1
|
Jonker I, Doorduin J, Knegtering H, van't Hag E, Dierckx RA, de Vries EFJ, Schoevers RA, Klein HC. Antiviral treatment in schizophrenia: a randomized pilot PET study on the effects of valaciclovir on neuroinflammation. Psychol Med 2023; 53:7087-7095. [PMID: 37016791 PMCID: PMC10719624 DOI: 10.1017/s0033291723000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 01/22/2023] [Accepted: 02/03/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Patients with schizophrenia experience cognitive impairment, which could be related to neuroinflammation in the hippocampus. The cause for such hippocampal inflammation is still unknown, but it has been suggested that herpes virus infection is involved. This study therefore aimed to determine whether add-on treatment of schizophrenic patients with the anti- viral drug valaciclovir would reduce hippocampal neuroinflammation and consequently improve cognitive symptoms. METHODS We performed a double-blind monocenter study in 24 male and female patients with schizophrenia, experiencing active psychotic symptoms. Patients were orally treated with the anti-viral drug valaciclovir for seven consecutive days (8 g/day). Neuroinflammation was measured with Positron Emission Tomography using the translocator protein ligand [11C]-PK11195, pre-treatment and at seven days post-treatment, as were psychotic symptoms and cognition. RESULTS Valaciclovir treatment resulted in reduced TSPO binding (39%) in the hippocampus, as well as in the brainstem, frontal lobe, temporal lobe, parahippocampal gyrus, amygdala, parietal lobe, occipital lobe, insula and cingulate gyri, nucleus accumbens and thalamus (31-40%) when using binding potential (BPND) as an outcome. With total distribution volume (VT) as outcome we found essentially the same results, but associations only approached statistical significance (p = 0.050 for hippocampus). Placebo treatment did not affect neuroinflammation. No effects of valaciclovir on psychotic symptoms or cognitive functioning were found. CONCLUSION We found a decreased TSPO binding following antiviral treatment, which could suggest a viral underpinning of neuroinflammation in psychotic patients. Whether this reduced neuroinflammation by treatment with valaciclovir has clinical implications and is specific for schizophrenia warrants further research.
Collapse
Affiliation(s)
- Iris Jonker
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Henderikus Knegtering
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Lentis Mental Health Institution, Groningen, The Netherlands
| | - Erna van't Hag
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudi A. Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Erik F. J. de Vries
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans C. Klein
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
2
|
Yolken R. Infections and neuropsychiatric disorders: new studies document pathways to prevention and treatment. Mol Psychiatry 2023; 28:2624-2626. [PMID: 37106118 PMCID: PMC10134699 DOI: 10.1038/s41380-023-02072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Robert Yolken
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
3
|
Yang J, Long Q, Zhang Y, Liu Y, Wu J, Zhao X, You X, Li X, Liu J, Teng Z, Zeng Y, Luo XJ. Whole transcriptome analysis reveals dysregulation of molecular networks in schizophrenia. Asian J Psychiatr 2023; 85:103649. [PMID: 37267675 DOI: 10.1016/j.ajp.2023.103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
To characterize the regulatory relationships between different types of transcripts and the altered molecular networks in schizophrenia (SCZ), we performed a whole transcriptome study by quantifying mRNAs, long noncoding RNAs (lncRNAs), miRNAs, and circular RNAs (circRNAs) in the same individuals simultaneously. A total of 807 dysregulated genes showed differential expression in SCZ cases compared with controls. Network-based analysis revealed dysregulation of molecular networks in SCZ. Finally, integration of the transcriptome data with published data identified promising SCZ candidate genes. Our study reveals that dysregulated molecular networks and regulatory relationships between different types of transcript may have a role in SCZ.
Collapse
Affiliation(s)
- Jinfeng Yang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China; Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Qing Long
- The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650101, China
| | - Yunqiao Zhang
- The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650101, China; Honghe Second People's Hospital, Honghe, Yunnan 654399, China; The Sixth Affiliated Hospital, Kunming Medical University, Yuxi, Yunnan 653100, China
| | - Yilin Liu
- The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650101, China
| | - Jie Wu
- The Affiliated Mental Health Center, Kunming Medical University, Kunming, Yunnan 650224, China
| | - Xinling Zhao
- The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650101, China
| | - Xu You
- Honghe Second People's Hospital, Honghe, Yunnan 654399, China
| | - Xiaoyan Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
| | - Jiewei Liu
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, China
| | - Zhaowei Teng
- The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650101, China.
| | - Yong Zeng
- The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650101, China.
| | - Xiong-Jian Luo
- Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing 210096, China; Department of Neurology, Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing, China.
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Multiple countries have reported increased COVID-19 mortality in patients with schizophrenia. The purpose of this review was to synthetize the consequences of the pandemic on patients with schizophrenia including vaccination data. RECENT FINDINGS We have synthetized data on the increased risk of infection and increased mortality, the impact of the pandemic and lockdowns on psychiatric care, vaccination policies, unwillingness to vaccine in patients and the rates of vaccination. SUMMARY Schizophrenia has been confirmed at increased risk of both COVID-19 infection and developing a severe/lethal form of the infection. Patients with schizophrenia should, therefore, be prioritized for vaccination whenever possible and should be prioritized for psychiatric and somatic care access. Psychotic symptomatology may be a barrier to vaccination in some patients, and heterogenous vaccination rates were identified in national databases. The COVID-19 pandemic has been also a unique opportunity to develop telehealth. A mixed face-to-face and distance model should be encouraged, whenever possible, to improve the experience of patients, relatives and healthcare professionals. No major change of long-acting antipsychotics has been reported in most countries, and there was no consistent evidence for clozapine prescription to increase the risk of COVID-19 infection or severe outcomes.
Collapse
Affiliation(s)
- Guillaume Fond
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille
- FondaMental Academic Advanced Center of Expertise for Depressive disorders and Schizophrenia (FACE-DR, FACE-SZ), Marseille, France
| | - Laurent Boyer
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille
- FondaMental Academic Advanced Center of Expertise for Depressive disorders and Schizophrenia (FACE-DR, FACE-SZ), Marseille, France
| |
Collapse
|
5
|
Yeo IJ, Yun J, Son DJ, Han SB, Webster MJ, Hong JT, Kim S. Overexpression of transmembrane TNFα in brain endothelial cells induces schizophrenia-relevant behaviors. Mol Psychiatry 2023; 28:843-855. [PMID: 36333582 DOI: 10.1038/s41380-022-01846-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Upregulation of genes and coexpression networks related to immune function and inflammation have been repeatedly reported in the brain of individuals with schizophrenia. However, a causal relationship between the abnormal immune/inflammation-related gene expression and schizophrenia has not been determined. We conducted co-expression networks using publicly available RNA-seq data from prefrontal cortex (PFC) and hippocampus (HP) of 64 individuals with schizophrenia and 64 unaffected controls from the SMRI tissue collections. We identified proinflammatory cytokine, transmembrane tumor necrosis factor-α (tmTNFα), as a potential regulator in the module of co-expressed genes that we find related to the immune/inflammation response in endothelial cells (ECs) and/or microglia of the brain of individuals with schizophrenia. The immune/inflammation-related modules associated with schizophrenia and the TNF signaling pathway that regulate the network were replicated in an independent cohort of brain samples from 68 individuals with schizophrenia and 135 unaffected controls. To investigate the association between the overexpression of tmTNFα in brain ECs and schizophrenia-like behaviors, we induced short-term overexpression of the uncleavable form of (uc)-tmTNFα in ECs of mouse brain for 7 weeks. We found schizophrenia-relevant behavioral deficits in these mice, including cognitive impairment, abnormal sensorimotor gating, and sensitization to methamphetamine (METH) induced locomotor activity and METH-induced neurotransmitter levels. These uc-tmTNFα effects were mediated by TNF receptor2 (TNFR2) and induced activation of TNFR2 signaling in astrocytes and neurons. A neuronal module including neurotransmitter signaling pathways was down-regulated in the brain of mice by the short-term overexpression of the gene, while an immune/inflammation-related module was up-regulated in the brain of mice after long-term expression of 22 weeks. Our results indicate that tmTNFα may play a direct role in regulating neurotransmitter signaling pathways that contribute to the clinical features of schizophrenia.
Collapse
Affiliation(s)
- In Jun Yeo
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungdeok-gu, Cheongju, Chungbuk, 28160, Republic of Korea
| | - Jaesuk Yun
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungdeok-gu, Cheongju, Chungbuk, 28160, Republic of Korea
| | - Dong Ju Son
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungdeok-gu, Cheongju, Chungbuk, 28160, Republic of Korea
| | - Sang-Bae Han
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungdeok-gu, Cheongju, Chungbuk, 28160, Republic of Korea
| | - Maree J Webster
- Stanley Brain Research Laboratory, Stanley Medical Research Institute, 9800 Medical Center Drive, Rockville, MD, 20850, USA
| | - Jin Tae Hong
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungdeok-gu, Cheongju, Chungbuk, 28160, Republic of Korea.
| | - Sanghyeon Kim
- Stanley Brain Research Laboratory, Stanley Medical Research Institute, 9800 Medical Center Drive, Rockville, MD, 20850, USA.
| |
Collapse
|
6
|
Abstract
There is increasingly compelling evidence that microorganisms may play an etiological role in the emergence of mental illness in a subset of the population. Historically, most work has focused on the neurotrophic herpesviruses, herpes simplex virus type 1 (HSV-1), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) as well as the protozoan, Toxoplasma gondii. In this chapter, we provide an umbrella review of this literature and additionally highlight prospective studies that allow more mechanistic conclusions to be drawn. Next, we focus on clinical trials of anti-microbial medications for the treatment of psychiatric disorders. We critically evaluate six trials that tested the impact of anti-herpes medications on inflammatory outcomes in the context of a medical disorder, nine clinical trials utilizing anti-herpetic medications for the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or schizophrenia, and four clinical trials utilizing anti-parasitic medications for the treatment of schizophrenia. We then turn our attention to evidence for a gut dysbiosis and altered microbiome in psychiatric disorders, and the potential therapeutic effects of probiotics, including an analysis of more than 10 randomized controlled trials of probiotics in the context of schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD).
