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Grant JE, Chamberlain SR, Collins M. Elevated rates of GI-focused inflammatory illnesses in trichotillomania and skin picking disorder: A survey study. Gen Hosp Psychiatry 2024:S0163-8343(24)00141-5. [PMID: 38862332 DOI: 10.1016/j.genhosppsych.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Affiliation(s)
- Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, United States of America.
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, UK and NHS Southern Gambling Service / Southern Health NHS Foundation Trust, Southampton, UK
| | - Madison Collins
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, United States of America
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Effects of celecoxib augmentation of antidepressant or anxiolytic treatment on affective symptoms and inflammatory markers in patients with anxiety disorders: exploratory study. Int Clin Psychopharmacol 2021; 36:126-132. [PMID: 33724256 DOI: 10.1097/yic.0000000000000356] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prolonged stress has been associated with elevated levels of circulating proinflammatory cytokines. Cyclo-oxygenase-2 inhibitors such as celecoxib exert anti-inflammatory effects and may enhance the response to antidepressant drug treatment in patients with depressive disorders, but their effect on anxiety symptoms in patients with anxiety disorders is uncertain. Patients with a primary diagnosis of an anxiety disorder, with stabilised symptoms, underwent either 6 weeks of celecoxib augmentation of continued treatment (n = 18) or continued 'treatment as usual' (n = 9). Assessments included the Warwick-Edinburgh mental well-being Scale (WEMWEBS), Hospital Anxiety and Depression Scale (HADS), Oxford questionnaire of emotional side effects of antidepressants (OQUESA) and Clinical Global Impression of Illness Severity (CGI-S). Venous blood samples were collected for assays of inflammatory cytokines. Patients who underwent celecoxib augmentation showed significant reductions in anxiety (HADS-A -3.17) and depressive (HADS-D -2.11) symptoms and in overall illness severity (CGI-S -1.11), and improvements in mental well-being (WEMWBS 7.5) and positive changes in emotional responsiveness (OQUESA-RP -3.56; OQUESA-AC -4.22): these were not seen with 'treatment as usual'. There were no significant changes in blood levels of inflammatory cytokines in either group. Celecoxib augmentation appeared associated with beneficial effects on anxiety and depressive symptoms and mental well-being. The findings from this pilot study merit further exploration within a double-blind, randomised placebo-controlled study.
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Kutuk MO, Tufan AE, Kilicaslan F, Mutluer T, Gokcen C, Karadag M, Yektas C, Kandemir H, Buber A, Guler Aksu G, Topal Z, Giray A, Celik F, Acikbas U, Kutuk O. Novel inflammatory targets for immunotherapies in pediatric patients with trichotillomania. Immunobiology 2020; 225:151913. [PMID: 32113788 DOI: 10.1016/j.imbio.2020.151913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/02/2020] [Accepted: 02/11/2020] [Indexed: 01/10/2023]
Abstract
Immune dysregulation may be important in the etiology of obsessive-compulsive and related disordersandbody-focusedrepetitivebehaviors, such as Trichotillomania (TTM). The role of inflammation and inflammatory markers in TTM has received relatively little attention. This study was aimed to determine the expression levels of inflammatory markers (i.e. IL-1β, IL-1α, IL-4, IL-6, IL-17, TNF-α and TGF-β) in peripheral blood mononuclear cells of children with TTM and healthy controls and to evaluate their association with clinical variables. Seventy-seven patients with TTM and 107 healthy controls were enrolled in the study. Peripheral blood was collected in standardized conditions. The mean age of patients and controls did not differ significantly (10.8 ± 4.4 and 12.0 ± 3.2 years; respectively). The majority of patients with TTM and controls were females (n = 55, 71.4 % and n = 55, 51.4 %; respectively); with a greater preponderance of females among TTM. Patients with TTM had significantly elevated expression levels of TNF-α, IL-6 and IL-17 compared to controls. However, the expression level of IL-4 was significantly reduced in TTM patients compared to controls. Accordingly, we found a pro-inflammatory state in TTM and those findings may suggest novel treatment options for TTM and further, cross-disciplinary studies focusing on neuro- inflammation in TTM conducted on larger samples are needed.
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Affiliation(s)
- Meryem Ozlem Kutuk
- Department of Child and Adolescent Psychiatry, Baskent University, Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Fethiye Kilicaslan
- Department of Child and Adolescent Psychiatry, Mehmet Akif İnan Education and Research Hospital, Sanliurfa, Turkey
| | - Tuba Mutluer
- Department of Child and Adolescent Psychiatry, Koc University, İstanbul, Turkey
| | - Cem Gokcen
- Department of Child and Adolescent Psychiatry, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Karadag
- Department of Child and Adolescent Psychiatry, Mardin State Hospital, Mardin, Turkey
| | - Cigdem Yektas
- Department of Child and Adolescent Psychiatry, Düzce University, Düzce, Turkey
| | - Hasan Kandemir
- Department of Child and Adolescent Psychiatry, Celal Bayar University, Manisa, Turkey
| | - Ahmet Buber
- Department of Child and Adolescent Psychiatry, Pamukkale University, Denizli, Turkey
| | - Gulen Guler Aksu
- Department of Child and Adolescent Psychiatry, Mersin University, Mersin, Turkey
| | - Zehra Topal
- Department of Child and Adolescent Psychiatry, Gaziantep University, Gaziantep, Turkey
| | - Asli Giray
- Department of Genetic and Bioengineering, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Fatma Celik
- Department of Child and Adolescent Psychiatry, Malatya Training and Research Hospital, Malatya, Turkey
| | - Ufuk Acikbas
- Department of Medical Genetics, Baskent University, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
| | - Ozgur Kutuk
- Department of Medical Genetics, Baskent University, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey.
