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Costa R, Fatourou E, Hoppensteadt D, Fareed J, Halaris A. Cardiolipin Antibody: A Potential Biomarker for Depression. J Pers Med 2022; 12:jpm12111759. [PMID: 36573728 PMCID: PMC9697829 DOI: 10.3390/jpm12111759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Inflammation plays a pivotal role in the etiopathology of Major Depressive Disorder (MDD), at least in a subset of patients. It is crucial to first establish which specific inflammatory biomarkers are of clinical utility. Anti-cardiolipin antibody (aCL IgM) is an inflammatory marker that has the potential to be such a candidate but there are insufficient studies to confirm this potential. Objective: To investigate the baseline titer level and the longitudinal progression of plasma titers of aCL IgM in MDD subjects receiving antidepressant therapy in comparison to healthy control (HC) subjects; to determine if changes in aCL IgM plasma titers correlate to changes in depressive symptoms; and, to ascertain if baseline aCL IgM plasma titers could predict treatment response. Methods: Forty-eight medically healthy outpatients diagnosed with MDD were enrolled in one of two groups in two sequentially conducted clinical trials. In Group-E, patients received a 12-week regimen of escitalopram (n = 20). Those in Group-Q received a 12-week regimen of quetiapine (n = 28). The main outcome measure was plasma aCL IgM titers, the Hamilton Rating Scale for Depression (HAM-D17) and the Hamilton Rating Scale for Anxiety (HAM-A). There were 16 HC subjects. Results: When Group-Q and Group-E participants were grouped together (n = 48), MDD subjects had an elevated baseline aCL IgM (19.9 μg/mL) compared to HC subjects (8.32 μg/mL) (p = 0.006). aCL IgM correlated significantly with HAM-D17 scores at baseline in MDD subjects (p = 0.0185, r = 0.296). Examining the individual groups, Group-Q MDD patients had a significantly elevated baseline aCL IgM (p = 0.008) while Group-E's MDD patients did not. On the other hand, only Group-E MDD patients showed a significant correlation at baseline between aCL IgM and HAM-A score (p = 0.0392, r = 0.4327); they also showed a significant inverse correlation between week 12 HAMD-17 Item #10 (Anxiety, Psychic) and week 12 aCL IgM titer (p = 0.0268, r = -0.5516). Conclusions: MDD patients had significantly higher plasma titers of aCL IgM when compared to HC subjects. Moreover, at baseline, the higher the aCL IgM titer, the higher the depression severity, as measured by HAMD-17 score. However, this study did not demonstrate that aCL IgM titers changed significantly throughout a 12-week course of antidepressant treatment and revealed no correlation between changes in depressive symptoms and changes in aCL IgM titers. Baseline aCL IgM could not predict treatment response. We conclude that, despite lacking predictive ability as regards treatment response, plasma titers of aCL IgM have a diagnostic potential in MDD that necessitates further exploration.
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Affiliation(s)
- Renzo Costa
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
| | - Evangelia Fatourou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, New York, NY 10029, USA
| | - Debra Hoppensteadt
- Department of Pathology, Laboratory Medicine, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Jawed Fareed
- Department of Pathology, Laboratory Medicine, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Angelos Halaris
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
- Correspondence:
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Leal Rato M, Bandeira M, Romão VC, Aguiar de Sousa D. Neurologic Manifestations of the Antiphospholipid Syndrome - an Update. Curr Neurol Neurosci Rep 2021; 21:41. [PMID: 34125304 PMCID: PMC8200381 DOI: 10.1007/s11910-021-01124-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW In recent years, the spectrum of neurological manifestations of antiphospholipid syndrome (APS) has been growing. We provide a critical review of the literature with special emphasis on presentation, proposed mechanisms of disease, and treatment of neurological involvement in APS. RECENT FINDINGS Although stroke is the most common cause of neurological manifestations in patients with APS, other neurological disorders have been increasingly associated with the disease, including cognitive dysfunction, headache, and epilepsy. Direct oral anticoagulants have failed to show non-inferiority compared to vitamin K antagonists for the prevention of major thrombotic events. Antiphospholipid antibodies are often found in patients with acute COVID-19 but clear evidence supporting an association between these antibodies and the risk of thrombotic events, including stroke and cerebral venous thrombosis, is still lacking. APS patients may present with several distinct neurological manifestations. New criteria will facilitate the classification of patients presenting with increasingly recognized non-criteria neurological manifestations.
