Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan.
Biomolecules. 2024 Sep 6;14(9):1128. doi: 10.3390/biom14091128.
For several decades, the dopamine hypothesis contributed to the discovery of numerous typical and atypical antipsychotics and was the sole hypothesis for the pathophysiology of schizophrenia. However, neither typical nor atypical antipsychotics, other than clozapine, have been effective in addressing negative symptoms and cognitive impairments, which are indices for the prognostic and disability outcomes of schizophrenia. Following the development of atypical antipsychotics, the therapeutic targets for antipsychotics expanded beyond the blockade of dopamine D2 and serotonin 5-HT2A receptors to explore the partial agonism of the D2 receptor and the modulation of new targets, such as D3, 5-HT1A, 5-HT7, and metabotropic glutamate receptors. Despite these efforts, to date, psychiatry has not successfully developed antipsychotics with antipsychotic properties proven to be superior to those of clozapine. The glutamate hypothesis, another hypothesis regarding the pathophysiology/pathomechanism of schizophrenia, was proposed based on clinical findings that N-methyl-D-aspartate glutamate receptor (NMDAR) antagonists, such as phencyclidine and ketamine, induce schizophrenia-like psychotic episodes. Large-scale genome-wide association studies (GWASs) revealed that approximately 30% of the risk genes for schizophrenia (the total number was over one hundred) encode proteins associated with glutamatergic transmission. These findings supported the validation of the glutamate hypothesis, which was inspired by the clinical findings regarding NMDAR antagonists. Additionally, these clinical and genetic findings suggest that schizophrenia is possibly a syndrome with complicated pathomechanisms that are affected by multiple biological and genetic vulnerabilities. The glutamate hypothesis has been the most extensively investigated pathophysiology/pathomechanism hypothesis, other than the dopamine hypothesis. Studies have revealed the possibility that functional abnormalities of the NMDAR play important roles in the pathophysiology/pathomechanism of schizophrenia. However, no antipsychotics derived from the glutamatergic hypothesis have yet been approved for the treatment of schizophrenia or treatment-resistant schizophrenia. Considering the increasing evidence supporting the potential pro-cognitive effects of glutamatergic agents and the lack of sufficient medications to treat the cognitive impairments associated with schizophrenia, these previous setbacks cannot preclude research into potential novel glutamate modulators. Given this background, to emphasize the importance of the dysfunction of the NMDAR in the pathomechanism and/or pathophysiology of schizophrenia, this review introduces the increasing findings on the functional abnormalities in glutamatergic transmission associated with the NMDAR.
几十年来,多巴胺假说推动了众多典型和非典型抗精神病药物的发现,并且是非典型精神分裂症病理生理学的唯一假说。然而,除了氯氮平之外,典型和非典型抗精神病药物都不能有效地治疗阴性症状和认知障碍,这些都是精神分裂症预后和残疾结果的指标。随着非典型抗精神病药物的发展,抗精神病药物的治疗靶点已经从多巴胺 D2 和 5-羟色胺 5-HT2A 受体的阻断扩展到探索 D2 受体的部分激动作用和新靶点的调制,如 D3、5-HT1A、5-HT7 和代谢型谷氨酸受体。尽管如此,迄今为止,精神病学还没有成功开发出具有优于氯氮平的抗精神病特性的抗精神病药物。谷氨酸假说,是关于精神分裂症病理生理学/发病机制的另一个假说,是基于这样的临床发现提出的,即 N-甲基-D-天冬氨酸谷氨酸受体(NMDAR)拮抗剂,如苯环利定和氯胺酮,会引发类似精神分裂症的精神病发作。大规模全基因组关联研究(GWAS)表明,精神分裂症的风险基因约有 30%(总数超过 100 个)编码与谷氨酸能传递相关的蛋白质。这些发现支持了谷氨酸假说的验证,该假说的灵感来自于关于 NMDAR 拮抗剂的临床发现。此外,这些临床和遗传发现表明,精神分裂症可能是一种综合征,具有复杂的发病机制,受多种生物和遗传脆弱性的影响。谷氨酸假说除了多巴胺假说之外,是最广泛研究的病理生理学/发病机制假说。研究表明,NMDAR 的功能异常在精神分裂症的病理生理学/发病机制中可能发挥重要作用。然而,还没有任何源自谷氨酸假说的抗精神病药物被批准用于治疗精神分裂症或治疗抵抗性精神分裂症。考虑到越来越多的证据支持谷氨酸能药物具有潜在的认知增强作用,以及缺乏足够的药物来治疗与精神分裂症相关的认知障碍,这些先前的挫折并不能排除对潜在新型谷氨酸调节剂的研究。有鉴于此,为了强调 NMDAR 功能障碍在精神分裂症发病机制和/或病理生理学中的重要性,本综述介绍了与 NMDAR 相关的谷氨酸能传递功能异常的最新发现。
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