Thomas Eklundh

Altered CSF 5-HIAA Disposition in Pathologic Male Gamblers

Previous reports concerning the cerebrospinal fluid (CSF) of pathologic gamblers have described disturbed norepinephrine and dopamine (but not serotonin) functioning in the central nervous system. We analyzed neurotransmitter metabolites in two consecutive 6-mL samples of CSF obtained from 10 pathologic male gamblers punctured at the L4-5 level following 8 hours of fasting along with strict bed rest. Data were compared with those for healthy male controls. In conformity with findings in healthy male controls, we found gradients in CSF 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA), but not 4-hydroxy-3-methoxyphenyl glycol (HMPG). Expressing the CSF concentrations as nmol x L-1 x min-1 of tapping time (an estimate of the mass flow through the needle), the levels of 5-HIAA and HMPG (but not HVA) were found to be significantly lower in gamblers. Levels of 5-HIAA and HVA showed a significant correlation in gamblers but not in healthy controls. Taking tapping time into account, the CSF levels of HMPG and 5-HIAA were significantly lower in gamblers. We concluded that, in light of previous CSF findings of disturbed norepinephrine and dopamine function, altered indolamine function cannot be fully ruled out.

Serum and cerebrospinal fluid concentrations of melatonin : a pilot study in healthy male volunteers.

Summary. Melatonin was determined in serum and cerebrospinal fluid (CSF) obtained from 13 healthy males lumbar-punctured in the sitting position without preceding bed rest.There was a significant correlation between the levels of melatonin in serum and the CSF.The serum concentration was lower than that in the CSF, a finding that calls in question the theory that melatonin is mainly released from the pineal gland into the bloodstream.In conclusion, serum levels of melatonin in healthy male volunteers, mirror the CSF concentrations when lumbar puncture is carried out using the described technique.

Gradients of CSF monoamine metabolites: a comparison between male and female volunteers.

Lumbar puncture at the L4-5 level was performed on 12 healthy male and 12 healthy female volunteers. Confirming previous results, we found pronounced gradients in cerebrospinal fluid (CSF) 5-HIAA and HVA (5-hydroxyindoleacetic acid and homovanillic acid). We also found a gradient in 4-hydroxy-3-methoxyphenylglycol (HMPG), but only in the male volunteers. We also found that tapping-time was significantly longer in females than in males. One reason for this discrepancy may be that an estimate of the spinal distance was greater in males, which might indicate that a hydrodynamic factor plays a role. On taking tapping-time into consideration, the 5-HIAA and HMPG concentrations were significantly higher in males than in females.

Influence of tapping-time and atmospheric pressure on concentrations of monoamine metabolites in the cerebrospinal fluid: A prospective study in female volunteers

Lumbar puncture was performed on 12 healthy female volunteers at the L4-5 level. CSF concentrations of 5-HIAA, HVA and HMPG were included in turn as dependent variables in repeated analyses of covariance with age, height, tapping-time, atmospheric pressure and the distance on the spine in the lying position as regressors. Use or non-use of oral contraceptives was included as a nominal variable. Results obtained were confirmed by nonparametric statistics. We found significant relationships between 5-HIAA and HVA, respectively, and height when the concentrations per minute of tapping-time (nM/min) were used as dependent variables. Hypothetically, the tapping-time mirrors the transport of concentrated CSF from the cranial to the caudal region when sitting up. We also found significant influences of atmospheric pressure and the use or non-use of oral contraceptives on HMPG. The role of atmospheric pressure is not clear but it might contribute to the transport of HMPG from the periphery to the CSF or affect the outflow of HMPG from the lumbar CSF compartment. The contribution of oral contraceptives might reflect interactions in the cerebral catecholamine metabolism.

Monoamine precursors, transmitters and metabolites in cerebrospinal fluid: a prospective study in healthy male subjects

In order to elucidate methodological aspects of CSF investigations, 14 healthy male subjects were lumbar-punctured at the L4-5 level following a standardised procedure. CSF concentrations of precursors, transmitters and transmitter metabolites were used as dependent variables, while age, height, body weight, atmospheric pressure and some other factors served as independent variables. 5-HIAA and HVA (but not HMPG) have pronounced concentration gradients. We also found CSF gradients for the precursors tryptophan and tyrosine, as well as for serotonin, dopamine and the dopamine metabolite DOPAC. Dopamine and atmospheric pressure showed a positive intercorrelation. Age correlated curvilinearly (convex upward) with tryptophan but showed a negatively directed linear correlation with serotonin. Serotonin and 5-HIAA showed no intercorrelation. Our results suggest an age-dependent disposition of tryptophan in the CSF. The absence of a correlation between serotonin and 5-HIAA might be inconsistent with the notion that 5-HIAA is a marker of central serotonin turnover. The comparatively high body weight of our volunteers might explain the lack of a gradient for HMPG.