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Affiliation(s)
- Miguel Leal Rato
- Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Matilde Bandeira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Diana Aguiar de Sousa
- Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.
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Borisova AB, Lisitsyna TA, Veltishchev DY, Reshetnyak TM, Seravina OF, Kovalevskaya OB, Krasnov VN, Nasonov EL. [Mental disorders and cognitive impairment in patients with antiphospholipid syndrome]. TERAPEVT ARKH 2020; 92:92-103. [PMID: 32598781 DOI: 10.26442/00403660.2020.05.000625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 11/22/2022]
Abstract
Mental disorders (mainly anxiety and depressive disorders) and cognitive impairment are often found in patients with antiphospholipid syndrome (APS), but their prevalence, structure, and mechanisms of occurrence are not well researched. The review provides literature data on the frequency, spectrum and possible causes of mental disorders and cognitive impairment in patients with APS, the pathogenetic mechanisms of these disorders (in particular, the important role of antiphospholipid antibodies, stress factors, chronic inflammation), the relationship between APS, mental disorders and as well as cognitive impairment is examined. Special attention is paid to the influence of mental disorders and cognitive impairment on patients adherence to treatment, their quality of life, as well as the particularities of psychopharmacotherapy of mental disorders in patients with APS. The aim of the review is to actualize the interdisciplinary problem of mental disorders and cognitive impairment in patients with APS and the need to introduce a partnership model of care.
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Affiliation(s)
- A B Borisova
- Moscow Research Institute of Psychiatry - branch of Serbskiy National Medical Research Center for Psychiatry and Addiction
| | | | - D Y Veltishchev
- Moscow Research Institute of Psychiatry - branch of Serbskiy National Medical Research Center for Psychiatry and Addiction.,Pirogov Russian National Research Medical University
| | - T M Reshetnyak
- Nasonova Research Institute of Rheumatology.,Russian Medical Academy of Continuous Professional Education
| | - O F Seravina
- Moscow Research Institute of Psychiatry - branch of Serbskiy National Medical Research Center for Psychiatry and Addiction
| | - O B Kovalevskaya
- Moscow Research Institute of Psychiatry - branch of Serbskiy National Medical Research Center for Psychiatry and Addiction
| | - V N Krasnov
- Moscow Research Institute of Psychiatry - branch of Serbskiy National Medical Research Center for Psychiatry and Addiction.,Pirogov Russian National Research Medical University
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4
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Aguirre-Villarreal D, Whittall LP, Fragoso-Loyo H, Cantú-Brito C, Crispín JC, Valdés-Ferrer SI. Intrathecal formation of anticardiolipin antibodies in a patient with SLE-related relapsing longitudinal myelitis: a possible pathogenic connection. Lupus 2018; 27:2292-2295. [PMID: 30394833 DOI: 10.1177/0961203318810430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nontraumatic acute transverse myelitis (ATM) can occur in response to infectious, inflammatory and vascular triggers; 1% of patients with systemic lupus erythematosus (SLE) develop ATM, but the mechanism remains unknown. OBJECTIVE The objective of this case report is to describe a case of intrathecal formation of anticardiolipin antibodies (aCL) during SLE-related ATM. METHODS A single patient analysis was conducted. RESULTS A 26-year-old housewife was diagnosed with SLE at age 19. Circulating aCL antibodies were positive at diagnosis. At age 21, she developed an episode of severe sepsis. At 23 years of age she developed an episode of ATM that left her paraplegic with a D10 sensory level, from which she recovered partially. Three years later, she developed a clinical relapse of ATM. During that second episode, serum levels of aCL were within normal limits, while cerebrospinal fluid levels were increased, suggesting intrathecal production of aCL. CONCLUSION Here, we present a case of a woman who developed relapsing SLE-related longitudinally extensive ATM in whom intrathecal formation of aCL was demonstrated, suggesting that local production and cross-recognition of nervous tissue by those autoantibodies may be myelopathic.