Collapse
|
7
|
James LM, Charonis SA, Georgopoulos AP. Schizophrenia, Human Leukocyte Antigen (HLA), and Herpes Viruses: Immunogenetic Associations at the Population Level. Neurosci Insights 2023; 18:26331055231166411. [PMID: 37077512 PMCID: PMC10108429 DOI: 10.1177/26331055231166411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/13/2023] [Indexed: 04/21/2023] Open
Abstract
Several factors have been implicated in schizophrenia (SZ), including human herpes viruses (HHV) and the adaptive immunity Human Leukocyte Antigen (HLA) genes. Here we investigated these issues in 2 complementary ways. In one analysis, we evaluated SZ-HLA and HHV-HLA associations at the level of a single allele by computing (a) a SZ-HLA protection/susceptibility (P/S) score based on the covariance between SZ and 127 HLA allele prevalences in 14 European countries, (b) estimating in silico HHV-HLA best binding affinities for the 9 HHV strains, and (c) evaluating the dependence of P/S score on HHV-HLA binding affinities. These analyses yielded (a) a set of 127 SZ-HLA P/S scores, varying by >200× (maximum/minimum), which could not be accounted for by chance, (b) a set of 127 alleles × 9 HHV best-estimated affinities, varying by >600×, and (c) a set of correlations between SZ-HLA P/S scores and HHV-HLA binding which indicated a prominent role of HHV1. In a subsequent analysis, we extended these findings to the individual person by taking into account the fact that every individual carries 12 HLA alleles and computed (a) the average SZ-HLA P/S scores of 12 randomly chosen alleles (2 per gene), an indicator of HLA-based SZ P/S for an individual, and (b) the average of the corresponding HHV estimated affinities for those alleles, an indicator of overall effectiveness of HHV-HLA binding. We found (a) that HLA protection for SZ was significantly more prominent than susceptibility, and (b) that protective SZ-HLA scores were associated with higher HHV-HLA binding affinities, indicating that HLA binding and subsequent elimination of several HHV strains may confer protection against schizophrenia.
Collapse
Affiliation(s)
- Lisa M James
- The HLA Research Group, Department of Veterans Affairs Health Care System, Brain Sciences Center, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Lisa M James, Brain Sciences Center (11B), Minneapolis VAHCS, One Veterans Drive, Minneapolis, MN 55417, USA.
| | - Spyros A Charonis
- The HLA Research Group, Department of Veterans Affairs Health Care System, Brain Sciences Center, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Apostolos P Georgopoulos
- The HLA Research Group, Department of Veterans Affairs Health Care System, Brain Sciences Center, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
8
|
Orlova VA, Mikhailova II, Zinserling VA. Infections and schizophrenia. JOURNAL INFECTOLOGY 2022. [DOI: 10.22625/2072-6732-2022-14-3-105-111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This paper provides a critical review of the literature, demonstrating a certain pathogenetic role of various infections, primarily viruses from the herpes and chlamydia groups, in the development and progression of schizophrenia, including published results of the authors’ own long-term studies.
Collapse
Affiliation(s)
- V. A. Orlova
- Research Institute of Vaccines and Serums named after I.I. Mechnikov
| | - I. I. Mikhailova
- Research Institute of Vaccines and Serums named after I.I. Mechnikov
| | - V. A. Zinserling
- National Medical Research Centre named after V.A. Almazov; Clinical Infectious Hospital named after S.P. Botkin
| |
Collapse
|
9
|
Herpesvirus Infections in the Human Brain: A Neural Cell Model of the Complement System Derived from Induced Pluripotent Stem Cells. Curr Top Behav Neurosci 2022; 61:243-264. [PMID: 36059003 DOI: 10.1007/7854_2022_383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Herpesviruses alter cognitive functions in humans following acute infections; progressive cognitive decline and dementia have also been suggested. It is important to understand the pathogenic mechanisms of such infections. The complement system - comprising functionally related proteins integral for systemic innate and adaptive immunity - is an important component of host responses. The complement system has specialized functions in the brain. Still, the dynamics of the brain complement system are still poorly understood. Many complement proteins have limited access to the brain from plasma, necessitating synthesis and specific regulation of expression in the brain; thus, complement protein synthesis, activation, regulation, and signaling should be investigated in human brain-relevant cellular models. Cells derived from human-induced pluripotent stem cells (hiPSCs) could enable tractable models. METHODS Human-induced pluripotent stem cells were differentiated into neuronal (hi-N) and microglial (hi-M) cells that were cultured with primary culture human astrocyte-like cells (ha-D). Gene expression analyses and complement protein levels were analyzed in mono- and co-cultures. RESULTS Transcript levels of complement proteins differ by cell type and co-culture conditions, with evidence for cellular crosstalk in co-cultures. Hi-N and hi-M cells have distinct patterns of expression of complement receptors, soluble factors, and regulatory proteins. hi-N cells produce complement factor 4 (C4) and factor B (FB), whereas hi-M cells produce complement factor 2 (C2) and complement factor 3 (C3). Thus, neither hi-N nor hi-M cells can form either of the C3-convertases - C4bC2a and C3bBb. However, when hi-N and hi-M cells are combined in co-cultures, both types of functional C3 convertase are produced, indicated by elevated levels of the cleaved C3 protein, C3a. CONCLUSIONS hiPSC-derived co-culture models can be used to study viral infection in the brain, particularly complement receptor and function in relation to cellular "crosstalk." The models could be refined to further investigate pathogenic mechanisms.
Collapse
|
10
|
Andreou D, Jørgensen KN, Nerland S, Ueland T, Vaskinn A, Haukvik UK, Yolken RH, Andreassen OA, Agartz I. Herpes simplex virus 1 infection on grey matter and general intelligence in severe mental illness. Transl Psychiatry 2022; 12:276. [PMID: 35821107 PMCID: PMC9276804 DOI: 10.1038/s41398-022-02044-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Schizophrenia and bipolar disorder are severe mental illnesses (SMI) linked to both genetic and environmental factors. Herpes simplex virus 1 (HSV1) is a common neurotropic pathogen which after the primary infection establishes latency with periodic reactivations. We hypothesized that the latent HSV1 infection is associated with brain structural abnormalities and cognitive impairment, especially in SMI. We included 420 adult patients with SMI (schizophrenia or bipolar spectrum) and 481 healthy controls. Circulating HSV1 immunoglobulin G concentrations were measured with immunoassays. We measured the total grey matter volume (TGMV), cortical, subcortical, cerebellar and regional cortical volumes based on T1-weighted MRI scans processed in FreeSurfer v6.0.0. Intelligence quotient (IQ) was assessed with the Wechsler Abbreviated Scale of Intelligence. Seropositive patients had significantly smaller TGMV than seronegative patients (642 cm3 and 654 cm3, respectively; p = 0.019) and lower IQ (104 and 107, respectively; p = 0.018). No TGMV or IQ differences were found between seropositive and seronegative healthy controls. Post-hoc analysis showed that (a) in both schizophrenia and bipolar spectrum, seropositive patients had similarly smaller TGMV than seronegative patients, whereas the HSV1-IQ association was driven by the schizophrenia spectrum group, and (b) among all patients, seropositivity was associated with smaller total cortical (p = 0.016), but not subcortical or cerebellar grey matter volumes, and with smaller left caudal middle frontal, precentral, lingual, middle temporal and banks of superior temporal sulcus regional cortical grey matter volumes. The results of this cross-sectional study indicate that HSV1 may be an environmental factor associated with brain structural abnormalities and cognitive impairment in SMI.
Collapse
Affiliation(s)
- Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway. .,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
| | - Kjetil Nordbø Jørgensen
- grid.5510.10000 0004 1936 8921Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.413684.c0000 0004 0512 8628Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Stener Nerland
- grid.5510.10000 0004 1936 8921Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.413684.c0000 0004 0512 8628Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Torill Ueland
- grid.55325.340000 0004 0389 8485Psychosis Research Section, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anja Vaskinn
- grid.5510.10000 0004 1936 8921Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Unn K. Haukvik
- grid.5510.10000 0004 1936 8921Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.55325.340000 0004 0389 8485Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Robert H. Yolken
- grid.21107.350000 0001 2171 9311Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Ole A. Andreassen
- grid.5510.10000 0004 1936 8921Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- grid.5510.10000 0004 1936 8921Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.413684.c0000 0004 0512 8628Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway ,grid.425979.40000 0001 2326 2191Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
11
|
Ibrahim IMA, Tobar S, Salah H, El-Sayed H, Mansour H, Eissa A, Wood J, Fathi W, Dickerson F, Yolken RH, El-Bahaey W, Nimgaonkar V. Failure to replicate associations between Toxoplasma gondii or hepatitis C virus infection and personality traits. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-021-00169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Infections with Toxoplasma gondii (Toxo), a protozoan that can infect the brain, have been reported to alter behavior in rodents and humans; several investigators have related Toxo infection to personality traits such as novelty seeking in humans. We investigated human personality traits in relation to Toxo in Egypt, where such infection is common.
