Convergent evidences from human and animal studies implicate angiotensin I-converting enzyme activity in cognitive performance in schizophrenia.

In schizophrenia (SCZ), higher angiotensin I-converting enzyme (ACE) levels have been reported in patient's blood and cerebrospinal fluid (CSF). Hereby, we propose to explore whether the ACE activity levels are associated to cognitive performance in SCZ. Seventy-two patients with SCZ or schizoaffective disorder diagnosis, and 69 healthy controls (HCs) underwent a cognitive battery with parallel collection of peripheral blood samples to measure ACE activity. Significant higher ACE activity levels were confirmed in the plasma of SCZ patients compared with HCs (Student's t=-5.216; P<0.001). ACE activity significantly correlated to Hopkins delayed recall measures (r=-0.247; P=0.004) and Hopkins total (r=-0.214; P=0.012). Subjects grouped as high ACE activity (above average) had worse performance compared with low ACE activity level group for Hopkins delayed recall measure, even after correction for clinical condition, age, gender and years of education (P=0.029). The adjusted R squared for this final model was 0.343. This result was evident only comparing extreme groups for ACE activity, when splitting the sample in three groups with similar number of subjects. To clarify this finding, we performed an evaluation of the cognitive performance of transgenic mice with three copies of ACE gene in novel object recognition (NOR) test, which showed that such animals presented impairment in NOR (P<0.05) compared with two copies of wild-type animals. The results observed in SCZ patients and animal model suggest both the association of ACE to cognitive deficits in SCZ. This finding may support the evaluation of novel treatment protocols and/or of innovative drugs for specific intervention of cognitive deficits in SCZ envisioning concomitant ACE activity and behavior evaluations.
Competing Interests: AG received PhD fellowship from CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), while AMV was a recipient of a fellowship from CNPq. MAS and CMY are recipients of a fellowship from FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo). VO, VA, RAB and MAFH are all supported by FAPESP, CAPES and CNPq. MAFH is also the recipient of a fellowship from CNPq (311815/2012-0). RAB has also received lecture fees from Astra Zeneca, Bristol, Janssen and Lundbeck, with research grants from private companies such as Janssen, Eli Lilly, Lundbeck, Novartis and Roche, and Fundação Safra and Fundação ABADS. RAB is also a shareholder of Radiopharmacus Ltda and Biomolecular Technology Ltda. The remaining authors declare no conflict of interest.