title: Anandamide levels in cerebrospinal fluid of first-episode schizophrenic patients: impact of cannabis use.
abstract: BACKGROUND
  Previous studies have shown that cerebrospinal fluid (CSF) from schizophrenic patients contains significantly higher levels of the endogenous cannabinoid anandamide than does CSF from healthy volunteers. Moreover, CSF anandamide levels correlated inversely with psychotic symptoms, suggesting that anandamide release in the central nervous system (CNS) may serve as an adaptive mechanism countering neurotransmitter abnormalities in acute psychoses. In the present study we examined whether cannabis use may alter such a mechanism.
  
  
  METHODS
  We used liquid chromatography/mass spectrometry (LC/MS) to measure anandamide levels in serum and CSF from first-episode, antipsychotic-naïve schizophrenics (n=47) and healthy volunteers (n=81). Based on reported patterns of cannabis use and urine delta9-tetrahydrocannabinol (delta9-THC) tests, each subject group was further divided into two subgroups: 'low-frequency' and 'high-frequency' cannabis users (lifetime use < or = 5 times and > 20 times, respectively). Serum delta9-THC was investigated to determine acute use and three patients were excluded from the analysis due to detectable delta9-THC levels in serum.
  
  
  RESULTS
  Schizophrenic low-frequency cannabis users (n=25) exhibited > 10-fold higher CSF anandamide levels than did schizophrenic high-frequency users (n=19, p=0.008), healthy low-frequency (n=55, p<0.001) or high-frequency users (n=26, p<0.001). In contrast, no significant differences in serum anandamide levels were found among the four subgroups. CSF anandamide levels and disease symptoms were negatively correlated in both user groups.
  
  
  CONCLUSIONS
  The results indicate that frequent cannabis exposure may down-regulate anandamide signaling in the CNS of schizophrenic patients, but not of healthy individuals. Thus, our findings suggest that alterations in endocannabinoid signaling might be an important component of the mechanism through which cannabis impacts mental health.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50924 Cologne, Germany. leweke@ecnp.net
authors.forename: F Markus
authors.initials: FM
authors.lastname: Leweke
authors.forename: Andrea
authors.initials: A
authors.lastname: Giuffrida
authors.forename: Dagmar
authors.initials: D
authors.lastname: Koethe
authors.forename: Daniela
authors.initials: D
authors.lastname: Schreiber
authors.forename: Brit M
authors.initials: BM
authors.lastname: Nolden
authors.forename: Laura
authors.initials: L
authors.lastname: Kranaster
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Neatby
authors.forename: Miriam
authors.initials: M
authors.lastname: Schneider
authors.forename: Christoph W
authors.initials: CW
authors.lastname: Gerth
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkötter
authors.forename: Daniele
authors.initials: D
authors.lastname: Piomelli
mesh_terms: D000208:Acute Disease; D000328:Adult; D001095:Arachidonic Acids / Q000134:cerebrospinal fluid*; D002186:Cannabinoids / Q000134:cerebrospinal fluid; D002853:Chromatography, Liquid; D063388:Endocannabinoids; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D053284:Polyunsaturated Alkamides / Q000134:cerebrospinal fluid*; D015995:Prevalence; D011618:Psychotic Disorders / Q000134:cerebrospinal fluid / Q000453:epidemiology; D012559:Schizophrenia / Q000134:cerebrospinal fluid* / Q000453:epidemiology*; D013997:Time Factors
chemical_list: D001095:Arachidonic Acids; D002186:Cannabinoids; D063388:Endocannabinoids; D053284:Polyunsaturated Alkamides; C078814:anandamide