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Özyurt G, Binici NC. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in adolescent obsessive-compulsive disorder: Does comorbid anxiety disorder affect inflammatory response? Psychiatry Res 2019; 272:311-315. [PMID: 30597382 DOI: 10.1016/j.psychres.2018.12.131] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 12/27/2022]
Abstract
Recent adult etiologic studies indicated evidence linking increased inflammatory parameters with psychiatric disorders. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are easily obtainable clinical markers of inflammation and have been found to be increased in various medical and mental disorders. In this study, we aimed to investigate the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in adolescents with obsessive-compulsive disorder (OCD). Secondarily, the effect of comorbid anxiety disorder with OCD on the inflammatory response was investigated. Sixty drug-naïve adolescents with OCD aged 12 to 18 years were enrolled in the patient group. Twenty-three of the OCD group had comorbid anxiety disorder (AD) and 37 had no comorbidities. One hundred twenty-eight adolescents in the same age range with no psychiatric disorders were recruited as the healthy control group. The severity of OCD symptoms was evaluated using the Children's Yale-Brown Obsessive Compulsive Scale. There were statistically significant differences in the neutrophil-lymphocyte ratio, white blood cell, neutrophil, and platelet counts among the three groups, even after adjusting for age and sex. The adolescents with OCD and AD had the highest neutrophil-lymphocyte ratio and white blood cell counts. A comorbid anxiety disorder diagnosis in addition to obsessive-compulsive disorder may increase the inflammatory response.
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Affiliation(s)
- Gonca Özyurt
- Child and Adolescent Psychiatry Department, Medical School, İzmir Katip Çelebi University, İzmir, Turkey.
| | - Nagihan Cevher Binici
- Child and Adolescent Psychiatry Specialist, Child and Adolescent Psychiatry Unit, Behçet Uz Children's Hospital, İzmir, Turkey.
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Immune Aberrations in Obsessive-Compulsive Disorder: a Systematic Review and Meta-analysis. Mol Neurobiol 2018; 56:4751-4759. [PMID: 30382535 DOI: 10.1007/s12035-018-1409-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/24/2018] [Indexed: 01/18/2023]
Abstract
Some lines of evidence have indicated that immune dysregulation could play a role in the pathophysiology of obsessive-compulsive disorder (OCD). However, results have been inconsistent across studies. Thus, a systematic review and meta-analysis of studies measuring immune mediators in participants with OCD compared to healthy controls (HC) was conducted. The PubMed/MEDLINE, PsycINFO, and EMBASE electronic databases were systematically searched from inception through June 21, 2018. Sixteen studies met inclusion criteria comprising data from 1001 participants (538 with OCD and 463 were HCs). Levels of TNF-α, IL-6, IL-1β, IL-4, IL-10, and interferon-γ did not significantly differ between participants with OCD and healthy controls. In addition, the ex vivo production of TNF-α and IL-6 by isolated macrophages did not significantly differ between participants with OCD and HCs. Nevertheless, included studies have varied in methodological quality with the enrollment of samples that differed regarding medication status, the proper matching of OCD participants and HCs, age groups, and the presence of psychiatric comorbidities. In conclusion, an association between immune dysregulation and OCD remains unproven. Future studies should consider enrolling larger and more homogeneous samples with OCD.
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Lamothe H, Baleyte JM, Smith P, Pelissolo A, Mallet L. Individualized Immunological Data for Precise Classification of OCD Patients. Brain Sci 2018; 8:E149. [PMID: 30096863 PMCID: PMC6119917 DOI: 10.3390/brainsci8080149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 12/11/2022] Open
Abstract
Obsessive⁻compulsive disorder (OCD) affects about 2% of the general population, for which several etiological factors were identified. Important among these is immunological dysfunction. This review aims to show how immunology can inform specific etiological factors, and how distinguishing between these etiologies is important from a personalized treatment perspective. We found discrepancies concerning cytokines, raising the hypothesis of specific immunological etiological factors. Antibody studies support the existence of a potential autoimmune etiological factor. Infections may also provoke OCD symptoms, and therefore, could be considered as specific etiological factors with specific immunological impairments. Finally, we underline the importance of distinguishing between different etiological factors since some specific treatments already exist in the context of immunological factors for the improvement of classic treatments.