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Affiliation(s)
- D Aguirre-Villarreal
- 1 Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INNSZ), Mexico City, Mexico
| | - L P Whittall
- 2 Department of Immunology and Rheumatology, INNSZ, Mexico City, Mexico
| | - H Fragoso-Loyo
- 2 Department of Immunology and Rheumatology, INNSZ, Mexico City, Mexico
| | - C Cantú-Brito
- 1 Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INNSZ), Mexico City, Mexico
| | - J C Crispín
- 2 Department of Immunology and Rheumatology, INNSZ, Mexico City, Mexico
| | - S I Valdés-Ferrer
- 1 Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INNSZ), Mexico City, Mexico.,3 Department of Infectious Diseases, INNSZ, Mexico City, Mexico.,4 Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, NY, USA
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5
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Frauenknecht K, Leukel P, Weiss R, von Pein HD, Katzav A, Chapman J, Sommer CJ. Decreased hippocampal cell proliferation in mice with experimental antiphospholipid syndrome. Brain Struct Funct 2018; 223:3463-3471. [PMID: 29936552 DOI: 10.1007/s00429-018-1699-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/14/2018] [Indexed: 12/31/2022]
Abstract
The antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of antiphospholipid antibodies, which may trigger vascular thrombosis with consecutive infarcts. However, cognitive dysfunctions representing one of the most commonest neuropsychiatric symptoms are frequently present despite the absence of any ischemic brain lesions. Data on the structural and functional basis of the neuropsychiatric symptoms are sparse. To examine the effect of APS on hippocampal neurogenesis and on white matter, we induced experimental APS (eAPS) in adult female Balb/C mice by immunization with β2-glycoprotein 1. To investigate cell proliferation in the dentate gyrus granular cell layer (DG GCL), eAPS and control mice (n = 5, each) were injected with 5-bromo-2'-deoxyuridine (BrdU) once a day for 10 subsequent days. Sixteen weeks after immunization, eAPS resulted in a significant reduction of BrdU-positive cells in the DG GCL compared to control animals. However, double staining with doublecortin and NeuN revealed a largely preserved neurogenesis. Ultrastructural analysis of corpus callosum (CC) axons in eAPS (n = 6) and control mice (n = 7) revealed no significant changes in CC axon diameter or g-ratio. In conclusion, decreased cellular proliferation in the hippocampus of eAPS mice indicates a limited regenerative potential and may represent one neuropathological substrate of cognitive changes in APS while evidence for alterations of white matter integrity is lacking.
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Affiliation(s)
- Katrin Frauenknecht
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. .,Institute of Neuropathology, University Hospital of Zurich, University of Zurich, Schmelzbergstr. 12, 8091, Zurich, Switzerland.
| | - Petra Leukel
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Ronen Weiss
- Department of Neurology, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Harald D von Pein
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Aviva Katzav
- Department of Neurology, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Joab Chapman
- Department of Neurology, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Clemens J Sommer
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Focus Program Translational Neurosciences (FTN), Rhine Main Neuroscience Network (rmn2), Mainz, Germany
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7
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Anti-phospholipid syndrome associated with schizophrenia description of five patients and review of the literature. Immunol Res 2017; 65:438-446. [DOI: 10.1007/s12026-017-8895-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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9
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Gris JC, Nobile B, Bouvier S. Neuropsychiatric presentations of antiphospholipid antibodies. Thromb Res 2015; 135 Suppl 1:S56-9. [DOI: 10.1016/s0049-3848(15)50445-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Brambilla P, Bellani M, Isola M, Bergami A, Marinelli V, Dusi N, Rambaldelli G, Tansella M, Maria Finardi A, Martino G, Perlini C, Furlan R. Increased M1/decreased M2 signature and signs of Th1/Th2 shift in chronic patients with bipolar disorder, but not in those with schizophrenia. Transl Psychiatry 2014; 4:e406. [PMID: 24984193 PMCID: PMC4119216 DOI: 10.1038/tp.2014.46] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/10/2014] [Accepted: 04/22/2014] [Indexed: 12/19/2022] Open
Abstract
We here present data on immune gene expression of chemokines, chemokine receptors, cytokines and regulatory T-cell (T-reg) markers in chronic patients suffering from either schizophrenia (SCZ, N=20) or bipolar disorder (BD=20) compared with healthy controls (HCs, N=20). We extracted RNA from peripheral blood mononuclear cells and performed real-time (RT)-PCR to measure mRNA levels of chemokines, chemokine receptors, cytokines and T-reg markers. All the analyses were Bonferroni-corrected. The classical monocyte activation (M1) markers il6, ccl3 were significantly increased in BD as compared with both HC and SCZ patients (P=0.03 and P=0.002; P=0.024 and P=0.021, respectively), whereas markers of alternative (M2) monocyte activation ccl1, ccl22 and il10 were coherently decreased (controls: P=0.01, P=0.001 and P=0.09; SCZ subjects: P=0.02, P=0.05 and P=0.011, respectively). Concerning T-cell markers, BD patients had compared with HC downregulated ccr5 (P=0.02) and upregulated il4 (P=0.04) and compared with both healthy and SCZ individuals downregulated ccl2 (P=0.006 and P=0.003) and tgfβ (P=0.004 and P=0.007, respectively). No significant associations were found between any immune gene expression and clinical variables (prior hospitalizations, Brief Psychiatric Rating Scale, medications' dosages and lifetime administration). Although some markers are expressed by different immune cell types, these findings suggest a coherent increased M1/decrease M2 signature in the peripheral blood of BD patients with potential Th1/Th2 shift. In contrast, all the explored immune marker levels were preserved in SCZ. Further larger studies are needed to investigate the relevance of inflammatory response in BD, trying to correlate it to psychopathology, treatment and outcome measures and, possibly, to brain connectivity.
