Cited by 367Schizophrenia research and treatmentAdvanced MRI Techniques and ApplicationsNeuroscience and Neuropharmacology Research

Nature of Glutamate Alterations in Schizophrenia: A Meta-analysis of Proton Magnetic Resonance Spectroscopy Studies

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Merritt, Kate, Egerton, Alice, Kempton, Matthew J., Taylor, Matthew J., McGuire, Philip K.·2016·JAMA Psychiatry

Abstract

IMPORTANCE: Alterations in glutamatergic neurotransmission may be fundamental to the pathophysiology of schizophrenia, and the glutamatergic system is a target for novel therapeutic interventions in the disorder. OBJECTIVE: To investigate the nature of brain glutamate alterations in schizophrenia by conducting a meta-analysis of glutamate proton magnetic resonance (MRS) spectroscopy studies. DATA SOURCES: The MEDLINE database was searched for studies published from January 1, 1980, to April 1, 2015. Search terms included magnetic resonance spectroscopy, schizophrenia, psychosis, clinical or genetic high risk, and schizoaffective. Inclusion criteria were single voxel 1H-MRS studies reporting glutamate, glutamine or Glx values for a patient or risk group in comparison to a healthy volunteer group. STUDY SELECTION: Fifty-nine studies were identified, which included 1686 patients and 1451 healthy individuals serving as controls. DATA EXTRACTION AND SYNTHESIS: A random-effects, inverse-weighted variance model was used to calculate the pooled effect size. Mean values were extracted and verified independently. Effect sizes were determined for glutamate, glutamine, and Glx in brain regions that had been examined in at least 3 different studies. A secondary analysis grouped studies into those examining patients at different stages of illness (high risk, first-episode psychosis, or chronic schizophrenia). Effects of age, antipsychotic dose, and symptom severity were determined using meta-regression. RESULTS: In schizophrenia, there were significant elevations in glutamate in the basal ganglia (Hedges g = 0.63; 95% CI, 0.15-1.11), glutamine in the thalamus (g = 0.56; 95% CI, 0.02-1.09), and Glx in the basal ganglia (g = 0.39; 95% CI, 0.09-0.70) and medial temporal lobe (g = 0.32; 95% CI, 0.12-0.52). No region showed a reduction in glutamate metabolites in schizophrenia. Secondary analyses revealed that elevated medial frontal Glx levels were evident in individuals at high risk for schizophrenia (g = 0.26; 95% CI, 0.05-0.46) but not in those with first-episode psychosis or chronic schizophrenia, whereas elevated Glx in the medial temporal lobe was seen with chronic schizophrenia (g = 0.40; 95% CI, 0.08-0.71) but not in the high-risk or first-episode groups. Meta-regression found no association with age, symptom severity, or antipsychotic dose. CONCLUSIONS AND RELEVANCE: Schizophrenia is associated with elevations in glutamatergic metabolites across several brain regions. This finding supports the hypothesis that schizophrenia is associated with excess glutamatergic neurotransmission in several limbic areas and further indicates that compounds that reduce glutamatergic transmission may have therapeutic potential.

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  • Evidence from magnetic resonance spectroscopy suggests that alterations in glutamatergic neurotransmission may change over the course of schizophrenia.

    “Evidence from magnetic resonance spectroscopy suggests that alterations in glutamatergic neurotransmission may change over the course of schizophrenia (96, 97).”

    From The Predictive Coding Account of Psychosis (2018) · cites this paper as [96]

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  1. Szulc A, Galinska B, Tarasów E, et al. Glutamatergic system dysfunction in schizophrenia: a proton magnetic resonance spectroscopy ( 1 H MRS) study. Pol J Radiol. 2004;69(1):33-36.

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Authors
Merritt, K., Egerton, A., Kempton, M. J., Taylor, M. J., & McGuire, P. K.
Affiliations
King's College London (GB)
Corresponding author
Merritt, Kate
Venue
JAMA Psychiatry
Published
2016-07-01
Volume
73
Issue
7
Pages
665
ISSN
2168-622X (ISSN-L)
OpenAlex
W2424710696
Cited by
367
References
82
Citations by year
2026: 26 · 2025: 23 · 2024: 25 · 2023: 37 · 2022: 33 · 2021: 50 · 2020: 55 · 2019: 44 · 2018: 41 · 2017: 28 · 2016: 5
FWCI
34.95
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
Funders
  • National Institute for Health and Care Research
  • King's College London
  • Medical Research Council (MR/L003988/1, MR/J008915/1)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
Keywords
schizophrenia, glutamate, glutamine, glutamatergic neurotransmission, basal ganglia, thalamus, medial temporal lobe, medial frontal cortex, first-episode psychosis, clinical high risk for psychosis, chronic schizophrenia, schizoaffective disorder, antipsychotic dosing, symptom severity, neuroimaging biomarkers
MeSH terms
Brain, Brain Mapping, Glutamine, Humans, Synaptic Transmission, Reference Values, Risk Factors, Schizophrenia, Glutamic Acid, Genetic Predisposition to Disease, Proton Magnetic Resonance Spectroscopy

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