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Affiliation(s)
- Hugues Lamothe
- Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France.
- Institut du Cerveau et de la Moelle Epinière, Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, 75013 Paris, France.
- Fondation FondaMental, 94000 Créteil, France.
| | - Jean-Marc Baleyte
- Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France.
- Fondation FondaMental, 94000 Créteil, France.
| | - Pauline Smith
- Institut du Cerveau et de la Moelle Epinière, Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, 75013 Paris, France.
| | - Antoine Pelissolo
- Fondation FondaMental, 94000 Créteil, France.
- Assistance Publique-Hôpitaux de Paris, Pôle de Psychiatrie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Université Paris-Est Créteil, 94000 Créteil, France.
- INSERM, U955, Team 15, 94000 Créteil, France.
| | - Luc Mallet
- Institut du Cerveau et de la Moelle Epinière, Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, 75013 Paris, France.
- Fondation FondaMental, 94000 Créteil, France.
- Assistance Publique-Hôpitaux de Paris, Pôle de Psychiatrie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Université Paris-Est Créteil, 94000 Créteil, France.
- Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, 1202 Geneva, Switzerland.
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Esawy MM, Shabana MA, Ali EF. Role of IL-6/IL-10 ratio in the diagnosis and in the assessment of the severity of obsessive-compulsive disorder. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s00580-018-2803-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Grant JE, Chamberlain SR. Salivary Inflammatory Markers in Trichotillomania: A Pilot Study. Neuropsychobiology 2018; 76:182-186. [PMID: 29920483 PMCID: PMC6098693 DOI: 10.1159/000489865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Immune dysregulation has been hypothesized to be important in the development and pathophysiology of compulsive disorders such as obsessive compulsive disorder (OCD), which has a high comorbid overlap with trichotillomania (both are OC-related disorders). The role of inflammation in the pathophysiology of trichotillomania has garnered little research to date. METHODS Individuals with trichotillomania provided saliva sample for analysis of inflammatory cytokines. Additionally, these participants were examined on a variety of demographic variables (including body mass index [BMI], previously found to relate to inflammation) along with clinical measures (symptom severity, functioning, and comorbidity). RESULTS Thirty-one participants, mean age of 24.7 (±10.2) years, 27 (87.1%) females were -included. The mean score on the Massachusetts General Hospital Hair Pulling Scale was 15.7 (±4.2), reflective of moderate symptom severity. Compared to normative data, the mean inflammatory marker levels in the trichotillomania sample had the following Z scores: interleukin-1β (IL-1β) Z = -0.26, IL-6 Z = -0.39, IL-8 Z = -0.32, and tumor necrosis factor-α Z = -0.83. Levels of inflammatory markers did not correlate significantly with BMI, depressive mood, symptom severity, or disability. CONCLUSIONS The relatively low level of inflammatory saliva cytokines observed in the current study (negative z scores versus normative data with medium effect sizes) indicates that evaluation of blood inflammatory levels in trichotillomania versus matched controls would be valuable in future work. If a hypoinflammatory state is confirmed -using blood samples, this would differentiate trichotillomania from other mental disorders (such as OCD, schizophrenia, and depression), which have typically been linked with high inflammatory measures in the literature, at least in some cases.
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Affiliation(s)
- Jon E. Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA,*Jon E. Grant, JD, MD, MPH, Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 3077, Chicago, IL 60637 (USA), E-Mail
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
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Hazari N, Narayanaswamy JC, Arumugham SS. Predictors of response to serotonin reuptake inhibitors in obsessive-compulsive disorder. Expert Rev Neurother 2016; 16:1175-91. [DOI: 10.1080/14737175.2016.1199960] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rao NP, Venkatasubramanian G, Ravi V, Kalmady S, Cherian A, Yc JR. Plasma cytokine abnormalities in drug-naïve, comorbidity-free obsessive-compulsive disorder. Psychiatry Res 2015; 229:949-52. [PMID: 26187339 DOI: 10.1016/j.psychres.2015.07.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 06/03/2015] [Accepted: 07/05/2015] [Indexed: 02/06/2023]
Abstract
Growing evidence in the last decade suggest significant role of immune alterations in the pathogenesis of obsessive-compulsive disorder (OCD). Cytokines, mediators of inflammation, alter the neurotransmitter concentration and result in a hyposerotonergic and hyperglutamatergic state implicated in pathogenesis of OCD. However, only few studies have examined cytokine abnormalities in OCD with inconsistent results possibly due to confounding effects of medications and comorbid anxiety-depression. We examined 20 comorbidity free, drug free OCD patients and 20 age and sex matched healthy controls. Clinical severity was assessed using Yale Brown Obsessive Compulsive Scale, Hamilton anxiety rating scale, Hamilton depression rating scale and Clinical Global Impression. Levels of different cytokines, Interleukin (IL)-2, IL-4, IL-6, IL-10, Tumor necrosis factor (TNF)-α and Interferon (IFN)-γ were assessed using Cytometric Bead Array. OCD patients had significantly greater plasma levels of IL-2, IL-4, IL-6, IL-10 and TNF-α levels than controls but not IFN-γ. Reanalysis of data with only drug naïve patients (excluding 4 drug free patients) did not alter the results. Presence of these abnormalities in drug-naïve patients suggests the possible role of cytokines in the pathogenesis of OCD. Study findings have potential clinical utility in development of novel therapeutic options targeting cytokine aberrations in OCD.
