrenia patients at their early stages of the disorder displayed higher PAA titers than older patients with longer duration of the disorder. AIM: To assess the blood titers of PAA in children with schizophrenia as compared to matched control subjects without psychotic disorders, as a possible diagnostic parameter. METHODS: Twenty-nine children with DSM-IV schizophrenia in the active psychotic state, with an age range of 6-12 years (mean ± SD: 9.6 ± 1.5 years), with average Positive and Negative Syndrome Scale scores of 108 ± 19.2, were assessed. The control group consisted of 25 children with DSM-IV conduct disorder in a similar age range of 5-12 years (mean ± SD: 9.5 ± 1.6 years). The blood titers of PAA were evaluated using an optimized ELISA test, expressed by a linear optical density (OD) scale. The blood samples of all participants were tested anonymously and were scored under a code number. A test recording above 1.4 OD units was predefined as positive. RESULTS: The titers of PAA of children with schizophrenia (1.9 ± 0.5 OD units, range: 0.7-2.44 units) were significantly (p < 0.00001) higher than those of the control group (1.0 ± 0.4 OD units, range: 0.45-2.28 units). In 83% of the children with schizophrenia (24 out of the 29 patients) a positive test, i.e. OD >1.4, was detected. In contrast, in the control group, only 12% (3 of the 25 subjects) displayed a positive test, p < 0.00001. CONCLUSIONS: High titers of PAA in children with schizophrenia as compared with nonpsychotic controls may indicate an active autoimmune process in the early onset of schizophrenia. The PAA level may therefore provide a supportive diagnostic biomarker for childhood schizophrenia.

Space asymmetry as a possible global feature.

A series of reports in the literature indicated symmetry breaking in assemblies of chiral molecules of opposite handedness. These unexpected observations could be accounted for as being generated by the "parity violation" of the nuclear weak force, combined with an autocatalytic amplification process. However, in many such cases, in particular of chiral fluids, this putative mechanism is far from providing a reasonable explanation for such discrimination. In this article it is suggested that space may have deviated a priori from absolute symmetry, a possibility which complies with observations in atoms and molecules and may even be implicated in the asymmetrical configuration of spiral galaxies. Space asymmetry can be extrapolated to a difference between the relative statistical weights of the "right" versus the "left" directions with respect to Euclidian coordinates or, analogously, to a difference between the clockwise and anticlockwise orientations in polar coordinates. The difference in weights of these directions in space is estimated to be around 1%, based on the differences observed in density values of chiral fluids and chiral crystals of NaClO3. The implied asymmetry of time, as the conjugated fourth dimension, suggests a similar difference in magnitude of the time coordinate in a right-handed versus left-handed space, which is feasible for experimental verification.

Intermolecular chiral assemblies in R(-) and S(+) 2-butanol detected by microcalorimetry measurements.

Supramolecular chiral assemblies of R(-) and S(+) 2-butanol, in their neat form or when dissolved in their nonchiral isomer isobutanol, were evaluated by isothermal titration calorimetry (ITC) ensuing mixing. Dilution of 0.5 M solution of R(-) 2-butanol in isobutanol into the latter liberated heat of several calories per mole, which was approximately double than that obtained in parallel dilutions of S(+) 2-butanol in isobutanol. The ITC dilution profiles indicated an estimate of about 100 isobutanol solvent molecules surrounding each of the 2-butanol enantiomers, presumably arranged in chiral configurations, with different adopted order between the isomers. Mixings of neat R and S 2-butanol were followed by endothermic ITC profiles, indicating that, in racemic 2-butanol, both the supramolecular order and the intermolecular binding energies are lower than in each of the neat chiral isomers. The diversion from symmetrical ITC patterns in these mixings indicated again a subtle difference in molecular organization between the neat enantiomers. It should be noted that the presence of impurities, α-pinene and teterhydrofuran, at a level totaling 0.5%, did not influence the ITC heat flow profiles. The findings of this study demonstrate for the first time that chiral solutes in organic solvents are expected to acquire asymmetric solvent envelopes that may be different between the enantiomers, thus broadening this phenomenon beyond the previously demonstrated cases in aqueous solutions.