Results
In a community-based sample of Egyptian adults (N = 255), Toxo infection were indexed by levels of IgG antibodies. Viruses like hepatitis C virus (HCV) have also been associated with cognitive dysfunction and mood disorders; therefore, HCV antibody titers were also assayed for comparison. The antibody levels were analyzed in relation to the Arabic version of the NEO personality inventory (NEO-FFI-3), accounting for demographic variables. No significant correlations were noted with Toxo or HCV antibody levels, after co-varying for demographic and socio-economic factors and following corrections for multiple comparisons.
Conclusions
Infection with Toxo or HCV infection was not associated with variations in personality traits in a sample of Egyptian adults. The possible reasons for the discordance with prior reported associations are discussed.
Collapse
|
12
|
Gene-Environment Interactions in Schizophrenia: A Literature Review. Genes (Basel) 2021; 12:genes12121850. [PMID: 34946799 PMCID: PMC8702084 DOI: 10.3390/genes12121850] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022] Open
Abstract
Schizophrenia is a devastating mental illness with a strong genetic component that is the subject of extensive research. Despite the high heritability, it is well recognized that non-genetic factors such as certain infections, cannabis use, psychosocial stress, childhood adversity, urban environment, and immigrant status also play a role. Whenever genetic and non-genetic factors co-exist, interaction between the two is likely. This means that certain exposures would only be of consequence given a specific genetic makeup. Here, we provide a brief review of studies reporting evidence of such interactions, exploring genes and variants that moderate the effect of the environment to increase risk of developing psychosis. Discovering these interactions is crucial to our understanding of the pathogenesis of complex disorders. It can help in identifying individuals at high risk, in developing individualized treatments and prevention plans, and can influence clinical management.
Collapse
|
13
|
Khandaker GM, Stochl J, Zammit S, Lewis G, Dantzer R, Jones PB. Association between circulating levels of C-reactive protein and positive and negative symptoms of psychosis in adolescents in a general population birth cohort. J Psychiatr Res 2021; 143:534-542. [PMID: 33229033 PMCID: PMC8126639 DOI: 10.1016/j.jpsychires.2020.11.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/13/2020] [Accepted: 11/12/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Schizophrenia is associated with elevated levels of circulating C-reactive protein (CRP) and other inflammatory markers, but it is unclear whether these associations extend to psychotic symptoms occurring in adolescence in the general population. A symptom-based approach may provide important clues for apparent trans-diagnostic effect of inflammation, which is also associated with depression and other psychiatric disorders. METHODS Based on data from 2421 participants from the Avon Longitudinal Study of Parents and Children birth cohort, we examined associations of serum CRP levels assessed around age 16 with ten positive and ten negative symptoms of psychosis assessed using questionnaires around age 17, using both individual symptoms and symptom dimension scores as outcomes. Regression models were adjusted for sex, body mass index, depressive symptoms, substance use, and other potential confounders. RESULTS Most prevalent positive symptoms were paranoid ideation (4.8%), visual (4.3%) and auditory (3.5%) hallucinations. Negative symptoms were more strongly correlated with concurrent depressive symptoms (r=0.51; P < 0.001) than positive symptoms (rpb=0.19; P < 0.001). The associations of CRP with positive and negative symptom dimension scores were similar. At individual symptom level, after adjusting for potential confounders including depressive symptoms, CRP was associated with auditory hallucinations (adjusted OR = 2.22; 95% CI, 1.04-4.76) and anhedonia (adjusted OR = 1.13; 95% CI, 1.02-1.26). CONCLUSIONS Inflammation is associated with sub-clinical psychotic symptoms in young people in general population. Association of CRP with symptoms commonly shared between mood and psychotic disorders, such as auditory hallucinations and anhedonia, could be one explanation for the apparent trans-diagnostic effect of inflammation.
Collapse
Affiliation(s)
- Golam M Khandaker
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, United Kingdom.
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom; Department of Kinanthropology, Charles University, José Martího 31, Prague, 165 52, Czech Republic
| | - Stanley Zammit
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom; Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, CF10 3AT, United Kingdom
| | - Glyn Lewis
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom
| | - Robert Dantzer
- Department for Symptom Research, University of Texas MD Anderson Cancer Center, Laboratory of Neuroimmunology, Unit 1055, Office: Z8.5042, 6565 MD Anderson Boulevard, Houston, TX, 77030, USA
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, United Kingdom
| |
Collapse
|
14
|
Yolken RH, Kinnunen PM, Vapalahti O, Dickerson F, Suvisaari J, Chen O, Sabunciyan S. Studying the virome in psychiatric disease. Schizophr Res 2021; 234:78-86. [PMID: 34016507 DOI: 10.1016/j.schres.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
An overlooked aspect of current microbiome studies is the role of viruses in human health. Compared to bacterial studies, laboratory and analytical methods to study the entirety of viral communities in clinical samples are rudimentary and need further refinement. In order to address this need, we developed Virobiome-Seq, a sequence capture method and an accompanying bioinformatics analysis pipeline, that identifies viral reads in human samples. Virobiome-Seq is able to enrich for and detect multiple types of viruses in human samples, including novel subtypes that diverge at the sequence level. In addition, Virobiome-Seq is able to detect RNA transcripts from DNA viruses and may provide a sensitive method for detecting viral activity in vivo. Since Virobiome-Seq also yields the viral sequence, it makes it possible to investigate associations between viral genotype and psychiatric illness. In this proof of concept study, we detected HIV1, Torque Teno, Pegi, Herpes and Papilloma virus sequences in Peripheral Blood Mononuclear Cells, plasma and stool samples collected from individuals with psychiatric disorders. We also detected the presence of numerous novel circular RNA viruses but were unable to determine whether these viruses originate from the sample or represent contaminants. Despite this challenge, we demonstrate that our knowledge of viral diversity is incomplete and opportunities for novel virus discovery exist. Virobiome-Seq will enable a more sophisticated analysis of the virome and has the potential of uncovering complex interactions between viral activity and psychiatric disease.
Collapse
Affiliation(s)
- Robert H Yolken
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Paula M Kinnunen
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Olli Vapalahti
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland; Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; HUS Diagnostic Center, HUSLAB, Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - Faith Dickerson
- Stanley Research Program, Sheppard Pratt, Baltimore, MD, USA
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ou Chen
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Sarven Sabunciyan
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
15
|
Herpes simplex virus, early neuroimaging markers and incidence of Alzheimer's disease. Transl Psychiatry 2021; 11:414. [PMID: 34333531 PMCID: PMC8325675 DOI: 10.1038/s41398-021-01532-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/27/2021] [Accepted: 07/12/2021] [Indexed: 02/08/2023] Open
Abstract
While previous studies suggest the implication of herpes simplex virus (HSV) in the onset of Alzheimer's disease (AD), no study has investigated its association with early neuroimaging markers of AD. In the Three-City and the AMI cohorts, the associations between HSV infection and (i) hippocampal volume (n = 349), (ii) white matter alterations in the parahippocampal cingulum and fornix using diffusion tensor imaging (n = 260), and (iii) incidence of AD (n = 1599) were assessed according to APOE4 status. Regardless of APOE4 status, infected subjects presented (i) significantly more microstructural alterations of the parahippocampal cingulum and fornix, (ii) lower hippocampal volumes only when their anti-HSV IgG level was in the highest tercile-reflecting possibly more frequent reactivations of the virus (p = 0.03 for subjects with a high anti-HSV IgG level while there was no association for all infected subjects, p = 0.19), and (iii) had no increased risk of developing AD. Nevertheless, among APOE4 carriers, infected subjects presented lower hippocampal volumes, although not significant (p = 0.09), and a two or three times higher risk of developing AD (adjusted Hazard ratio (aHR) = 2.72 [1.07-6.91] p = 0.04 for infected subjects and aHR = 3.87 [1.45-10.28] p = 0.007 for infected subjects with an anti-HSV IgG level in the highest tercile) while no association was found among APOE4 noncarriers. Our findings support an association between HSV infection and AD and a potential interaction between HSV status and APOE4. This reinforces the need to further investigate the infectious hypothesis of AD, especially the associated susceptibility factors and the possibility of preventive treatments.
Collapse
|
16
|
Prasad KM. Infectious agents as risk factors for psychosis - A time to reconsider and reinvigorate investigations. Schizophr Res 2021; 233:111-113. [PMID: 34325962 DOI: 10.1016/j.schres.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Konasale M Prasad
- Department of Psychiatry and Bioengineering, University of Pittsburgh School of Medicine and Swanson School of Engineering, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15213, USA.
| |
Collapse
|
17
|
Campos EMN, Rodrigues LD, Oliveira LF, Dos Santos JCC. Dementia and cognitive impairment in adults as sequels of HSV-1-related encephalitis: a review. Dement Neuropsychol 2021; 15:164-172. [PMID: 34345357 PMCID: PMC8283880 DOI: 10.1590/1980-57642021dn15-020002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
Considering the variety of mechanisms of Herpes simplex virus (HSV-1) contamination and its broad invasive potential of the nervous system, a life-long latent infection is established. Infected adult individuals may be susceptible to viral reactivation when under the influence of multiple stressors, especially regarding immunocompromised patients. This guides a series of neuroinflammatory events on the cerebral cortex, culminating, rarely, in encephalitis and cytotoxic / vasogenic brain edema. A sum of studies of such processes provides an explanation, even though not yet completely clarified, on how the clinical evolution to cognitive impairment and dementia might be enabled. In addition, it is of extreme importance to recognize the current dementia and cognitive deficit worldwide panorama. The aim of this literature review is to elucidate the available data upon the pathophysiology of HSV-1 infection as well as to describe the clinical panorama of the referred afflictions.