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Affiliation(s)
- Naren P Rao
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India.
| | | | - Vasanthapuram Ravi
- Department of Neurovirology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Sunil Kalmady
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Anish Cherian
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Janardhan Reddy Yc
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
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Bo Y, Liu S, Yin Y, Wang Z, Cui J, Zong J, Zhang X, Li X. Association study between IL-1β-511 C/T polymorphism and obsessive-compulsive disorder (OCD) in Chinese Han population. Int J Psychiatry Med 2014; 46:145-52. [PMID: 24552038 DOI: 10.2190/pm.46.2.b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM This study investigated the potential association between Obsessive-Compulsive Disorder (OCD) and a functional polymorphism of IL-1beta-511 C/T in Chinese Han population. METHODS The authors genotyped the IL-1beta-511 C/T of 241 OCD patients and 444 healthy control subjects and then performed a case-control association analysis. RESULTS No difference was found in IL-1beta-511 C/T genotypic and allelic frequencies between OCD cases and controls (chi2 = 0.501, df = 2, P = 0.78 by genotype; chi2 = 0.487, df = 1, P = 0.49 by allele). CONCLUSION IL-1beta-511 polymorphism may not play a major role in the genetic predisposition to OCD in Chinese Han population. Given that this is an early investigation of this gene in OCD, further studies are required to draw firm conclusions.
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Affiliation(s)
- Yongli Bo
- Shandong University and Qingdao University, China
| | | | | | | | | | | | | | - Xingang Li
- Neurosurgery Department of Qilu Hospital, Brain Sciences Research Institute, Shandong University, Jinan, China
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Teixeira AL, Rodrigues DH, Marques AH, Miguel EC, Fontenelle LF. Searching for the immune basis of obsessive-compulsive disorder. Neuroimmunomodulation 2014; 21:152-8. [PMID: 24557049 DOI: 10.1159/000356554] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The etiopathogenesis of obsessive-compulsive disorder (OCD) remains elusive. Clinical observation of the elevated frequency of obsessive-compulsive symptoms in patients with rheumatic fever, a post-streptococcal autoimmune disease, prompted the study of immune parameters in OCD. Anti-basal ganglia antibodies have been described in a subset of OCD patients. The assessment of circulating cytokines and immune cells confirmed unequivocal changes in at least some patients, although it is difficult to establish a particular immune profile in OCD. Several factors, including the use of psychotropic drugs and the presence of comorbid conditions, seem to influence these immune parameters.
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Affiliation(s)
- Antonio Lucio Teixeira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Belo Horizonte, Brazil
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Abstract
Several studies have examined levels of proinflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6. This meta-analysis was conducted to examine the association between obsessive-compulsive disorder (OCD) and plasma serum levels of proinflammatory cytokines. Twelve studies met inclusion criteria. The meta-analysis demonstrated a significant reduction in IL-1β levels in OCD. No significant difference in plasma levels of IL-6 or TNF-α was demonstrated. Stratified subgroup analysis revealed possible moderating effects of age and medication use on IL-6 levels. Studies including children on psychotropic medication had lower plasma IL-6 levels. Stratified subgroup analysis revealed a moderating effect of comorbid depression on TNF-α levels. Elevated TNF-α levels were reported in studies that included individuals with comorbid depression. Future studies examining immune function in OCD should adjust for potential confounding due to medication use and comorbid depression. Further studies assessing cerebrospinal fluid cytokine levels in OCD are also needed.
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Liu S, Liu Y, Yin Y, Zhang X, Ma X. A case-control study of interleukin-12 1188A/C polymorphism in obsessive-compulsive disorder in Chinese population. Acta Neuropsychiatr 2012; 24:172-5. [PMID: 26953011 DOI: 10.1111/j.1601-5215.2011.00616.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Previous studies indicated that the levels of serum interleukin (IL)-12 at baseline were elevated in obsessive-compulsive disorder (OCD) patients compared with control subjects, suggesting that IL-12 maybe involved in the etiopathogenesis of OCD. Therefore, we study the relationship between 1188A/C polymorphism of IL-12(rs3212227) and OCD in Chinese Han population. METHODS We genotyped 194 OCD patients and 322 healthy individuals by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), then analyzed the data using case-control association test. RESULTS No significant differences were found in 1188A/C genotypic and allelic frequencies between OCD cases and controls ( X 2 = 2.12, df = 2, P = 0.35 by genotype; X 2 = 0.005, df = 1, P = 0.94 by allele). CONCLUSIONS Our results suggested that there may be lack of an association between OCD and IL-12 1188A/C polymorphism in Chinese Han population.