Chiral configuration of the hydration layers of D- and L-alanine in water implied from dilution calorimetry.

The size and configuration of the hydration layer of solutes play a major role in their thermodynamic features. With respect to amino acids in water, a series of indirect evidence strongly suggest that their hydration layer acquires a chiral configuration induced by their chiral centers. Such a chiral hydration may act as a recognition factor in the various biochemical interactions, but information on it remains rather scarce. In this study, we determined by dilution microcalorimetry the fraction of the hydration energy invested in the chiral distortion of the hydration layer surrounding D- and I-alanine in water. The results indicate that in dilute solutions, a multilayered chiral hydration surrounds each of these solutes and amounts to over 100 water molecules. In concentrated solutions, the immediate chiral hydration layer decreases to approximately 30 water molecules. The energy invested in the induction of the chiral twist in the hydration layer is predominantly attributed to TDeltaS, the energy associated with "configurational entropy," which amounts to only several cal/mol, about a thousandth of the total energy of the hydration shell.

Blind verification of elevated platelet autoantibodies in serum of schizophrenic patients--part II: adult subjects.

BACKGROUND: In our preceding study, we assayed in a blind fashion the blood sera of young normal subjects and schizophrenic patients for levels of platelet autoantibodies (PAA). The recorded PAA titers of the schizophrenic patients were significantly higher than those of the normal subjects. This observation has lent support to this test being used as an objective evaluation of schizophrenia in young subjects in the future. In addition, this finding strongly suggested that the etiology of a distinct group of sufferers of this disorder could have originated from an autoimmune reaction against platelets which can, under certain conditions, cross-react with brain tissue. AIMS: In the present study, PAA titers in the sera of adult schizophrenic patients and matched normal subjects were determined analogously to the preceding study. The effect of hospitalization and drug treatments on the apparent blood test scoring in adult subjects could thus be evaluated. METHODS: A total of 46 schizophrenia patients (30 men and 16 women) aged 19-45 years (mean +/- SD: 31.7 +/- 8.0 years) with a minimum score of 60 on the Positive and Negative Symptom Scale and 43 healthy control subjects (22 men and 21 women) aged 21-44 years (mean +/- SD: 31.9 +/- 6.9 years) participated in the study. The blood titers of PAA were evaluated in a single-blind fashion using an optimized ELISA test scored by optical density (OD) units. A positive test was defined as a value above 1.3 OD units. RESULTS: The titers of PAA in the group of schizophrenic patients (1.1 +/- 0.55 OD units, range: 0.360-2.285 OD units) were significantly higher in comparison to those of the healthy control subjects (0.81 +/- 0.37 OD units, range: 0.360-1.704 OD units; p = 0.004, two-tailed unpaired t-test). Significantly more schizophrenic patients showed a positive test (15 patients out of 46) than the control subjects (5 out of 43). However, significantly higher OD values of 1.55 +/- 0.5 were recorded in the group of patients with less than 3 years of registered disease (n = 16, age 19-30 years), while in the group with 4-20 years of hospitalization (n = 30, age 24-45 years) the recorded OD values (0.85 +/- 0.4 OD units) were practically indistinguishable from those of the control group. CONCLUSIONS: In the adult schizophrenic patients, the PAA blood test remains valid for patients who were hospitalized for less than 3 years. Drug treatment, length of disease and age can be assumed to reduce the PAA level considerably.

Blind verification of elevated platelet autoantibodies in serum of schizophrenic patients--part I: young subjects.

