Potentiation of the NMDA receptor in the treatment of schizophrenia: focused on the glycine site |
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Authors: | Seong S Shim Michael D Hammonds Baik S Kee |
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Institution: | (1) Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland VA Medical Center Psychiatric Services 116 A(W), Cleveland, Ohio 44106, USA;(2) Psychiatric Services 116 W(A), Cleveland VA Medical Center, 10701 East Blvd., Cleveland, Ohio 44106, USA;(3) Research and Education Foundation, Cleveland VA Medical Center, Cleveland, OH, USA;(4) Department of Neuropsychiatry, College of Medicine, Chung-Ang University Hospital, Seoul, Korea |
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Abstract: | N-methyl-d-aspartate receptor (NMDAR) hypo-function theory of schizophrenia proposes that impairment in NMDAR function be associated
with the pathophysiology of schizophrenia and suggests that enhancement of the receptor function may produce efficacy for
schizophrenia. Consistent with this theory, for the last decade, clinical trials have demonstrated that the enhancement of
NMDAR function by potentiating the glycine site of the receptor is efficacious in the treatment of schizophrenia. Full agonists
of the glycine site, glycine and d-serine and a glycine transporter-1 inhibitor, sarcosine, added to antipsychotic drugs, have been shown to be effective in
the treatment of negative symptoms and possibly cognitive symptoms without significantly affecting the positive symptoms of
schizophrenia. A partial agonist of the glycine site, d-cycloserine, added to antipsychotic drugs, can be effective for the negative symptoms at the therapeutic doses. However,
these drugs have not shown clinical efficacy when added to clozapine, suggesting that the interactions of clozapine and the
glycine site potentiators may be different from those of other antipsychotic drugs and the potentiators. This article suggests
that the glycine site potentiators may produce efficacy for negative and cognitive symptoms by blocking apoptosis-like neuropathological
processes in patients with chronic schizophrenia and thereby can deter progressive deterioration of the disorder. This article
proposes a polypharmacy of glycine site potentiators augmented with antipsychotic drugs to control positive and negative symptoms
in a synergistic manner and block deterioration in schizophrenia. Since the NMDAR complex consists of multiple sites modulating
receptor functions, the efficacy of glycine site potentiators for schizophrenia suggests the possibility that manipulation
of other modulating sites of the NMDAR can also be efficacious in the treatment of schizophrenia. |
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Keywords: | glycine site agonists NMDA receptor negative symptoms cognitive symptoms neurodegeneration schizophrenia |
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