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Affiliation(s)
- Shiguo Liu
- Shandong Provincial Key Laboratory of Metabolic Disease, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Yanhui Liu
- Departments of psychiatry and Psychological clinic, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Yingying Yin
- Departments of psychiatry and Psychological clinic, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Xinhua Zhang
- Departments of psychiatry and Psychological clinic, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Xu Ma
- Graduate school, Peking Union Medical College, Beijing, China
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15
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Liu S, Liu Y, Zhang X, Ma X. Lack of association of -251T/A polymorphism in interleukin 8 gene with susceptibility to obsessive-compulsive disorder in Chinese Han population. Cytokine 2012; 59:209-10. [PMID: 22609211 DOI: 10.1016/j.cyto.2012.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
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Zohar J, Greenberg B, Denys D. Obsessive-compulsive disorder. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:375-90. [DOI: 10.1016/b978-0-444-52002-9.00021-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Hou R, Baldwin DS. A neuroimmunological perspective on anxiety disorders. Hum Psychopharmacol 2012; 27:6-14. [PMID: 22213434 DOI: 10.1002/hup.1259] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 11/18/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Research into psychoneuroimmunology has led to substantial advances in our understanding of the reciprocal interactions between the central nervous system and the immune system in neuropsychiatric disorders. To date, the presence of inflammatory responses and the crucial role of cytokines in major depression have been addressed in numerous studies. However, neuroinflammatory hypotheses in anxiety disorders have been studied less extensively than in major depression. There is a high research need for better understanding of both the heterogeneous role of specific cytokines in the control of anxious states and in different anxiety disorders and of the immunomodulating effects of antidepressants on anxiety. METHODS Relevant literature was identified through a search of MEDLINE via PubMed. We discuss recent research on neuroimmunology in anxiety and make methodological recommendations for future investigation of neuroinflammatory hypotheses in anxiety disorders. RESULTS Some accumulating evidence has indicated modulatory effects of cytokines on neuronal communication and anxiety; however, research has not revealed consistent reproducible findings. CONCLUSIONS The availability of inflammatory biomarkers may provide an opportunity to identify patients via specific pathophysiological processes and to monitor therapeutic responses within relevant pathways. Further understanding of the neuroimmunological mechanisms to untangle the reciprocal associations between inflammation and anxiety is warranted.
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Affiliation(s)
- Ruihua Hou
- University Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK.
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Fluitman S, Denys D, Vulink N, Schutters S, Heijnen C, Westenberg H. Lipopolysaccharide-induced cytokine production in obsessive-compulsive disorder and generalized social anxiety disorder. Psychiatry Res 2010; 178:313-6. [PMID: 20452055 DOI: 10.1016/j.psychres.2009.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 05/12/2009] [Accepted: 05/12/2009] [Indexed: 11/29/2022]
Abstract
The immune system is implicated in the pathophysiology of various psychiatric disorders. In anxiety disorders such as obsessive-compulsive disorder (OCD) and generalized social anxiety disorder (GSAD), immunological findings are equivocal and sparse. In this study, we investigated the lipopolysaccharide (LPS)- stimulated cytokine levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8) by peripheral blood leukocytes in 26 OCD patients, 26 GSAD patients, and 52 healthy controls. We found that leukocytes of OCD patients produced less IL-6 compared with matched controls, whereas no cytokine differences were found between GSAD patients and matched controls. When both patient groups were compared, a trend toward lower IL-6 levels in OCD patients was observed. This supports the idea of immunological involvement in the pathophysiology of OCD and suggests that GSAD and OCD might be different in immunological respect.
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Affiliation(s)
- Sjoerd Fluitman
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
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Disgust affects TNF-alpha, IL-6 and noradrenalin levels in patients with obsessive-compulsive disorder. Psychoneuroendocrinology 2010; 35:906-11. [PMID: 20044210 DOI: 10.1016/j.psyneuen.2009.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/04/2009] [Accepted: 12/04/2009] [Indexed: 11/21/2022]
Abstract
Neurobiological research of obsessive-compulsive disorder (OCD) has rarely taken in account the context dependent evocation of obsessive-compulsive symptoms. To bypass this obstacle, this study investigated neurobiological parameters during a standardized disgust provocation paradigm in patients with OCD and healthy controls. Ten OCD patients and 10 healthy controls were exposed to 9 disgust related items using a standardized provocation paradigm. Catecholamines and cortisol in plasma and lipopolysaccharide (LPS) stimulated levels of TNF-alpha and IL-6 by peripheral leucocytes were assessed along with severity of obsessive-compulsive symptoms, disgust, and anxiety levels using Visual Analogue Scales prior, during and after a provocation paradigm. Noradrenalin levels increased, while LPS stimulated TNF-alpha and IL-6 by peripheral leucocytes decreased during exposure to disgust related objects in OCD patients but not in healthy controls. Cortisol levels were not affected by exposure neither in patients nor in controls, but overall cortisol levels of OCD patients were increased compared to controls. In conclusion, our data suggests that symptom provocation in OCD patients with contamination fear is accompanied by alterations in the immune and neuroendocrine systems but does not affect cortisol levels.