Collapse
Affiliation(s)
| | - Laís Damasceno Rodrigues
- Neuroscience Laboratory, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Leandro Freitas Oliveira
- Neuroscience Laboratory, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Júlio César Claudino Dos Santos
- Neuroscience Laboratory, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, SP, Brazil.,Faculty of Medicine, Christus University Center, Fortaleza, CE, Brazil
| |
Collapse
|
18
|
Choudhury Z, Lennox B. Maternal Immune Activation and Schizophrenia-Evidence for an Immune Priming Disorder. Front Psychiatry 2021; 12:585742. [PMID: 33679468 PMCID: PMC7925413 DOI: 10.3389/fpsyt.2021.585742] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Schizophrenia is a complex neurodevelopmental disorder affecting around 19. 8 million people worldwide. The etiology of the disorder is due to many interacting genetic and environmental factors, with no one element causing the full spectrum of disease symptoms. Amongst these factors, maternal immune activation (MIA) acting during specific gestational timings has been implicated in increasing schizophrenia risk in offspring. Epidemiological studies have provided the rationale for this link with prevalence of maternal infection correlating to increased risk, but these studies have been unable to prove causality due to lack of control of confounding factors like genetic susceptibility and inability to identify specific cellular and molecular mechanisms. Animal models have proved significantly more useful in establishing the extent to which MIA can predispose an individual to schizophrenia, displaying how maternal infection alone can directly result in behavioral abnormalities in rodent offspring. Alongside information from genome wide association studies (GWAS), animal models have been able to identify the role of complement proteins, particularly C4, and display how alterations in this system can cause development of schizophrenia-associated neuropathology and behavior. This article will review the current literature in order to assess whether schizophrenia can, therefore, be viewed as an immune priming disorder.
Collapse
Affiliation(s)
- Zahra Choudhury
- The Queens College, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
19
|
Kano SI, Hodgkinson CA, Jones-Brando L, Eastwood S, Ishizuka K, Niwa M, Choi EY, Chang DJ, Chen Y, Velivela SD, Leister F, Wood J, Chowdari K, Ducci F, Caycedo DA, Heinz E, Newman ER, Cascella N, Mortensen PB, Zandi PP, Dickerson F, Nimgaonkar V, Goldman D, Harrison PJ, Yolken RH, Sawa A. Host-parasite interaction associated with major mental illness. Mol Psychiatry 2020; 25:194-205. [PMID: 30127472 PMCID: PMC6382596 DOI: 10.1038/s41380-018-0217-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/16/2018] [Accepted: 06/20/2018] [Indexed: 11/23/2022]
Abstract
Clinical studies frequently report that patients with major mental illness such as schizophrenia and bipolar disorder have co-morbid physical conditions, suggesting that systemic alterations affecting both brain and peripheral tissues might underlie the disorders. Numerous studies have reported elevated levels of anti-Toxoplasma gondii (T. gondii) antibodies in patients with major mental illnesses, but the underlying mechanism was unclear. Using multidisciplinary epidemiological, cell biological, and gene expression profiling approaches, we report here multiple lines of evidence suggesting that a major mental illness-related susceptibility factor, Disrupted in schizophrenia (DISC1), is involved in host immune responses against T. gondii infection. Specifically, our cell biology and gene expression studies have revealed that DISC1 Leu607Phe variation, which changes DISC1 interaction with activating transcription factor 4 (ATF4), modifies gene expression patterns upon T. gondii infection. Our epidemiological data have also shown that DISC1 607 Phe/Phe genotype was associated with higher T. gondii antibody levels in sera. Although further studies are required, our study provides mechanistic insight into one of the few well-replicated serological observations in major mental illness.
Collapse
Affiliation(s)
- Shin-Ichi Kano
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Colin A Hodgkinson
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Lorraine Jones-Brando
- Stanley Division of Developmental Neurovirology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Sharon Eastwood
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
| | - Koko Ishizuka
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Minae Niwa
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Eric Y Choi
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Daniel J Chang
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Yian Chen
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Swetha D Velivela
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Flora Leister
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joel Wood
- Departments of Psychiatry and Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Kodavali Chowdari
- Departments of Psychiatry and Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Francesca Ducci
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Daniel A Caycedo
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Elizabeth Heinz
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Emily R Newman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Nicola Cascella
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Preben B Mortensen
- National Centre for Register-Based Research, University of Aarhus, Aarhus, 8000, Denmark
| | - Peter P Zandi
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Faith Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, 21204, USA
| | - Vishwajit Nimgaonkar
- Departments of Psychiatry and Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - David Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
| | - Robert H Yolken
- Stanley Division of Developmental Neurovirology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Akira Sawa
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| |
Collapse
|
20
|
Nimgaonkar VL, Bhatia T, Mansour A, Wesesky MA, Deshpande S. Herpes Simplex Virus Type-1 Infection: Associations with Inflammation and Cognitive Aging in Relation to Schizophrenia. Curr Top Behav Neurosci 2020; 44:125-139. [PMID: 31049838 DOI: 10.1007/7854_2018_86] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most persons experience cognitive decline as they grow older. The term "cognitive aging," coined to describe milder varieties of cognitive decline, is likely to be due to multiple causes. Persistent or repeated infections of the central nervous system (whether subclinical or diagnosable) can cause damage to neurons directly or indirectly through inflammation resulting in incremental neuronal damage, thus eroding cognitive reserve. This possibility has not been considered widely. We evaluated the data linking persistent infection with herpes simplex virus type 1 (HSV-1) and cognitive aging by applying the Bradford Hill criteria. Despite inherent problems in establishing causal relations for chronic disorders, our analyses suggest plausible links. These studies are pertinent for patients with schizophrenia, who are particularly vulnerable due to disorder-related cognitive impairment. Further investigations are warranted to test a causal hypothesis, particularly prospective studies and intervention studies.
Collapse
Affiliation(s)
- Vishwajit L Nimgaonkar
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Triptish Bhatia
- Training Program for Psychiatric Genetics in India, Post-graduate Institute for Medical Education and Research, Dr Ram Manohar Lohia Hospital, Delhi, India
| | - Abdelaziz Mansour
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maribeth A Wesesky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Smita Deshpande
- Post-graduate Institute for Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi, India
| |
Collapse
|
21
|
Persistent Infection with Herpes Simplex Virus 1 and Alzheimer's Disease-A Call to Study How Variability in Both Virus and Host may Impact Disease. Viruses 2019; 11:v11100966. [PMID: 31635156 PMCID: PMC6833100 DOI: 10.3390/v11100966] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023] Open
Abstract
Increasing attention has focused on the contributions of persistent microbial infections with the manifestation of disease later in life, including neurodegenerative conditions such as Alzheimer’s disease (AD). Current data has shown the presence of herpes simplex virus 1 (HSV-1) in regions of the brain that are impacted by AD in elderly individuals. Additionally, neuronal infection with HSV-1 triggers the accumulation of amyloid beta deposits and hyperphosphorylated tau, and results in oxidative stress and synaptic dysfunction. All of these factors are implicated in the development of AD. These data highlight the fact that persistent viral infection is likely a contributing factor, rather than a sole cause of disease. Details of the correlations between HSV-1 infection and AD development are still just beginning to emerge. Future research should investigate the relative impacts of virus strain- and host-specific factors on the induction of neurodegenerative processes over time, using models such as infected neurons in vitro, and animal models in vivo, to begin to understand their relationship with cognitive dysfunction.
Collapse
|
22
|
Nissen J, Trabjerg B, Pedersen MG, Banasik K, Pedersen OB, Sørensen E, Nielsen KR, Erikstrup C, Petersen MS, Paarup HM, Bruun-Rasmussen P, Westergaard D, Hansen TF, Pedersen CB, Werge T, Torrey F, Hjalgrim H, Mortensen PB, Yolken R, Brunak S, Ullum H, Burgdorf KS. Herpes Simplex Virus Type 1 infection is associated with suicidal behavior and first registered psychiatric diagnosis in a healthy population. Psychoneuroendocrinology 2019; 108:150-154. [PMID: 31284079 DOI: 10.1016/j.psyneuen.2019.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 12/29/2022]
Abstract
Increasing evidence shows that latent infections and inflammation is associated with cognitive and behavioral changes in humans. This case-control study investigates the association between Herpes Simplex Virus Type 1 (HSV-1) infection and C-reactive Protein (CRP) levels, and psychiatric disorders and suicidal behavior. Public health register data from 81,912 participants in the Danish Blood Donor Study, were reviewed to identify individuals registered with an ICD-10 code of any psychiatric diagnosis, or who had attempted or committed suicide. We found 1,504 psychiatric cases and 353 suicidal cases; for all cases, controls were frequency-matched by age and sex, resulting in 5,336 participants. Plasma samples were analyzed for IgG-class antibodies against HSV-1 and CRP. HSV-1 infection was associated with suicidal behavior (odds-ratio, 1.40; 95% confidence interval [CI] 1.11-1.77). Accounting for temporality, HSV-1 infection was associated with having first psychiatric disorder after the date of blood collection (incidence rate ration, 1.44; 95% CI, 1.05-1.95). No association between CRP and psychiatric disorders or suicidal behavior was found. The finding that HSV-1 was associated with suicidal behavior and first psychiatric disorder indicates that infection may play a role in the etiology and pathogenesis of suicidal behavior and development of psychiatric disorders.
