Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

A Retrospective Chart Analysis of Baseline Amino Acids and Associated Catecholamine Levels in Mental Health Disorders Patrick Leonard, B.S., OMS-II 1 , Zachary Fitzgerald, B.S., OMS-II 1 , Amanda Sanko, B.S., OMS-II 1 , Giovanni Reyes, B.S., OMS-II 1 , Robert Westbrook, B.S. , OMS-II 1 , Andrew Walker, PhD, OMS-III 1 , Atul Ganta, B.A., M.A., OMS-II 1 , Margaret Morehouse, B.A., OMS-II 1 , Kashfaa Tasmim, B.S., M.A., OMS-II 1 , Damian Gluchowski, B.S. 2 , J. Christopher Caston, MD 2 , Paul Switzer, MD, DHA 1 , JuliSu Dimucci-Ward, PhD 1 . 1. Edward Via College of Osteopathic Medicine Departments of Clinical Medicine, Spartanburg, South Carolina. 2. Upstate Psychiatric Associates, Spartanburg, South Carolina. Introduction Results Discussion

• Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are relevant psychiatric diagnoses with complex pathophysiology. The role of biochemical markers, particularly the relationship between the amino acid building blocks (tryptophan (Trp), phenylalanine (Phe), tyrosine (Tyr) and catecholamines (norepinephrine (NE), epinephrine (Epi), dopamine (DA)), remains an area of interest. This study explores these relationships to better understand the biochemical profiles underlying MDD and GAD. Aspects to be investigated: • Phe and Tyr are precursors that can be used for catecholamine synthesis. Is there any correlation between Phe vs. NE or Tyr vs NE? • Is there a correlation between Phe vs NE or Tyr vs NE when we look at JUST those that have an ANXIETY disorder? • Is there a correlation between Phe vs NE or Tyr vs NE when we look at just those that have a DEPRESSIVE disorder? • What percent of each value (Trp/Tyr/Phe/NE) in our data falls within the top 25th percentile or bottom 25th percentile population level?

References • Statistically significant correlations were observed between amino acid precursors and catecholamine levels, aligning with the expected trends of the established biosynthesis pathways. • Based on statistical analysis there is a mild positive correlation between Phe and NE levels. • There was a failure to reject the null hypothesis in that there is no linear relationship between AA precursor levels and NE in MDD. However, when compared to GAD there is a substantially smaller p-value. Patients with MDD were only 0.0027 from meeting the threshold for statistical significance, indicating a potential for meeting that threshold with a larger sample size. • P-values associated with table (a) and table (b) were significant in a binomial test for patients whose lab data fell into the top 25 th percentile of the population. This indicates that for GAD and MDD, the data was shifted downwards; therefore, having high levels of Phe/Tyr/Trp are rare in this population. Conclusions • This study highlights the complexity of catecholamine regulation and suggests that neurotransmitter dysregulation in psychiatric disorders may involve multifactorial processes that are not captured by the precursor-to-catecholamine correlations alone. Directions for Future Research: • Investigate a larger more diverse sample size to improve generalizability. • Explore the role of enzymes and co-factors in catecholamine regulation. • Prospective study with controlled variables potentially relating to medication regimens and social factors. The authors of this poster would like to acknowledge and thank Edward Via College of Osteopathic Medicine Carolinas for their support in this research project and their Institutional Review Board approval (IRB) # 1997682-5; 08/01/2024. Additionally, our thanks go to Upstate Psychiatric Associates in Spartanburg South Carolina. Acknowledgements 3. Hagen, J. M., Sutterland, A. L., Collard, D., de Jonge, C. D. E., van Zuiden, M., Zantvoord, J. B., Tan, H. L., van Valkengoed, I. G. M., van den Born, B. J. H., Zwinderman, A. H., de Haan, L., & Lok, A. (2021). Ethnic discrimination and depressed mood: The role of autonomic regulation. Journal of psychiatric research, 144, 110 – 117. https://doi.org/10.1016/j.jpsychires.2021.09.048 4. Shih, J. C., Chen, K., & Ridd, M. J. (1999). Monoamine oxidase: from genes to behavior. Annual review of neuroscience, 22, 197 – 217. https://doi.org/10.1146/annurev.neuro.22.1.197 5. Paine, N. J., Watkins, L. L., Blumenthal, J. A., Kuhn, C. M., & Sherwood, A. (2015). Association of depressive and anxiety symptoms with 24-hour urinary catecholamines in individuals with untreated high blood pressure. 1. Huffman, J. C., & Stern, T. A. (2007). Neuropsychiatric consequences of cardiovascular medications. Dialogues in clinical neuroscience, 9(1), 29 – 45. https://doi.org/10.31887/DCNS.2007.9.1/jchuffman 2. Gupta M, Al Khalili Y. Methyldopa. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551671/

Figure 1. Using linear regression we can see a significance level alpha= 0.05 and m=2; after a Bonferroni correction of alpha'= alpha/m= 0.025, there is a mild positive correlation between Phenylalanine and NE levels that is statistically significant.

Figure 2. Using Linear regression we can see a significance level alpha= 0.05. There is a failure to reject the null hypothesis

Methods

Study Design • Retrospective chart review of 50 psychiatric patients. • Data from outpatient psychiatric clinic paper charts.

Exclusion Criteria • Pl aabt oi erna tt so rwy i dt ha ti an cf oo rmcpalteetcehoorl ammi isns ei ns go r precursor amino acids. • Cp shyacrht si awt riitch dui na gc lneoasreos r. m i s s i n g

Inclusion Criteria • Patients aged ≥18. • Diagnosed with MDD or GAD. • Dacoicdulmeveenlste. d catecholamine and amino

Table 1. Percentage of our data that falls into the top 25 th percentile of the population (a.). Percentage of our data that falls into the bottom 25 th percentage of the population (b.)

Procedure

Chart Review: • mReeavsi euwr eemd epnattsi eanntdcahvaerrtas gteodc ot hl lee cl et vcealtse oc hf oe laacmh iinned iavni dduaaml pi naot i ae cnitd. l e v e l s o v e r t h r e e s e p a r a t e De-identification: • Replaced patient names with coded identifiers to ensure confidentiality. Categorization: • aCcliadsasnifdiecdacteactehcohlaomlaimneinreeafenrdenacmeiinnotearcvidalsle:vels into quartiles based on LabCorp plasma amino • Above Normal Range • High (Top 25%) • Normal Range (Middle 50%) Data Recording: • MEanntenr-eWdhciatnteegyoUrizTeedstd.ata into Excel for comparison and analysis using linear regression and • Low (Bottom 25%) • Below Normal Range

a.

b.

2025 Research Recognition Day

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