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Tourette's syndrome, trichotillomania, and obsessive-compulsive disorder: how closely are they related? Psychiatry Res 2009; 170:32-42. [PMID: 19801170 DOI: 10.1016/j.psychres.2008.06.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 08/24/2007] [Accepted: 06/12/2008] [Indexed: 11/22/2022]
Abstract
The question of whether Tourette's syndrome (TS) and trichotillomania (TTM) are best conceptualized as obsessive-compulsive spectrum disorders was raised by family studies demonstrating a close relationship between TS and obsessive-compulsive disorder (OCD), and by psychopharmacological research indicating that both TTM and OCD respond more robustly to clomipramine than to desipramine. A range of studies have subsequently allowed comparison of the phenomenology, psychobiology, and management of TS and TTM, with that of OCD. Here we briefly review this literature. The data indicate that there is significant psychobiological overlap between TS and OCD, supporting the idea that TS can be conceptualized as an OCD spectrum disorder. TTM and OCD have only partial overlap in their phenomenology and psychobiology, but there are a number of reasons for why it may be useful to classify TTM and other habit disorders as part of the obsessive-compulsive spectrum of disorders.
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Marazziti D, Mungai F, Masala I, Baroni S, Vivarelli L, Ambrogi F, Catena Dell'Osso M, Consoli G, Massimetti G, Dell'Osso L. Normalisation of immune cell imbalance after pharmacological treatments of patients suffering from obsessive-compulsive disorder. J Psychopharmacol 2009; 23:567-73. [PMID: 18755814 DOI: 10.1177/0269881108089605] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent data have shown the presence of immunological alterations in adult patients suffering from obsessive-compulsive disorder (OCD). The objective of this study was to examine the possible effects of 12 months of treatment with different serotonergic drugs, such as clomipramine and selective serotonin reuptake inhibitors (SSRIs) on peripheral immunological cells of 18 OCD patients. Both the absolute number and percent of CD4+, CD8+, CD3+, CD19+ and CD56+ cells were measured in peripheral blood before and after treatment by means of a Facstar Flow Sorter apparatus. At baseline, all patients showed a significant increase of CD8+ and decrease of CD4+ lymphocytes when compared with a similar group of healthy control subjects; after the treatment, CD8+ and CD4+ cells, respectively, decreased and increased significantly, and the CD4+/CD8+ ratio increased, when compared with baseline values, in parallel with the clinical improvement. These data suggest that the alterations of immune cells reported in patients with OCD at baseline may be reverted by treatment with SRIs and should be considered a state-dependent marker, perhaps related to a condition of stress.
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Affiliation(s)
- D Marazziti
- Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, Pisa 56100, Italy.
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TNF-alpha polymorphisms are associated with obsessive-compulsive disorder. Neurosci Lett 2008; 442:86-90. [PMID: 18639610 DOI: 10.1016/j.neulet.2008.07.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 07/08/2008] [Accepted: 07/09/2008] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Several lines of evidence support an immunologic involvement in obsessive-compulsive disorder (OCD): the increased prevalence of OCD in patients with rheumatic fever (RF), and the aggregation of obsessive-compulsive spectrum disorders among relatives of RF probands. Tumor necrosis factor alpha is a proinflammatory cytokine involved in RF and other autoimmune diseases. Polymorphisms in the promoter region of the TNFA gene have been associated with RF. Given the association between OCD and RF, the goal of the present study was to investigate a possible association between polymorphisms within the promoter region of TNFA and OCD. MATERIALS AND METHODS Two polymorphisms were investigated: -308 G/A and -238 G/A. The allelic and genotypic frequencies of these polymorphisms were examined in 111 patients who fulfilled DSM-IV criteria for OCD and compared with the frequencies in 250 controls. RESULTS Significant associations were observed between both polymorphisms and OCD. For -238 G/A, an association between the A allele and OCD was observed (chi(2)=12.05, p=0.0005). A significant association was also observed between the A allele of the -308 G/A polymorphism and OCD (chi(2)=7.09, p=0.007). Finally, a haplotype consisting of genotypes of these two markers was also examined. Significant association was observed for the A-A haplotype (p=0.0099 after correcting for multiple testing). DISCUSSION There is association between the -308 G/A and -238 G/A TNFA polymorphisms and OCD in our Brazilian sample. However, these results need to be replicated in larger samples collected from different populations.
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da Rocha FF, Correa H, Teixeira AL. Obsessive-compulsive disorder and immunology: a review. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1139-46. [PMID: 18262706 DOI: 10.1016/j.pnpbp.2007.12.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 12/23/2007] [Accepted: 12/24/2007] [Indexed: 11/17/2022]
Abstract
Interest in the possibility of an immune-mediated pathophysiology of obsessive-compulsive disorder and related disorders has increased. In the late 1980s, the National Institute of Mental Health reported an increase in obsessive-compulsive symptoms (OCS) in patients with Sydenham chorea (SC). Subsequently, a precipitating streptococcal infection in children with sudden onset of OCS but no chorea led to the coining of PANDAS (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection). This association has furthered interest in biological measures for immune and genetic susceptibility in non-PANDAS obsessive-compulsive disorder patients (OCD). Furthermore, some studies are trying to demonstrate alterations of immune parameters in OCD patients, with few positive results. In this narrative review, our objective was to describe the immunologic findings in OCD, PANDAS, and their association with SC.