Collapse
Affiliation(s)
- Janna Nissen
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Betina Trabjerg
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - M G Pedersen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Karina Banasik
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kaspar René Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Peter Bruun-Rasmussen
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - David Westergaard
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - T F Hansen
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark; Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Denmark; Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Carsten B Pedersen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Thomas Werge
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Fuller Torrey
- Stanley Medical Research Institute, Kensington, MD School of Medicine, Baltimore, USA
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Robert Yolken
- Stanley Division of Developmental Neurovirology, Stanley Neurovirology Laboratory, Johns Hopkins University, USA
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K S Burgdorf
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
23
|
Meshreky KM, Wood J, Chowdari KV, Hall MH, Wilckens KA, Yolken R, Buysse DJ, Nimgaonkar VL. Infection with Herpes Simplex virus type 1 (HSV-1) and sleep: The dog that did not bark. Psychiatry Res 2019; 280:112502. [PMID: 31382180 PMCID: PMC7265549 DOI: 10.1016/j.psychres.2019.112502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
Persistent infection with Herpes Simplex viruses (HSV) and other brain infections is consistently associated with cognitive impairment. These infections can also affect sleep. Thus, sleep abnormalities could explain the cognitive dysfunction. We investigated the association between sleep variables and persistent HSV-1, HSV-2, cytomegalovirus (CMV) and Toxoplasma gondii (Tox) infections. Sleep data were collected from older adults with or without insomnia (N = 311, total); a subset completed polysomnographic and actigraphy studies (N = 145). No significant associations were found between the infections and insomnia or the remaining sleep variables following corrections for multiple comparisons. Sleep dysfunction is unlikely to explain the infection-related cognitive dysfunction.
Collapse
Affiliation(s)
| | - Joel Wood
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kodavali V Chowdari
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Martica H Hall
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristine A. Wilckens
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert Yolken
- Stanley Laboratory of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel J. Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vishwajit L Nimgaonkar
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States.
| |
Collapse
|
24
|
Assessment of cognitive impairment in HSV-1 positive schizophrenia and bipolar patients: Systematic review and meta-analysis. Schizophr Res 2019; 209:40-47. [PMID: 30639164 DOI: 10.1016/j.schres.2019.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/22/2022]
Abstract
A common characteristic among schizophrenia and bipolar disorder patients is cognitive dysfunction, especially for memory and attention. Recent evidence has suggested that cognitive impairment in schizophrenia and bipolar disorder patients could be associated with herpes simplex virus 1 (HSV-1) infection, due to the ability of HSV-1 to infect neurons in the temporal lobe, which plays a key role in the formation of memory and processing of sensory input. The objective of this review is to analyze the aggregate neuropsychological testing data from previous studies regarding the impact of HSV-1 infection on cognitive function in schizophrenia and bipolar disorder. A systematic literature search generated a total of 379 articles; 12 full-text case control and cross-sectional studies met the eligibility criteria to be included in the review. Pooled effects assessed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) total scores and the three index scores for immediate memory, delayed memory, and attention in a random effects model. The overall effect for RBANS total score was in favor of the HSV-1 positive group (z = 3.10, p = 0.002). A statistically significant overall effect of cognitive impairment for memory and attention indices was in favor of HSV positive schizophrenia patients (z = 5.95 p < 0.00001). The findings from the meta-analysis suggest that serological evidence of HSV-1 infection has a significant impact on cognitive function with small to moderate effect sizes (-0.23 to -0.49), particularly affecting memory and attention, in schizophrenia and bipolar patients.
Collapse
|
25
|
Breier A, Buchanan RW, D'Souza D, Nuechterlein K, Marder S, Dunn W, Preskorn S, Macaluso M, Wurfel B, Maguire G, Kakar R, Highum D, Hoffmeyer D, Coskinas E, Litman R, Vohs JL, Radnovich A, Francis MM, Metzler E, Visco A, Mehdiyoun N, Yang Z, Zhang Y, Yolken RH, Dickerson FB. Herpes simplex virus 1 infection and valacyclovir treatment in schizophrenia: Results from the VISTA study. Schizophr Res 2019; 206:291-299. [PMID: 30478008 DOI: 10.1016/j.schres.2018.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several studies have implicated herpes simplex virus-type 1 (HSV-1) in the pathophysiology of schizophrenia. A recent trial demonstrated that the anti-viral medication valacylovir, which prevents replication of activated HSV-1, improved selected cognitive deficits in people with schizophrenia. In this study, we examined demographic and illness related differences between HSV-1 positive versus HSV-1 negative subjects with early phase schizophrenia and attempted to replicate the previous valacyclovir treatment results in this population. METHODS 170 subjects with schizophrenia (HSV-1 positive N = 70; HSV-1 negative N = 96) from 12 US sites participated in the HSV-1 positive versus negative comparisons, and were randomized 1:1 to valacyclovir (1.5 g BID) or placebo for a 16-week, double-blind efficacy trial. The primary endpoints were working and verbal memory. RESULTS The HSV-1 positive group, as compared to the HSV-1 negative group, were older (p < 0.001) with fewer males (p = 0.003), and had a longer duration of illness (p = 0.008), more positive symptoms (p = 0.013), poorer quality of life (p = 0.034) and more impairment on the letter-number sequencing test, which is a measure of working memory (p = 0.045). Valacyclovir failed to significantly improve any of the cognitive indices, symptom or functioning measures. CONCLUSIONS HSV-1 sero-positivity appears to be a marker of a subgroup with a more severe form of schizophrenia. Valacyclovir was not efficacious in the study, perhaps because the herpes virus was in the dormant, non-activated state and therefore non-responsive to valacyclovir effects. ClinicalTrials.gov Identifier: NCT02008773.
Collapse
Affiliation(s)
- Alan Breier
- Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, University of Maryland, Baltimore, MD, United States of America
| | - Deepak D'Souza
- Yale University School of Medicine, New Haven, CT, United States of America
| | | | - Stephen Marder
- Semel Institute, UCLA, Los Angeles, CA, United States of America
| | - Walter Dunn
- Semel Institute, UCLA, Los Angeles, CA, United States of America
| | - Sheldon Preskorn
- Kansas University School of Medicine, Wichita, KS, United States of America
| | - Matthew Macaluso
- Kansas University School of Medicine, Wichita, KS, United States of America
| | - Brent Wurfel
- Laureate Institute for Brain Research, KS, United States of America
| | - Gerald Maguire
- University of California, Riverside, CA, United States of America
| | - Rishi Kakar
- Segal Institute for Clinical Research, United States of America
| | - Diane Highum
- CITrials, Bellflower, CA, United States of America
| | | | | | | | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Alexander Radnovich
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Michael M Francis
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Emmalee Metzler
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Andrew Visco
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Nicole Mehdiyoun
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Ziyi Yang
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Ying Zhang
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Robert H Yolken
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Faith B Dickerson
- Sheppard Pratt Health System, Baltimore, MD, United States of America
| |
Collapse
|
26
|
Lin HC, Huang KY, Chung CH, Lin HA, Chen RM, Tsao CH, Chien WC, Chiueh TS. Infection with Trichomonas vaginalis increases the risk of psychiatric disorders in women: a nationwide population-based cohort study. Parasit Vectors 2019; 12:88. [PMID: 30867042 PMCID: PMC6417068 DOI: 10.1186/s13071-019-3350-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/26/2019] [Indexed: 12/27/2022] Open
Abstract
Background Trichomonas vaginalis is a protozoan parasite that causes trichomoniasis and annually infects approximately 276 million people worldwide. We observed an ambiguously higher probability of trichomoniasis in patients from the psychiatric department of Tri-Service General Hospital. Herein, we aimed to investigate the association between trichomoniasis and the risk of developing psychiatric disorders. Methods The nationwide population-based study utilized the database of the National Health Insurance (NHI) programme in Taiwan. A total of 46,865 subjects were enrolled in this study from 2000–2013, comprising 9373 study subjects with trichomoniasis and 37,492 subjects without trichomoniasis as the control group. Cox proportional hazards regression analysis was performed to calculate the hazard ratio (HR) of psychiatric disorders during the 14 years of follow-up. Results Of the study subjects with trichomoniasis, 875 (9.34%) developed psychiatric disorders compared with 1988 (5.30%) in the control group (P < 0.001). The adjusted hazard ratio (aHR) of overall psychiatric disorders in the study subjects was 1.644 (95% confidence interval, CI: 1.514–1.766; P < 0.001). More specifically, the study subjects had a higher risk for developing an individual psychiatric disorder, including depression, anxiety, bipolar disorder, schizophrenia and substance abuse. Although metronidazole treatment reduced the risk for developing several subgroups of psychiatric disorders, significant reduction was detected for depression only. Furthermore, refractory trichomoniasis (trichomoniasis visits ≥ 2) enhanced the risk of psychiatric disorders. Conclusions We show herein that T. vaginalis infection increases the overall risk for psychiatric disorders. The novel role of T. vaginalis in developing psychiatric disorders deserves more attention, and the control of such a neglected pathogen is of urgent public health importance. Electronic supplementary material The online version of this article (10.1186/s13071-019-3350-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hsin-Chung Lin
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Yang Huang
- Graduate Institute of Pathology and Parasitology, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Hsin-An Lin
- Division of Infection, Department of Medicine, Tri-Service General Hospital SongShan Branch, Taipei, Taiwan
| | - Rei-Min Chen
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan. .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. .,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Tzong-Shi Chiueh
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| |
Collapse
|
27
|
Khandaker GM, Meyer U, Jones PB. From Infection to the Microbiome: An Evolving Role of Microbes in Schizophrenia. Curr Top Behav Neurosci 2019; 44:67-84. [PMID: 30847804 PMCID: PMC6732248 DOI: 10.1007/7854_2018_84] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The study of microorganisms such as bacteria, viruses, archaea, fungi, and protozoa in the context of psychiatric disorders may be surprising to some. This intersection of disciplines, however, has a rich history and is currently revitalized by newfound functions of the microbiome and the gut-brain axis in human diseases. Schizophrenia, in particular, fits this model as a disorder with gene and environmental roots that may be anchored in the immune system. In this context, the combination of a precisely timed pathogen exposure in a person with genetically encoded altered immunity may have especially destructive consequences for the central nervous system (CNS). Furthermore, significant components of immunity, such as the development of the immune response and the concept of immune tolerance, are largely dictated by the commensal residents of the microbiome. When this community of microbes is imbalanced, perhaps as the result of a pathogen invasion, stress, or immune gene deficiency, a pathological cycle of localized inflammation, endothelial barrier compromise, translocation of gut-derived products, and systemic inflammation may ensue. If these pathologies enable access of gut and microbial metabolites and immune molecules to the CNS across the blood-brain barrier (BBB), and studies of the gut-brain axis support this hypothesis, a worsening of cognitive deficits and psychiatric symptoms is predicted to occur in susceptible individuals with schizophrenia. In this chapter, we review the role of microbes in various stages of this model and how these organisms may contribute to documented phenotypes of schizophrenia. An increased understanding of the role of pathogens and the microbiome in psychiatric disorders will better guide the development of microbial and immune-based therapeutics for disease prevention and treatment.