BACKGROUND: It has been hypothesized that the etiology of schizophrenia, in a distinct group of patients, originates from an autoimmune reaction against platelets. Previous open screenings have recorded significantly higher blood titers of platelet-associated autoantibodies (PAA) in schizophrenic patients as compared to normal healthy subjects. In addition, young schizophrenic patients at the early stages of their disorder displayed higher PAA titers than older patients with a longer duration of the disorder. A blood test based on these observations was proposed. AIM: To verify by a blind test a significant difference in PAA between young schizophrenic patients and matched healthy control subjects, for the validation of a blood test for schizophrenia. METHODS: A total of 36 young schizophrenic patients in an active psychotic state, aged 13-20 years (mean +/- SD: 16.2 +/- 2.1 years) with an average PANSS score of 115.6 +/- 14.5 and illness duration of 9.5 +/- 9.4 months, were examined. The control group consisted of 49 healthy young subjects between the ages of 13 and 21 years (16.2 +/- 2.2 years). The blood titers of PAA were evaluated blindly using an optimized ELISA test, expressed by a linear optical density (OD) scale. The blood samples of all participants were tested anonymously, and were scored under a code number. A test recording above 1.3 OD units was defined as positive. RESULTS: The PAA titers of schizophrenia patients (1.6 +/- 0.4 OD units, range: 0.7-2.3 OD units) were significantly higher than those of the control group (1.0 +/- 0.4 OD units, range: 0.4-1.8 OD units; p < 0.0001). In 61% of the young schizophrenic patients (22 out of the 36 patients), a positive result (OD >1.3 units) was recorded. In the control group, only 12.2% (6 of the 49 subjects) displayed a positive result (p < 0.0001). CONCLUSIONS: These findings support further assessment of PAA titers as a potential biomarker for patients with clinical signs and symptoms of schizophrenia.

Comments in a discussion: differential rates of D- and L-tyrosine crystallization.

We earlier reported that we had observed quantifiable differences in crystallization rates of D and L tyrosine. It has been suggested that these results were due to the presence of impurities. Here we argue that it is premature to conclude that impurities entirely explain the results. More generally, there is an accumulating weight of evidence that D and L enantiomers display unexpected differences in their physical properties and behavior. These should be taken into account as we attempt to understand the origin of biochirality.

Entrapped energy in chiral solutions: quantification and information capacity.

A homogeneous solution of a chiral substance stores a residual chemical potential, related to its overall anisotropy. Therefore, by mixing solutions of opposite enantiomers, heat release may take place, corresponding to the mutual anisotropy annulment. In the following study we present proofs for this fundamental, yet unexplored, prediction by measuring the heat released upon mixing of aqueous solutions of D-proline with L-proline, as well as D-alanine with L-alanine, using isothermal titration calorimetry. Heat release in the range of 0.6-6 cal/mol was detected in these intermolecular racemizations at 30 degrees C. Its magnitude varied linearly with the apparent optical rotation, which complied with the possibility that the hydration envelope coating the chiral molecule is of a long-range condensed and asymmetrical configuration that can expand by integration with adjacent hydration envelopes. The ordered water in such hydration layers constitutes regions of "negative entropy", a basic medium for information storage. On the basis of our findings, a fundamental expression which combines entropy, information capacity, and thermal energy is proposed.

Intrinsic asymmetries of amino acid enantiomers and their peptides: a possible role in the origin of biochirality.

L-amino acids and D-carbohydrates were incorporated into the first forms of life over 3.5 billion years ago, presumably from racemic mixtures of organic solutes produced by abiotic synthetic pathways. The process by which this choice occurred has not been established, but a consensus view is that it was a chance event, such that life could equally well have used D-amino acids and L sugars. In this review we will explore a second, less plausible alternative that minute differences in the physical properties of certain enantiomers made it more likely that L-amino acids and D-carbohydrates would be incorporated into early life. By all classical criteria, chiral isomers are perfect mirror image structures and, therefore, are expected to be identical in their macroscopic properties. However, scattered reports in the literature suggest that there may be slight differences in the physical properties of L- and D-amino acids and their polymers, which could lead to a preferred incorporation of L-amino acids into primitive forms of life. Here we present a literature survey of this issue and discuss its possible role in the origin of biochirality.

Ortho-para spin isomers of the protons in the methylene group--possible implications for protein structure.