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Affiliation(s)
- P Brambilla
- DISM, Inter-University Center for Behavioural Neurosciences (ICBN), University of Udine, Udine, Italy,IRCCS “E. Medea” Scientific Institute, Udine, Italy,DISM, Inter-University Center for Behavioural Neurosciences (ICBN), University of Udine, P.le Kolbe no. 3, Udine 33100, Italy. E-mail:
| | - M Bellani
- Section of Psychiatry and Section of Clinical Psychology, Department of Public Health and Community Medicine, ICBN, University of Verona, Verona, Italy
| | - M Isola
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - A Bergami
- Department of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - V Marinelli
- Section of Psychiatry and Section of Clinical Psychology, Department of Public Health and Community Medicine, ICBN, University of Verona, Verona, Italy
| | - N Dusi
- Section of Psychiatry and Section of Clinical Psychology, Department of Public Health and Community Medicine, ICBN, University of Verona, Verona, Italy
| | - G Rambaldelli
- Section of Psychiatry and Section of Clinical Psychology, Department of Public Health and Community Medicine, ICBN, University of Verona, Verona, Italy
| | - M Tansella
- Section of Psychiatry and Section of Clinical Psychology, Department of Public Health and Community Medicine, ICBN, University of Verona, Verona, Italy
| | - A Maria Finardi
- Department of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - G Martino
- Department of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - C Perlini
- Section of Psychiatry and Section of Clinical Psychology, Department of Public Health and Community Medicine, ICBN, University of Verona, Verona, Italy
| | - R Furlan
- Department of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy
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Bergink V, Gibney SM, Drexhage HA. Autoimmunity, inflammation, and psychosis: a search for peripheral markers. Biol Psychiatry 2014; 75:324-31. [PMID: 24286760 DOI: 10.1016/j.biopsych.2013.09.037] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/08/2013] [Accepted: 09/27/2013] [Indexed: 02/06/2023]
Abstract
Accumulating evidence supports the view that deregulation of the immune system represents an important vulnerability factor for psychosis. In a subgroup of psychotic patients, the high comorbidity with autoimmune and chronic inflammatory conditions suggests a common underlying immune abnormality leading to both conditions. The reviewed data of affective and nonaffective psychosis show that if immune biomarkers exist for such immune abnormality, they may be found in raised macrophage/monocyte inflammatory activation patterns (monocytosis, high-inflammatory gene expression, raised glucocorticoid receptor β/glucocorticoid receptor α ratio, and high levels of proinflammatory and anti-inflammatory monocyte/macrophage derived cytokines in serum/plasma), reduced T cell numbers/proliferation, and TH1 skewing. This activation of the inflammatory response system may be suggestive for microglia activation, as these cells are the macrophages of the brain. Indeed, there is some evidence of activation of the microglia as detected in positron emission tomography scans and in histopathology, and it is assumed that this activation disturbs the development and function of neuronal circuits in the brain. Further, animal models of psychotic conditions (maternal stress and inflammation paradigms) suggest that such monocyte/microglia activation could be seen as the result of a combination of genetic predisposition and an immune-mediated two-hit model. Infection but also environmental stressors during gestation/early life activate microglia, perturbing neuronal development, thereby setting the stage for vulnerability for later psychotic disorders. A second hit, such as endocrine changes, stress, or infection, could further activate microglia, leading to functional abnormalities of the neuronal circuitry in the brain and psychosis.