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Affiliation(s)
- Felipe Filardi da Rocha
- Service of Psychiatry, Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Pharmacology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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di Michele F. Utility of systematic studies of the immune function in obsessive-compulsive disorder patients. Aust N Z J Psychiatry 2007; 41:460-1. [PMID: 17464741 DOI: 10.1080/00048670701261244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Konuk N, Tekın IO, Ozturk U, Atik L, Atasoy N, Bektas S, Erdogan A. Plasma levels of tumor necrosis factor-alpha and interleukin-6 in obsessive compulsive disorder. Mediators Inflamm 2007; 2007:65704. [PMID: 17497035 PMCID: PMC1847475 DOI: 10.1155/2007/65704] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 12/29/2006] [Accepted: 12/30/2006] [Indexed: 12/02/2022] Open
Abstract
Aim. Recent research implicated place of an immune mechanism in the pathophysiology of obsessive-compulsive disorder (OCD). Despite increasing evidence involvement of cytokine release in OCD, results of the studies are inconsistent. The aim of this study was to evaluate the plasma levels of the cytokines; tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in OCD patients. Methods. Plasma concentrations of TNF-α and IL-6 were measured in 31 drug-free outpatients with OCD, and 31-year age and sex-matched healthy controls. TNF-α and IL-6 concentrations in blood were determined by enzyme-linked immunosorbent assay (ELISA). Results. Both TNF-α and IL-6 levels showed statistically significant increases in OCD patients compared to controls (P < .000, P < .001, resp.). In addition, the age of onset was negatively correlated with TNF-α level (r = −.402, P = .025) and duration of illness was weakly correlated with IL-6 levels (r : .357; P : .048) in patients group. Conclusion. OCD patients showed increases in TNF-α and IL-6 levels compared to the healthy controls. This study provides evidence for alterations in the proinflamatory cytokines which suggest the involvement of the immune system in the pathophysiology of OCD.
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Affiliation(s)
- N. Konuk
- Department of Psychiatry, Faculty of Medicine, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey
- *N. Konuk:
| | - I. O. Tekın
- Department of Immunology, Faculty of Medicine, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey
| | - U. Ozturk
- Department of Psychiatry, Faculty of Medicine, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey
| | - L. Atik
- Department of Psychiatry, Faculty of Medicine, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey
| | - N. Atasoy
- Department of Psychiatry, Faculty of Medicine, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey
| | - S. Bektas
- Department of Pathology, Faculty of Medicine, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey
| | - A. Erdogan
- Department of Psychiatry, Faculty of Medicine, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey
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Abstract
Childhood OCD often develops into a chronic illness that lasts decades. Proof that some type of immunotherapy (such as antibiotic prophylaxis) could significantly reduce recurrence or exacerbation of symptoms of OC or tics would suggest a supportive role for immune triggers in the onset or worsening of these conditions and provide additional tools for improving outcome. The validity of PANDAS will continue to be questioned, however,because demonstrating a clear causation will be difficult on a background ofa common childhood illness. Along with the previously mentioned immuno-therapy study, validation of the PANDAS phenotype (broadly interpreted)would be advanced from new and continued research in the following areas: (1) prospective studies to identify infectious triggers in the onset and exacerbations of OCD spectrum disorders, (2) biological measures for immune and genetic susceptibility, and (3) large scale epidemiological studies demonstrating the relationship between infection and OCD spectrum disorders. The assimilation of these study results should allow for elucidation of the immune system's role in the onset and maintenance of OCD.
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Affiliation(s)
- Tanya K Murphy
- Department of Psychiatry, University of Florida School of Medicine, Gainesville, FL 32610, USA.