The two hydrogen atoms attached to the carbon in the methylene group are of two different spin configurations, similar to those in the case of water: ortho, where the two proton spins are parallel to each other, and para, where they are antiparallel. The ortho configuration has three degenerate states, while the para configuration is singular, leading to a statistical ratio of these isomers 3:1 ortho/para. Such spin isomers are present in glycine and most chiral amino acids where they may induce broadening of structural zones, a possibility which remains to be assessed. The implications of this neglected possibility could be far-reaching, in particular with respect to protein structure and the origins of biochirality.

Subtle differences in structural transitions between poly-L- and poly-D-amino acids of equal length in water.

Mirror-image asymmetric molecules, i.e., chiral isomers or enantiomers, are classically considered as chemically identical. Recent studies, however, have indicated that parity violation by the nuclear weak force induces a tiny energy difference between chiral isomers. Upon combination with a massive amplification process, expansion of this difference to a detectable macroscopic level may be achieved. Yet, experimental tests of this possibility, where one enantiomer is compared to the other in solution, are hampered by the possible presence of undetectable impurities. In this study we have overcome this problem by comparing structural and dynamic features of synthetic D- and L-polyglutamic acid and polylysine molecules each of 24 identical residues. In these water-soluble polypeptides helix formation is an intramolecular autocatalytic process amplified by each turn, which is actually unaffected by low level of putative impurities in the solvent. The helix and random coil configurations and their transition were determined in this study by circular dichroism (CD) and isothermal titration calorimetry (ITC) in water and deuterium oxide. Distinct differences in structure and transition energies between the enantiomeric polypeptides were detected by both CD and ITC when dissolved in water. Intriguingly, these differences were by and large abolished in deuterium oxide. Our findings suggest that deviation from physical invariance between the D- and L-polyamino acids is induced in part by different hydration in water which is eliminated in deuterium oxide. Based on the recent findings by Tikhonov and Volkov (V. I. Tikhonov and A. A. Volkov, Science 2002, 296, 2363) we suggest that ortho-H(2)O, which constitutes 75% of bulk H(2)O, has a preferential affinity to L-enantiomers. Differential hydration of enantiomers may have played a role in the selection of L-amino acids by early forms of life.

Identification of cellular target proteins for signaling cyclic phosphates.

Cyclic glycerophosphates and their deoxy analogs were previously found to induce intracellular tyrosine and threonine phosphorylation in Chinese hamster ovary (CHO) cells. Further studies have indicated that these compounds induce neuronal outgrowth in PC-12 cells, as well as elevation of the state of cellular differentiation in human breast cancer cell lines. The mechanism by which these cyclic phosphates operate is not yet fully delineated. Using an affinity labeling approach we probed for possible cyclic phosphate target proteins in CHO cells. A 170 kDa protein that was labeled by an affinity cyclic phosphate reagent was identified by mass spectrometry as the largest subunit of the eukaryotic initiation factor 3 (eIF3). Using In-Gel kinase assays allowed the detection of a approximately 70 kDa target kinase directly activated by cyclic phosphates. Identification of these proteins may provide a basis for deciphering the mechanisms, by which cyclic phosphates exert their effects.

Phenotypic differentiation of human breast cancer cells by 1,3 cyclic propanediol phosphate.