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Affiliation(s)
- Veerle Bergink
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, Netherlands.
| | - Sinead M Gibney
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Hemmo A Drexhage
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, Netherlands
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12
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Tsai JD, Lin CL, Lin CC, Sung FC, Lue KH. Risk of epilepsy in patients with systemic lupus erythematosus - a retrospective cohort study. Neuropsychiatr Dis Treat 2014; 10:1635-43. [PMID: 25214788 PMCID: PMC4159130 DOI: 10.2147/ndt.s64323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) affects central and peripheral nervous systems, manifesting neuropsychiatric disorders that vary from subtle signs to life-threatening complications. This study compared the risk of epilepsy between a general population and patients with SLE. METHODS From the national insurance claims data of the Taiwan National Health Research Institutes, we identified 32,301 patients with newly diagnosed SLE from 1997-2010 and, for comparison, 129,204 randomly selected people without SLE; the frequencies of both groups were matched by sex, age, and diagnosis date. The incidence of epilepsy was estimated for both cohorts by the end of 2010. RESULTS The incidence of epilepsy was 2.86-fold higher in the SLE cohort than in the non-SLE cohort (9.10 per 10,000 person-years versus 3.18 per 10,000 person-years), with a Cox method estimated adjusted hazard ratio (aHR) of 2.33 (95% confidence interval [CI] =1.89-2.88) for the SLE cohort. The incidence increased with age in the non-SLE cohort, while it decreased with the increase of age in the SLE cohort. Compared with the non-SLE cohort, the age-specific aHR of epilepsy for the SLE cohort decreased from 8.05 (95% CI =4.30-15.0) for those aged ≤20 years to 0.90 (95% CI =0.57-1.42) for those aged 60 years and above (P=0.01). Comorbidities that had a significant association with epilepsy included infarction (aHR =7.62), intracerebral hemorrhage (aHR =5.75), aseptic meningoencephalitis (aHR =5.35), and psychiatric disorder (aHR =3.31). CONCLUSION Patients with SLE are at higher risk of epilepsy than the general population, especially younger SLE patients. Neurologic comorbidities and psychiatric disorders increase the epilepsy risk further.
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Affiliation(s)
- Jeng-Dau Tsai
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan ; Department of Pediatrics, Chung Shan Medical University and Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Institute of Clinical and Medical Science, China Medical University, Taichung, Taiwan ; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University School of Medicine, Taichung, Taiwan ; Division of Family Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Fung-Chang Sung
- Institute of Clinical and Medical Science, China Medical University, Taichung, Taiwan ; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan ; Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Ko-Huang Lue
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan ; Department of Pediatrics, Chung Shan Medical University and Hospital, Taichung, Taiwan
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13
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A systematic, quantitative review of blood autoantibodies in schizophrenia. Schizophr Res 2013; 150:245-51. [PMID: 23953827 DOI: 10.1016/j.schres.2013.07.029] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Schizophrenia is associated with immune system dysfunction, including an increased prevalence of autoimmune disorders and autoantibodies. We performed a systematic, quantitative review of self-reacting blood antibodies in patients with schizophrenia. METHOD We identified articles by searching PubMed, PsychInfo, and ISI, and the reference lists of identified studies. RESULTS Eighty-one of 111 studies identified met the inclusion criteria. There was a significant increased prevalence of positive titers for 20 different autoantibodies in patients with schizophrenia compared to controls. The prevalence of positive anti-cardiolipin IgG and NMDA receptor titers was also significantly increased in subjects with first-episode psychosis versus controls (p<0.01). Absolute titers for anti-cardiolipin IgG and IgM, and nerve growth factor were significantly increased in patients with schizophrenia compared to controls (p<0.02 for each). CONCLUSION Schizophrenia is associated with an increased prevalence of multiple autoantibodies, although there is marked study heterogeneity, and correlations between autoantibodies and clinical features are inconsistent. This area merits more research evaluation, especially controlling for potential confounding factors such as clinical status, age, genetic background, psychotropic medications, BMI, and smoking.