Monoamine compounds in cerebrospinal fluid of healthy subjects punctured without preceding strict bed rest: A pilot study

The interpretation of data on compounds in the lumbar cerebrospinal fluid (CSF) is limited by several confounding factors, e.g. motor activity for which strict bed rest prior to lumbar puncture is recommended for standardisation. Now we report data from 14 healthy males employing the standardised procedure except for the requirement of strict bed rest. The levels of serotonin, noradrenaline, 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid and 4-hydroxy-3-methoxyphenylglycol in the second CSF fraction (7–12 ml) were significantly higher than those in the first fraction (0–6 ml), indicating the presence of concentration gradients. 5-HIAA was negatively influenced by age and the neuraxis distance in the lying position and positively by atmospheric pressure. Storage time and atmospheric pressure contributed to the variance in dopamine. Both tyrosine, tryptophan and dopamine were linearly correlated with storage time. We also found a significant curvilinear correlation between tapping time and atmospheric pressure. On comparing with previous studies, the results support the notion that the issue of strict bed rest or not prior to lumbar puncture might have to be taken into consideration when interpreting lumbar monoamine CSF data.

Cholecystokinin peptides in cerebrospinal fluid : a study in healthy male subjects

The clinical reliability of measuring cholecystokinin (CCK) peptides in the cerebrospinal fluid (CSF) has not been fully elucidated. Therefore, we have assayed CCK-8S and CCK-4 in CSF obtained from 14 healthy male subjects, lumbar-punctured at the L4-5 level following a strictly standardised procedure. CSF concentrations of free CCK-8S and free CCK-4 were used as dependent variables while age, height, body weight, atmospheric pressure and some other factors served as independent variables. It was shown that the CCK-8S ratio between the second (7-12 ml) and first (0-6 ml) CSF fractions, correlated significantly with the atmosphere pressure at the time of puncture. Neither CCK-8S nor CCK-4 displayed concentration gradients in CSF. The CCK-4 levels, expressed as pmol l-1 in the total amount of CSF were found to be positively correlated with the neuraxis distance in the lying position and negatively with the neuraxis distance in the sitting position. Furthermore, CCK-4, expressed as pmol l-1 per min of tapping-time (pmol l-1 min-1), showed a negative correlation with storage time, presumably mirroring a proteolytic process. CCK-8S and CCK-4 intercorrelated positively independently of whether expressed as pmol l-1 or pmol l-1 min-1. In conclusion, the results of this exploratory study indicate that the neuraxis distance (in the sitting and lying positions) and storage-time have to be accounted for when interpreting data on CSF levels of CCK-4. Attention has to be paid to the potential influence of atmospheric pressure on the concentration ratio of CCK-8S.

Lower CSF Taurine Levels in Male Pathological Gamblers than in Healthy Controls

Amino acids were determined in CSF obtained from 10 males fulfilling the DSM‐III‐R criteria for pathological gambling. On comparing with seven healthy male controls, the mean CSF level of the inhibitory amino acid taurine in the third (13–18 ml) CSF fraction, was significantly lower in gamblers (p<0·05). Furthermore, the CSF taurine concentration was significantly influenced by height, but differently in gamblers and controls. There were no differences between gamblers and controls regarding other amino acids. The results might indicate that pathological gamblers have a functional disturbance of the disposition of taurine in the CSF. Whether this is due to a reduced entry of taurine across the blood–brain barrier, increased elimination from the CSF, a disturbed CSF circulation or a combination thereof, needs to be clarified.

Intraspinal Pressure Influences CSF Disposition of Tryptophan and 5-HIAA

Cerebrospinal fluid (CSF) concentrations of monoamine compounds are influenced by factors such as age, gender, height, body weight, tapping time, and atmospheric pressure. We have now examined the role of intraspinal pressure. Thirteen male volunteers underwent lumbar puncture in the right decubitus position without preceding strict bed rest. The intraspinal pressure was recorded, and monoamine precursors, transmitters, and metabolites were analyzed in two consecutively collected CSF fractions. Tryptophan in 12 ml of CSF and the 5-hydroxyindoleacetic acid concentration ratio [fraction II (7–12 ml CSF)/fraction I (0–6 ml CSF)] correlated with the intraspinal pressure. Hypothetically, the intraspinal pressure may be a confounding factor for a correct interpretation of CSF tryptophan and 5-hydroxyindoleacetic acid concentrations, and this is an issue that has to be addressed in future CSF studies.

CSF taurine level is influenced by plasma cholesterol and the CYP2D6 phenotype

Eight healthy male volunteers, lumbar-punctured before and during simvastatin treatment, were phenotyped for CYP2D6 analysis of the debrisoquine metabolic ratio (the ratio between the urinary recovery of debrisoquine and its 4-hydroxy metabolite) after a single oral dose of debrisoquine. The mean cerebrospinal fluid concentrations of cholesterol and taurine did not differ before and during treatment. During (but not before) treatment taurine in the CSF correlated with the debrisoquine metabolic ratio (r=-0.93, P=0.0007) Our results might indicate an influence of CYP2D6 on the level of taurine in the CSF that was secondary to the change in plasma cholesterol. ⌐ 2003 Elsevier B.V./ECNP. All rights reserved.