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In a preliminary study using blood and spinal fluid samples from 200 people, Johns Hopkins Medicine researchers say they have evidence that a well-studied protein involved in blood pressure regulation may serve as a marker for—and perhaps play a role in—treatment-resistant schizophrenia and other psychoses.

The findings, if confirmed in larger studies, could eventually contribute to more objective ways of identifying people with psychosis who may need different treatment approaches, the researchers say.

In the study published online Sept. 9 in JAMA Psychiatry, researchers found significantly lower levels of angiotensin-converting enzyme (ACE), a protein that helps regulate blood pressure, in the blood of people with treatment-resistant psychosis compared with people with early-stage psychosis not classified as treatment-resistant. Importantly, the investigators say, ACE protein levels in blood correlated with ACE levels in cerebrospinal fluid, suggesting that a simple blood test may accurately reflect what is happening in the brain.

Because ACE is known to narrow blood vessels, ACE inhibitors are widely prescribed for hypertension, blocking the protein from doing its normal job. "The new findings suggest this protein may be doing something entirely different in the context of psychosis," says Akira Sawa, M.D., director of the Johns Hopkins Schizophrenia Center.

"Our next step is to understand this additional, unrecognized function of ACE protein.

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