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Increased anti-phospholipid antibodies in autism spectrum disorders. Mediators Inflamm 2013; 2013:935608. [PMID: 24174712 PMCID: PMC3794552 DOI: 10.1155/2013/935608] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/14/2013] [Indexed: 12/14/2022] Open
Abstract
Autism spectrum disorders (ASD) are characterized by impairments in communication, social interactions, and repetitive behaviors. While the etiology of ASD is complex and likely involves the interplay of genetic and environmental factors, growing evidence suggests that immune dysfunction and the presence of autoimmune responses including autoantibodies may play a role in ASD. Anti-phospholipid antibodies are believed to occur from both genetic and environmental factors and have been linked to a number of neuropsychiatric symptoms such as cognitive impairments, anxiety, and repetitive behaviors. In the current study, we investigated whether there were elevated levels of anti-phospholipid antibodies in a cross-sectional analysis of plasma of young children with ASD compared to age-matched typically developing (TD) controls and children with developmental delays (DD) other than ASD. We found that levels of anti-cardiolipin, β2-glycoprotein 1, and anti-phosphoserine antibodies were elevated in children with ASD compared with age-matched TD and DD controls. Further, the increase in antibody levels was associated with more impaired behaviors reported by parents. This study provides the first evidence for elevated production of anti-phospholipid antibodies in young children with ASD and provides a unique avenue for future research into determining possible pathogenic mechanisms that may underlie some cases of ASD.
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Chiaie RD, Caronti B, Macrì F, Campi S, Marino M, Corrado A, Caredda M, Biondi M. Anti-purkinje cell and natural autoantibodies in a group of psychiatric patients. Evidences for a correlation with the psychopathological status. Clin Pract Epidemiol Ment Health 2012; 8:81-90. [PMID: 22934121 PMCID: PMC3428622 DOI: 10.2174/1745017901208010081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 12/19/2022]
Abstract
Phenomena of autoimmunity are frequent among psychiatric patients, but we don't know yet if they should be considered primary and linked to the pathophisiology of the disorder, or aspecific and associated to a general immune system activation. Paraneoplastic Cerebellar Degeneration (PCD) represents a well known model of specific autoimmunity. In order to better understand the abovementioned issues, we used this condition to compare a set of immune dysfunctions found in a group of psychiatric patients. For this reason we tested sera from 48 psychiatric patients (24 schizophrenics, 17 bipolars and 7 obsessive-compulsive), 22 PCD patients and 52 healthy controls for the presence of anti-Purkinje autoantibodies and of some natural autoantibodies (ANAs, AMAs, APCAs, ASMAs). Psychopatological status of the psychiatric patients was assessed with BPRS, SANS, SAPS, HAM-D, CGI-S. In the psychiatric group anti-Purkinje autoantibodies were identified in 11/48 (22,9%) patients, while they were present in 22/22 (100%) PCD patients and in 0/52 (0%) healthy controls. Among all anti-Purkinje autoantibody positive patients (in the PCD and psychiatric samples), only those belonging to the psychiatric sample, but not those with PCD, were frequently found positive also for natural autoantibodies, that are considered good markers of aspecific immune activation. In these patients, both anti-Purkinje and natural autoantibodies were found associated with acute/positive psychopathological symptoms. These results seem to point out that some phenomena of auto-immunity described in psychiatric patients could be aspecific, unrelated to the pathophysiology of the concomitant mental disorders and could be more frequent during phases of acute/positive symptoms.