Collapse
Affiliation(s)
- Golam M. Khandaker
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Urs Meyer
- grid.5801.c0000 0001 2156 2780Verhaltensneurobiologie, ETH Zürich, Schwerzenbach, Switzerland
| | - Peter B. Jones
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| |
Collapse
|
28
|
Kim S, Jo Y, Webster MJ, Lee D. Shared co-expression networks in frontal cortex of the normal aged brain and schizophrenia. Schizophr Res 2019; 204:253-261. [PMID: 30224231 DOI: 10.1016/j.schres.2018.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/17/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
Abstract
Previous studies on the brain of people with schizophrenia have identified structural changes and gene expression changes, suggesting that brain aging maybe accelerated in people with schizophrenia. To better characterize gene expression profiles in schizophrenia and in the aged population we constructed co-expression networks using RNA-Seq data from frontal cortex. The first data set analysed was from 62 subjects with schizophrenia and 51 unaffected controls ranging in age from 19 to 63 years. The second separate data set was from normal control individuals ranging in age from 29 to 106 years. In the first data set, we found two co-expression modules significantly associated with schizophrenia. One was a downregulated co-expression module enriched for neuron function related genes and the other was an upregulated immune/inflammation-related module. In the second data set of normal individuals, we found seven co-expression modules significantly correlated with age. A comparison of the co-expression modules from the two data sets revealed a significant consensus in nodes associated with schizophrenia and those associated with normal aging. The results indicate that a co-expression module related to neuronal function is downregulated and an immune/inflammation related co-expression module is upregulated, and associated with cells of the blood vessels, in both schizophrenia and in normal aging. This finding adds further support to the hypothesis that there may be accelerated brain aging in schizophrenia.
Collapse
Affiliation(s)
- Sanghyeon Kim
- Stanley Brain Research Laboratory, Stanley Medical Research Institute, 9800 Medical Center Drive, Rockville, MD 20850, United States of America.
| | - Yousang Jo
- Department of Bio and Brain Engineering, KAIST, 291 Daehak-ro, Yuseong-gu, Daejeon 305-701, Republic of Korea
| | - Maree J Webster
- Stanley Brain Research Laboratory, Stanley Medical Research Institute, 9800 Medical Center Drive, Rockville, MD 20850, United States of America
| | - Doheon Lee
- Department of Bio and Brain Engineering, KAIST, 291 Daehak-ro, Yuseong-gu, Daejeon 305-701, Republic of Korea.
| |
Collapse
|
29
|
Pollak TA, Rogers JP, Nagele RG, Peakman M, Stone JM, David AS, McGuire P. Antibodies in the Diagnosis, Prognosis, and Prediction of Psychotic Disorders. Schizophr Bull 2019; 45:233-246. [PMID: 29474698 PMCID: PMC6293207 DOI: 10.1093/schbul/sby021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Blood-based biomarker discovery for psychotic disorders has yet to impact upon routine clinical practice. In physical disorders antibodies have established roles as diagnostic, prognostic and predictive (theranostic) biomarkers, particularly in disorders thought to have a substantial autoimmune or infective aetiology. Two approaches to antibody biomarker identification are distinguished: a "top-down" approach, in which antibodies to specific antigens are sought based on the known function of the antigen and its putative role in the disorder, and emerging "bottom-up" or "omics" approaches that are agnostic as to the significance of any one antigen, using high-throughput arrays to identify distinctive components of the antibody repertoire. Here we review the evidence for antibodies (to self-antigens as well as infectious organism and dietary antigens) as biomarkers of diagnosis, prognosis, and treatment response in psychotic disorders. Neuronal autoantibodies have current, and increasing, clinical utility in the diagnosis of organic or atypical psychosis syndromes. Antibodies to selected infectious agents show some promise in predicting cognitive impairment and possibly other symptom domains (eg, suicidality) within psychotic disorders. Finally, infectious antibodies and neuronal and other autoantibodies have recently emerged as potential biomarkers of response to anti-infective therapies, immunotherapies, or other novel therapeutic strategies in psychotic disorders, and have a clear role in stratifying patients for future clinical trials. As in nonpsychiatric disorders, combining biomarkers and large-scale use of "bottom-up" approaches to biomarker identification are likely to maximize the eventual clinical utility of antibody biomarkers in psychotic disorders.
Collapse
Affiliation(s)
- Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Joint first authors
| | - Jonathan P Rogers
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Joint first authors
| | - Robert G Nagele
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ
| | - Mark Peakman
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - James M Stone
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| |
Collapse
|
30
|
Amlie-Wolf A, Tang M, Mlynarski EE, Kuksa PP, Valladares O, Katanic Z, Tsuang D, Brown CD, Schellenberg GD, Wang LS. INFERNO: inferring the molecular mechanisms of noncoding genetic variants. Nucleic Acids Res 2018; 46:8740-8753. [PMID: 30113658 PMCID: PMC6158604 DOI: 10.1093/nar/gky686] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 01/02/2023] Open
Abstract
The majority of variants identified by genome-wide association studies (GWAS) reside in the noncoding genome, affecting regulatory elements including transcriptional enhancers. However, characterizing their effects requires the integration of GWAS results with context-specific regulatory activity and linkage disequilibrium annotations to identify causal variants underlying noncoding association signals and the regulatory elements, tissue contexts, and target genes they affect. We propose INFERNO, a novel method which integrates hundreds of functional genomics datasets spanning enhancer activity, transcription factor binding sites, and expression quantitative trait loci with GWAS summary statistics. INFERNO includes novel statistical methods to quantify empirical enrichments of tissue-specific enhancer overlap and to identify co-regulatory networks of dysregulated long noncoding RNAs (lncRNAs). We applied INFERNO to two large GWAS studies. For schizophrenia (36,989 cases, 113,075 controls), INFERNO identified putatively causal variants affecting brain enhancers for known schizophrenia-related genes. For inflammatory bowel disease (IBD) (12,882 cases, 21,770 controls), INFERNO found enrichments of immune and digestive enhancers and lncRNAs involved in regulation of the adaptive immune response. In summary, INFERNO comprehensively infers the molecular mechanisms of causal noncoding variants, providing a sensitive hypothesis generation method for post-GWAS analysis. The software is available as an open source pipeline and a web server.
Collapse
Affiliation(s)
- Alexandre Amlie-Wolf
- Genomics and Computational Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mitchell Tang
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Elisabeth E Mlynarski
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Pavel P Kuksa
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Otto Valladares
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zivadin Katanic
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Debby Tsuang
- VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Christopher D Brown
- Genomics and Computational Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Genetics. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Gerard D Schellenberg
- Genomics and Computational Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Genetics. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Li-San Wang
- Genomics and Computational Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Genetics. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
31
|
Abstract
Typical and atypical antipsychotics are the first-line treatments for schizophrenia, but these classes of drugs are not universally effective, and they can have serious side effects that impact compliance. Antipsychotic drugs generally target the dopamine pathways with some variation. As research of schizophrenia pathophysiology has shifted away from a strictly dopamine-centric focus, the development of new pharmacotherapies has waned. A field of inquiry with centuries-old roots is gaining traction in psychiatric research circles and may represent a new frontier for drug discovery in schizophrenia. At the forefront of this investigative effort is the immune system and its many components, pathways and phenotypes, which are now known to actively engage the brain. Studies in schizophrenia reveal an intricate association of environmentally-driven immune activation in concert with a disrupted genetic template. A consistent conduit through this gene-environmental milieu is the gut-brain axis, which when dysregulated can generate pathological autoimmunity. In this review, we present epidemiological and biochemical evidence in support of an autoimmune component in schizophrenia and depict gut processes and a dysbiotic microbiome as a source and perpetuator of autoimmune dysfunction in the brain. Within this framework, we review the role of infectious agents, inflammation, gut dysbioses and autoantibody propagation on CNS pathologies such as neurotransmitter receptor hypofunction and complement pathway-mediated synaptic pruning. We then review the new pharmacotherapeutic horizon and novel agents directed to impact these pathological conditions. At the core of this discourse is the understanding that schizophrenia is etiologically and pathophysiologically heterogeneous and thus its treatment requires individualized attention with disease state variants diagnosed with objective biomarkers.