Breast cancer cells in their virulent undifferentiated state are characterized by lack of functional estrogen receptors (ER) and/or progesterone receptors (PR) as well as relatively low levels of other normal differentiation markers such as milk proteins and lipid droplets. To date, no method for in situ elevation of the state of differentiation of breast cancer cells has yet been proven effective in patients. We have recently shown that 1,3 cyclic propanediol phosphate (1,3 cPP), an analog of 1,3 cyclic glycerophosphate (1,3 cGP), can promote morphological, neuronal-like differentiation in pheochromocytoma-12 cells in vitro. In view of this observation, we tested the potential of 1,3 cPP to elevate the state of cellular differentiation of the human breast cancer cell lines MCF-7 (ER(+)) and HCC1954 (ER(-)), as characterized by the expression of steroid receptors, casein kinase, lipid droplet histology and signal-transduction gene profiles. In the range of 5-100 microM 1,3 cPP the in vitro expression of ER-alpha, PR and casein kinase increased by approximately 2-fold while the mRNA transcription increased by 2-6-fold. Moreover, following 9-12 days of incubation with 1,3 cPP, HCC1954 cells exhibited a significant increase in the production of lipid droplets as observed by Oil Red O staining. The in vivo effect of 1,3 PP on MCF-7 xenografted into nude mice was also determined. After 4 biweekly i.p. injections of 0.5 mg 1,3 cPP per mouse, tumors in the 1,3 cPP treated virtually did not grow at all while the tumors in the control group grew rapidly. Based on these findings, we propose that this novel differentiating compound has the potential to transform the malignant tumor phenotype into a near-normal phenotype, as well as to sensitize the tumor cells to anti-estrogen therapy via upgrading the status of steroid hormone receptors.

Unexpected differences between D- and L- tyrosine lead to chiral enhancement in racemic mixtures.

We report here an unexpected difference in the solubilities of D- and L-tyrosine in water, which could be discerned by their rate of crystallization and the resulting concentrations of their saturated solutions. A supersaturated solution of 10 mM L-tyrosine at 20 degrees C crystallized much more slowly than that of D-tyrosine under the same conditions, and the saturated solution of L-tyrosine was more concentrated than that of D-tyrosine. Supersaturated solutions of 10 mM DL-tyrosine in water formed precipitates of predominantly D-tyrosine and DL-tyrosine, resulting in an excess of L-tyrosine in the saturated solution. The experimental setups were monitored independently by UV-absorption, radioactivity tracing, optical rotation and X-ray diffraction. The process of nucleation and crystallization of D- and L-tyrosine is characterized by an exceptionally high cooperativity. It is possible that minute energy differences between D- and L-tyrosine, originating from parity violation or other non-conservative chiral discriminatory rules, could account for the observations. The physical process that initiated chiral selection in biological systems remains a challenging problem in understanding the origin of life, and it is possible that chiral compounds were concentrated from supersaturated racemic mixtures by preferential crystallization.

A conformational epitope which detects autoantibodies from schizophrenic patients.

We previously found autoantibodies against platelets in schizophrenic patients. One of the platelet proteins that bind these antibodies is enolase. Here, we describe the isolation and sequencing of an immunoreactive peptide after enzymatic digestion of enolase. The 3-D structure of enolase indicates that, unexpectedly, this peptide is buried inside the protein. However, 3-D surface analysis leads to the identification of a conformational epitope that resembles the binding peptide and might constitute a specific binder of the autoantibodies. In a screening of antibody binding with the peptide LVVGLCK, we found in 50 serum samples of controls a mean of O.D.=0.46; s= +/- 0.21 relative enzyme immunoassay units, while in sera of 39 schizophrenic patients, we found a mean of O.D.=1.47; s= +/- 0.65; P<0.0001. Furthermore, an inverse correlation was observed between duration of schizophrenia and the level of the detected autoantibodies. A screening of autoantibodies in sera of various mental disorders with this peptide is currently in progress.

Diet enriched with omega-3 fatty acids alleviates convulsion symptoms in epilepsy patients.

PURPOSE: We examined whether a dietary supplement containing omega-3 polyunsaturated fatty acids (n-3 PUFAs) can alleviate and/or reduce the frequency of epileptic seizures in patients with central nervous system (CNS) diseases treated with anticonvulsive drugs (ACDs). METHODS: A special spread containing 65% n-3 PUFAs was added to the daily diet. The patients consumed 5 g of this spread at every breakfast for 6 months. RESULTS: Five patients completed the study. In all of them, a marked reduction in both frequency and strength of the epileptic seizures was recorded. CONCLUSIONS: Incorporation of the dietary supplement containing n-3 PUFAs may be beneficial in suppression of some cases of epileptic seizures.