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Affiliation(s)
- Roberto Delle Chiaie
- Departement of Neurology and Psichiatry, "Sapienza” University of Rome, Italy
- Policlinico Umberto-I Hospital, Rome, Italy
| | - Brunella Caronti
- Departement of Neurology and Psichiatry, "Sapienza” University of Rome, Italy
- Policlinico Umberto-I Hospital, Rome, Italy
| | - Francesco Macrì
- Departement of Neurology and Psichiatry, "Sapienza” University of Rome, Italy
| | - Sandra Campi
- Departement of Neurology and Psichiatry, "Sapienza” University of Rome, Italy
| | - Marzia Marino
- Departement of Neurology and Psichiatry, "Sapienza” University of Rome, Italy
| | - Alessandra Corrado
- Departement of Neurology and Psichiatry, "Sapienza” University of Rome, Italy
| | - Maria Caredda
- Departement of Neurology and Psichiatry, "Sapienza” University of Rome, Italy
- Policlinico Umberto-I Hospital, Rome, Italy
| | - Massimo Biondi
- Departement of Neurology and Psichiatry, "Sapienza” University of Rome, Italy
- Policlinico Umberto-I Hospital, Rome, Italy
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16
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Richard MD, Brahm NC. Schizophrenia and the immune system: pathophysiology, prevention, and treatment. Am J Health Syst Pharm 2012; 69:757-66. [PMID: 22517021 DOI: 10.2146/ajhp110271] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Published evidence on established and theoretical connections between immune system dysfunction and schizophrenia is reviewed, with a discussion of developments in the search for immunologically-targeted treatments. SUMMARY A growing body of evidence indicates that immunologic influences may play an important role in the etiology and course of schizophrenia. A literature search identified more than 100 articles pertaining to suspected immunologic influences on schizophrenia published over the past 15 years. Schizophrenia researchers have explored a wide range of potential immune system-related causal or contributory factors, including neurobiological and neuroanatomical disorders, genetic abnormalities, and environmental influences such as maternal perinatal infection. Efforts to establish an immunologic basis for schizophrenia and identify reliable immune markers continue to be hindered by sampling challenges and methodological problems. In aggregate, the available evidence indicates that at least some cases of schizophrenia have an immunologic component, suggesting that immune-focused prevention strategies (e.g., counseling of pregnant women to avoid immune stressors) and close monitoring of at-risk children are appropriate. While antipsychotics remain the standard treatments for schizophrenia, a variety of drugs with immunologic effects have been investigated as adjunctive therapies, with variable and sometimes conflicting results; these include the cyclooxygenase-2 inhibitor celecoxib, immune-modulating agents (e.g., azathioprine and various anticytokine agents such as atlizumab, anakinra, and tumor necrosis factor-α blockers), and an investigational anti-interferon-γ agent. CONCLUSION The published evidence indicates that immune system dysfunction related to genetic, environmental, and neurobiological influences may play a role in the etiology of schizophrenia in a subset of patients.
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Vasic N, Connemann BJ, Wolf RC, Tumani H, Brettschneider J. Cerebrospinal fluid biomarker candidates of schizophrenia: where do we stand? Eur Arch Psychiatry Clin Neurosci 2012; 262:375-91. [PMID: 22173848 DOI: 10.1007/s00406-011-0280-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/03/2011] [Indexed: 02/07/2023]
Abstract
Here, we review the cerebrospinal fluid (CSF) candidate markers with regard to their clinical relevance as potential surrogates for disease activity, prognosis assessment, and predictors of treatment response. We searched different online databases such as MEDLINE and EMBASE for studies on schizophrenia and CSF. Initial studies on cerebrospinal fluid in patients with schizophrenia revealed increased brain-blood barrier permeability with elevated total protein content, increased CSF-to-serum ratio for albumin, and intrathecal production of immunoglobulins in subgroups of patients. Analyses of metabolites in CSF suggest alterations within glutamatergic neurotransmission as well as monoamine and cannabinoid metabolism. Decreased levels of brain-derived neurotrophic factor and nerve growth factor in CSF of first-episode patients with schizophrenia reported in recent studies point to a dysregulation of neuroprotective and neurodevelopmental processes. Still, these findings must be considered as non-specific. A more profound characterization of the particular psychopathological profiles, the investigation of patients in the prodromal phase or within the first episode of schizophrenia promoting longitudinal investigations, implementation of different approaches of proteomics, and rigorous adherence to standard procedures based on international CSF guidelines are necessary to improve the quality of CSF studies in schizophrenia, paving the way for identification of syndrome-specific biomarker candidates.
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Affiliation(s)
- Nenad Vasic
- Department of Psychiatry and Psychotherapy III, University of Ulm, Germany.
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Anti-phospholipid antibodies in cerebrospinal fluid but not serum from a boy with psychosis. Pediatr Neurol 2008; 39:293-4. [PMID: 18805373 DOI: 10.1016/j.pediatrneurol.2008.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 06/17/2008] [Accepted: 07/16/2008] [Indexed: 11/23/2022]
Abstract
A 12-year-old African American boy with mental retardation and Asperger's disorder presented with acute psychosis. Antiphospholipid antibody testing with enzyme-linked immunosorbent assay showed increased levels of immunoglobulin G anticardiolipin antibodies in the cerebrospinal fluid, but not in the serum. Although antiphospholipid antibodies have been reported in the serum of patients with thrombotic and neurologic disorders, there are only a few reports of these antibodies in cerebrospinal fluid. This finding is consistent with a recent report of antiphospholipid antibodies found in the cerebrospinal fluid of adults with acute psychosis.
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