Collapse
Affiliation(s)
| | | | - Robert H Yolken
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW Viruses, particularly herpes simplex virus (HSV), may be a cause of Alzheimer's disease (AD). The evidence supporting the viral hypothesis suggests that antiviral treatment trials, which have not been conducted, are warranted. RECENT FINDINGS HSV1 (oral herpes) and HSV2 (genital herpes) can trigger amyloid aggregation, and their DNA is common in amyloid plaques. HSV1 reactivation is associated with tau hyperphosphorylation and possibly tau propagation. Anti-HSV drugs reduce Aβ and p-tau accumulation in infected mouse brains. Clinically, after the initial oral infection, herpes simplex virus-1 (HSV1) becomes latent in the trigeminal ganglion and recurrent reactivation may produce neuronal damage and AD pathology. Clinical studies show cognitive impairment in HSV seropositive patients, and antiviral drugs show strong efficacy against HSV. An antiviral treatment trial in AD is clearly warranted. A phase II treatment trial with valacyclovir, an anti-HSV drug, recently began with evaluation of clinical and biomarker outcomes.
Collapse
|
33
|
Harris SA, Harris EA. Molecular Mechanisms for Herpes Simplex Virus Type 1 Pathogenesis in Alzheimer's Disease. Front Aging Neurosci 2018; 10:48. [PMID: 29559905 PMCID: PMC5845560 DOI: 10.3389/fnagi.2018.00048] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/12/2018] [Indexed: 12/12/2022] Open
Abstract
This review focuses on research in the areas of epidemiology, neuropathology, molecular biology and genetics that implicates herpes simplex virus type 1 (HSV-1) as a causative agent in the pathogenesis of sporadic Alzheimer’s disease (AD). Molecular mechanisms whereby HSV-1 induces AD-related pathophysiology and pathology, including neuronal production and accumulation of amyloid beta (Aβ), hyperphosphorylation of tau proteins, dysregulation of calcium homeostasis, and impaired autophagy, are discussed. HSV-1 causes additional AD pathologies through mechanisms that promote neuroinflammation, oxidative stress, mitochondrial damage, synaptic dysfunction, and neuronal apoptosis. The AD susceptibility genes apolipoprotein E (APOE), phosphatidylinositol binding clathrin assembly protein (PICALM), complement receptor 1 (CR1) and clusterin (CLU) are involved in the HSV lifecycle. Polymorphisms in these genes may affect brain susceptibility to HSV-1 infection. APOE, for example, influences susceptibility to certain viral infections, HSV-1 viral load in the brain, and the innate immune response. The AD susceptibility gene cholesterol 25-hydroxylase (CH25H) is upregulated in the AD brain and is involved in the antiviral immune response. HSV-1 interacts with additional genes to affect cognition-related pathways and key enzymes involved in Aβ production, Aβ clearance, and hyperphosphorylation of tau proteins. Aβ itself functions as an antimicrobial peptide (AMP) against various pathogens including HSV-1. Evidence is presented supporting the hypothesis that Aβ is produced as an AMP in response to HSV-1 and other brain infections, leading to Aβ deposition and plaque formation in AD. Epidemiologic studies associating HSV-1 infection with AD and cognitive impairment are discussed. Studies are reviewed supporting subclinical chronic reactivation of latent HSV-1 in the brain as significant in the pathogenesis of AD. Finally, the rationale for and importance of clinical trials treating HSV-1-infected MCI and AD patients with antiviral medication is discussed.
Collapse
Affiliation(s)
- Steven A Harris
- St. Vincent Medical Group, Northside Internal Medicine, Indianapolis, IN, United States
| | - Elizabeth A Harris
- Department of Neurology, University of Chicago Medical Center, Chicago, IL, United States
| |
Collapse
|
34
|
Emotion discrimination in humans: Its association with HSV-1 infection and its improvement with antiviral treatment. Schizophr Res 2018; 193:161-167. [PMID: 28830742 PMCID: PMC5818324 DOI: 10.1016/j.schres.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Herpes simplex virus, type 1 (HSV-1) infects over 3.4 billion people, world-wide. Though it can cause encephalitis, in the vast majority it is asymptomatic, with lifelong latent infection in neurons. HSV-1 infected individuals have greater cognitive dysfunction than uninfected individuals, particularly persons with schizophrenia - even without encephalitis. We investigated whether HSV-1 related cognitive dysfunction is progressive or remediable. METHODS In a prospective naturalistic follow up sample (PNFU), temporal changes in cognitive functions were analyzed in relation to baseline HSV-1 infection in persons with/without schizophrenia (N=226). Independently, in a randomized controlled trial (RCT), HSV-1 infected, clinically stabilized SZ outpatients received Valacyclovir (VAL, an HSV-1 specific antiviral, 1.5G twice daily for 16weeks) or placebo (PLA) added to standard antipsychotic treatment, using a stratified randomization design, following placebo run-in (N=67). In both samples, HSV-1 infection (seropositivity) was estimated using serum IgG antibodies. Clinical evaluations were blinded to HSV-1 or treatment status. Standardized Z scores for accuracy on eight cognitive domains were analyzed for temporal trajectories using generalized linear models (PNFU) and VAL/PLA differences compared with intent to treat analyses (RCT). RESULTS PNFU: At baseline, HSV-1 infected participants had significantly lower accuracy scores for Emotion Identification and Discrimination (EMOD), Spatial memory and Spatial ability, regardless of SZ diagnosis (p=0.025, 0.029, 0.046, respectively). They also had significantly steeper temporal worsening for EMOD (p=0.03). RCT: EMOD improved in VAL-treated patients (p=0.048, Cohen's d=0.43). CONCLUSIONS A proportion of age related decline in EMOD is attributable to HSV-1 infection.
Collapse
|
35
|
Mohagheghi M, Eftekharian MM, Taheri M, Alikhani MY. Determining the IgM and IgG antibodies titer against HSV1, HSV2 and CMV in the serum of schizophrenia patients. Hum Antibodies 2018; 26:87-93. [PMID: 29036805 DOI: 10.3233/hab-170325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Schizophrenia is a destructive clinical syndrome with diverse mental pathologies. Different mechanisms and factors have a role in this disease. A possible mechanism is that teratogenic viruses cause brain changes and results in the disease appearance. The schizophrenia patients were diagnosed by psychologists and with the consent of patients, five CC of venous blood was drawn. Than Serum samples were isolated and immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against herpes simplex virus-1 (HSV-1), herpes simplex virus-2 (HSV-2) and cytomegalovirus (CMV) were quantified by ELISA sandwich kit. The Results showed that anti-CMV and anti-HSV1 and anti-HSV2 IgG antibodies in schizophrenia patients were increased significantly (p< 0.05). The increasing of the anti-HSV2 IgM was also observed but increasing amount of the anti-HSV1 IgM was not statistically significant (p< 0.05). Therefore, as a result of this study CMV and HSV1 and HSV2 infection can probably intensify the symptoms in schizophrenia patients.
Collapse
Affiliation(s)
| | - Mohammad Mahdi Eftekharian
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Faculty of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taheri
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Urogenital Stem Cell Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
36
|
Ohnuma T, Nishimon S, Takeda M, Sannohe T, Katsuta N, Arai H. Carbonyl Stress and Microinflammation-Related Molecules as Potential Biomarkers in Schizophrenia. Front Psychiatry 2018; 9:82. [PMID: 29593588 PMCID: PMC5859354 DOI: 10.3389/fpsyt.2018.00082] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/28/2018] [Indexed: 12/30/2022] Open
Abstract
This literature review primarily aims to summarize our research, comprising both cross-sectional and longitudinal studies, and discuss the possibility of using microinflammation-related biomarkers as peripheral biomarkers in the diagnosis and monitoring of patients with schizophrenia. To date, several studies have been conducted on peripheral biomarkers to recognize the potential markers for the diagnosis of schizophrenia and to determine the state and effects of therapy in patients with schizophrenia. Research has established a correlation between carbonyl stress, an environmental factor, and the pathophysiology of neuropsychiatric diseases, including schizophrenia. In addition, studies on biomarkers related to these stresses have achieved results that are either replicable or exhibit consistent increases or decreases in patients with schizophrenia. For instance, pentosidine, an advanced glycation end product (AGE), is considerably elevated in patients with schizophrenia; however, low levels of vitamin B6 [a detoxifier of reactive carbonyl compounds (RCOs)] have also been reported in some patients with schizophrenia. Another study on peripheral markers of carbonyl stress in patients with schizophrenia revealed a correlation of higher levels of glyceraldehyde-derived AGEs with higher neurotoxicity and lower levels of soluble receptors capable of diminishing the effects of AGEs. Furthermore, studies on evoked microinflammation-related biomarkers (e.g., soluble tumor necrosis factor receptor 1) have reported relatively consistent results, suggesting the involvement of microinflammation in the pathophysiology of schizophrenia. We believe that our cross-sectional and longitudinal studies as well as various previous inflammation marker studies that could be interpreted from several perspectives, such as mild localized encephalitis and microvascular disturbance, highlighted the importance of early intervention as prevention and distinguished the possible exclusion of inflammations in schizophrenia.
Collapse
Affiliation(s)
- Tohru Ohnuma
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shohei Nishimon
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Mayu Takeda
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takahiro Sannohe
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Narimasa Katsuta
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Heii Arai
- Juntendo University Schizophrenia Projects (JUSP), Department of Psychiatry, Faculty of Medicine, Juntendo University, Tokyo, Japan
| |
Collapse
|
37
|
Temporal Cognitive Decline Associated With Exposure to Infectious Agents in a Population-based, Aging Cohort. Alzheimer Dis Assoc Disord 2017; 30:216-22. [PMID: 26710257 DOI: 10.1097/wad.0000000000000133] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Numerous cross-sectional studies have related exposure to neurotropic infectious agents with cognitive dysfunction in older adults, however, the temporal sequence is uncertain. METHODS In a representative, well-characterized, population-based aging cohort, we determined whether the temporal trajectories of multiple cognitive domains are associated with exposure to cytomegalovirus (CMV), Herpes Simplex virus, type 1 (HSV-1), Herpes Simplex virus, type 2 (HSV-2), or Toxoplasma gondii (TOX). Complex attention, executive functions, memory, language, and visuospatial function were assessed annually for 5 years among consenting individuals. Study entry IgG antibody titers indexing exposure to each infectious agent were examined in relation to slopes of subsequent temporal cognitive decline using multiple linear regressions adjusted for potential confounders. RESULTS The IgG levels for HSV-2 were significantly associated with baseline cognitive domain scores (N=1022 participants). Further, the IgG levels for HSV-2, TOX, and CMV, but not HSV-1 were significantly associated with greater temporal cognitive decline that varied by type of infection. CONCLUSIONS Exposure to CMV, HSV-2, or TOX is associated with cognitive deterioration in older individuals, independent of general age-related variables. An increased understanding of the role of infectious agents in cognitive decline may lead to new methods for its prevention and treatment.