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Carpenter LL, Moreno FA, Kling MA, Anderson GM, Regenold WT, Labiner DM, Price LH. Effect of vagus nerve stimulation on cerebrospinal fluid monoamine metabolites, norepinephrine, and gamma-aminobutyric acid concentrations in depressed patients. Biol Psychiatry 2004; 56:418-26. [PMID: 15364040 DOI: 10.1016/j.biopsych.2004.06.025] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 04/27/2004] [Accepted: 06/22/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vagus nerve stimulation (VNS) has shown promising antidepressant effects in treatment-resistant depression, but the mechanisms of action are not known. Cerebrospinal fluid (CSF) studies in epilepsy patients show that VNS alters concentrations of monamines and gamma-aminobutyric acid (GABA), neurotransmitter systems possibly involved in the pathogenesis of depression. METHODS Twenty-one adults with treatment-resistant, recurrent, or chronic major depression underwent standardized lumbar puncture for collection of 12 mL CSF on three separate but identical procedure days during participation in the VNS D-02 clinical trial. All subjects remained on stable regimens of mood medications. Collections were made at baseline (2 weeks after surgical implantation but before device activation), week 12 (end of the acute-phase study), and week 24. Cerebrospinal fluid concentrations of norepinephrine (NE), 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) were determined with high-performance liquid chromatography. Concentrations of GABA were assayed with mass spectrometry. RESULTS Comparison of sham versus active VNS revealed a significant (mean 21%) VNS-associated increase in CSF HVA. Mean CSF concentrations of NE, 5-HIAA, MHPG, and GABA did not change significantly. Higher baseline HVA/5-HIAA ratio predicted worse clinical outcome. CONCLUSIONS Although several of the CSF neurochemical effects we observed in this VNS study were similar to those described in the literature for antidepressants and electroconvulsive therapy, the results do not suggest a putative antidepressant mechanism of action for VNS.
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Affiliation(s)
- Linda L Carpenter
- Laboratory for Clinical Neuroscience, Butler Hospital, Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, Rhode Island 02906, USA. Linda_Carpenter_MD@Brown .edu
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Denys D, Fluitman S, Kavelaars A, Heijnen C, Westenberg H. Decreased TNF-alpha and NK activity in obsessive-compulsive disorder. Psychoneuroendocrinology 2004; 29:945-52. [PMID: 15177711 DOI: 10.1016/j.psyneuen.2003.08.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2003] [Revised: 08/27/2003] [Accepted: 08/27/2003] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accumulating evidence points towards the involvement of autoimmune mechanisms in the pathophysiology of some subgroups of obsessive-compulsive disorder (OCD). This study was carried out to investigate whether obsessive-compulsive disorder is associated with altered activity of the immune system, and whether these changes are related to particular clinical characteristics. METHODS Ex vivo production of TNF-alpha, IL-4, IL-6, IL-10, and IFN-gamma in whole blood cultures, and NK-cell activity and peripheral blood NK cell-, monocytes-, T-cell-, and B-cell- percentages were measured in 50 medication-free outpatients with OCD and 25 controls. RESULTS In OCD patients, we found a significant decrease in production of TNF-alpha (p < 0.0001) and NK-activity (p = 0.002) in comparison with controls. No significant differences were observed in the other immune variables. Patients with first-degree relatives with OCD had significant lower NK-activity than patients who had no relatives with OCD (p = 0.02), and patients with a childhood onset of OCD had significantly lower number of NK-cells than patients with a late onset (p= 0.003). CONCLUSIONS Changes in TNF-alpha and NK activity suggest a potential role of altered immune function in the pathophysiology of obsessive-compulsive disorder.
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Affiliation(s)
- Damiaan Denys
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
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Frati A, Salvati M, Mainiero F, Ippoliti F, Rocchi G, Raco A, Caroli E, Cantore G, Delfini R. Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma: a prospective study. J Neurosurg 2004; 100:24-32. [PMID: 14743908 DOI: 10.3171/jns.2004.100.1.0024] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Object. To evaluate the role of local inflammation in the pathogenesis and postoperative recurrence of chronic subdural hematoma (CSDH), the authors conducted an investigation in a selected group of patients who could clearly recall a traumatic event and who did not have other risk factors for CSDH. Inflammation was analyzed by measuring the concentration of the proinflammatory and inflammatory cytokines interleukin (IL)-6 and IL-8. The authors also investigated the possible relationship between high levels of local inflammation that were measured and recurrence of the CSDH.
Methods. A prospective study was performed between 1999 and 2001. Thirty-five patients who could clearly recall a traumatic event that had occurred at least 3 weeks previously and who did not have risk factors for CSDH were enrolled. All patients were surgically treated by burr hole irrigation plus external drainage.
The concentration of inflammatory cytokines was very high in the lesion, whereas it was normal in serum. In five cases in which recurrence occurred, concentrations of both IL-6 and IL-8 were significantly increased (p < 0.01) in comparison with cases without a recurrence. In a layering hematoma, the IL-6 and IL-8 concentrations were significantly higher (p < 0.05). Layering CSDHs were also significantly correlated with recurrence. Trabecular hematoma had the lowest cytokine levels and the longest median interval between trauma and clinical onset. The interval from trauma did not significantly influence recurrence, although it did differ significantly between the trabecular and layering CSDH groups. Concentrations of IL-6 and IL-8 in the CSDHs did not differ significantly in relation to either the age of the hematoma (measured as the interval from trauma) or the age of the patient.
Conclusions. Brain trauma causes the onset of an inflammatory process within the dural border cell layer; high levels of inflammatory cytokines were significantly correlated with recurrence and layering CSDH. A prolonged postoperative antiinflammatory medicine given as prophylaxis may help prevent the recurrence of a CSDH.
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Affiliation(s)
- Alessandro Frati
- Department of Neurosurgery, Institute for Health Care and Scientific Research, Isernia Italy
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