Collapse
|
38
|
Nimgaonkar VL, Prasad KM, Chowdari KV, Severance EG, Yolken RH. The complement system: a gateway to gene-environment interactions in schizophrenia pathogenesis. Mol Psychiatry 2017; 22:1554-1561. [PMID: 28761078 PMCID: PMC5656502 DOI: 10.1038/mp.2017.151] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 02/08/2023]
Abstract
The pathogenesis of schizophrenia is considered to be multi-factorial, with likely gene-environment interactions (GEI). Genetic and environmental risk factors are being identified with increasing frequency, yet their very number vastly increases the scope of possible GEI, making it difficult to identify them with certainty. Accumulating evidence suggests a dysregulated complement pathway among the pathogenic processes of schizophrenia. The complement pathway mediates innate and acquired immunity, and its activation drives the removal of damaged cells, autoantigens and environmentally derived antigens. Abnormalities in complement functions occur in many infectious and autoimmune disorders that have been linked to schizophrenia. Many older reports indicate altered serum complement activity in schizophrenia, though the data are inconclusive. Compellingly, recent genome-wide association studies suggest repeat polymorphisms incorporating the complement 4A (C4A) and 4B (C4B) genes as risk factors for schizophrenia. The C4A/C4B genetic associations have re-ignited interest not only in inflammation-related models for schizophrenia pathogenesis, but also in neurodevelopmental theories, because rodent models indicate a role for complement proteins in synaptic pruning and neurodevelopment. Thus, the complement system could be used as one of the 'staging posts' for a variety of focused studies of schizophrenia pathogenesis. They include GEI studies of the C4A/C4B repeat polymorphisms in relation to inflammation-related or infectious processes, animal model studies and tests of hypotheses linked to autoimmune diseases that can co-segregate with schizophrenia. If they can be replicated, such studies would vastly improve our understanding of pathogenic processes in schizophrenia through GEI analyses and open new avenues for therapy.
Collapse
Affiliation(s)
- Vishwajit L. Nimgaonkar
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA
- Department of Human Genetics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA
| | - Konasale M. Prasad
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Kodavali V. Chowdari
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Emily G. Severance
- Stanley Division of Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Robert H. Yolken
- Stanley Division of Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| |
Collapse
|
39
|
Association of cognitive function and liability to addiction with childhood herpesvirus infections: A prospective cohort study. Dev Psychopathol 2017; 30:143-152. [PMID: 28420448 DOI: 10.1017/s0954579417000529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Liability to substance use disorder (SUD) is largely nonspecific to particular drugs and is related to behavior dysregulation, including reduced cognitive control. Recent data suggest that cognitive mechanisms may be influenced by exposure to neurotropic infections, such as human herpesviruses. In this study, serological evidence of exposure to human herpesvirus Herpes simplex virus Type 1 (HSV-1), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) as well as Toxoplasma gondii was determined in childhood (age ~11 years) in 395 sons and 174 daughters of fathers with or without SUD. Its relationships with a cognitive characteristic (IQ) in childhood and with risk for SUD in adulthood were examined using correlation, regression, survival, and path analyses. Exposure to HSV-1, EBV, and T. gondii in males and females, and CMV in males, was associated with lower IQ. Independent of that relationship, EBV in females and possibly in males, and CMV and possibly HSV-1 in females were associated with elevated risk for SUD. Therefore, childhood neurotropic infections may influence cognitive development and risk for behavior disorders such as SUD. The results may point to new avenues for alleviating cognitive impairment and SUD risk.
Collapse
|
40
|
Rechenchoski DZ, Faccin-Galhardi LC, Linhares REC, Nozawa C. Herpesvirus: an underestimated virus. Folia Microbiol (Praha) 2016; 62:151-156. [PMID: 27858281 DOI: 10.1007/s12223-016-0482-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/08/2016] [Indexed: 01/31/2023]
Abstract
Herpes simplex virus (HSV) infections are common and widespread; nevertheless, their outcome can be of unpredictable prognosis in neonates and in immunosuppressed patients. Anti-HSV therapy is effective, but the emergence of drug-resistant strains or the drug toxicity that hamper the treatment is of great concern. Vaccine has not yet shown relevant benefit; therefore, palliative prophylactic measures have been adopted to prevent diseases. This short review proposes to present concisely the history of HSV, its taxonomy, physical structure, and replication and to explore the pathogenesis of the infection, clinical manifestations, laboratory diagnosis, treatment, prophylaxis and epidemiology of the diseases.
Collapse
Affiliation(s)
- Daniele Zendrini Rechenchoski
- Departamento de Microbiologia, Laboratório de Virologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Campus Universitário, Rod. Celso Garcia Cid, (Pr 445), km 380, Bairro: Jardim Portal de Versalhes, Londrina, Paraná, CEP: 86051-970, Brazil.
| | - Ligia Carla Faccin-Galhardi
- Departamento de Microbiologia, Laboratório de Virologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Campus Universitário, Rod. Celso Garcia Cid, (Pr 445), km 380, Bairro: Jardim Portal de Versalhes, Londrina, Paraná, CEP: 86051-970, Brazil
| | - Rosa Elisa Carvalho Linhares
- Departamento de Microbiologia, Laboratório de Virologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Campus Universitário, Rod. Celso Garcia Cid, (Pr 445), km 380, Bairro: Jardim Portal de Versalhes, Londrina, Paraná, CEP: 86051-970, Brazil
| | - Carlos Nozawa
- Departamento de Microbiologia, Laboratório de Virologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Campus Universitário, Rod. Celso Garcia Cid, (Pr 445), km 380, Bairro: Jardim Portal de Versalhes, Londrina, Paraná, CEP: 86051-970, Brazil
| |
Collapse
|
41
|
Tanaka T, Matsuda T, Hayes LN, Yang S, Rodriguez K, Severance EG, Yolken RH, Sawa A, Eaton WW. Infection and inflammation in schizophrenia and bipolar disorder. Neurosci Res 2016; 115:59-63. [PMID: 27856235 DOI: 10.1016/j.neures.2016.11.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/02/2016] [Accepted: 11/10/2016] [Indexed: 12/18/2022]
Abstract
The present study investigated the relationship between exposure to infectious agents and inflammation markers in individuals with schizophrenia (SZ), bipolar disorder (BP), and controls without a psychiatric disorder. We measured plasma levels of antibodies and innate immune markers and correlated them with clinical symptoms and cognitive function. In both SZ and BP, we found an increase in soluble CD14, and in BP an increase in C-reactive protein, IgM class antibodies against cytomegalovirus (CMV), and IgG class antibodies against herpes simplex virus 2. Furthermore in BP, we observed a negative relationship between IgG antibodies against CMV and scores for cognitive function.
Collapse
Affiliation(s)
- Teppei Tanaka
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Taro Matsuda
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21287, USA
| | - Lindsay N Hayes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Shuojia Yang
- Stanley Laboratory of Developmental Neurovirology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Katrina Rodriguez
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21287, USA
| | - Emily G Severance
- Stanley Laboratory of Developmental Neurovirology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Robert H Yolken
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Stanley Laboratory of Developmental Neurovirology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Akira Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21287, USA.
| | - William W Eaton
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21287, USA.
| |
Collapse
|
42
|
Mathai AJ, Lowry CA, Cook TB, Brenner LA, Brundin L, Groer MW, Peng X, Giegling I, Hartmann AM, Konte B, Friedl M, Fuchs D, Rujescu D, Postolache TT. Reciprocal moderation by Toxoplasma gondii seropositivity and blood phenylalanine - tyrosine ratio of their associations with trait aggression. Pteridines 2016; 27:77-85. [PMID: 28943719 DOI: 10.1515/pterid-2016-0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We previously reported that trait aggression, proposed as an endophenotype for suicidal behavior, is positively associated with Toxoplasma gondii (T. gondii) seropositivity in females, but not in males. Additionally, older males seropositive for T. gondii had lower scores on measures of trait aggression, including self-aggression. Trait aggression may be influenced by dopaminergic signaling, which is known to be moderated by gender and age, and potentially enhanced in T. gondii positives through the intrinsic production of dopamine by the microorganism. Therefore, we investigated associations between trait aggression and interactions between T. gondii enzyme-linked immunoabsorbant assay (ELISA) IgG titer-determined seropositivity and high-performance liquid chromatography- (HPLC-) measured blood levels of dopamine precursors phenylalanine (Phe), tyrosine (Tyr), and their ratio in a sample of 1000 psychiatrically healthy participants. Aggressive traits were assessed using the questionnaire for measuring factors of aggression (FAF), the German version of the Buss-Durkee hostility questionnaire. We found that 1) the decrease in trait aggression scores in T. gondii-positive older males was only present in individuals with a low Phe:Tyr ratio, and 2) that there was a positive correlation between Phe:Tyr ratio and total aggression and selected subscales of aggression in T. gondii-positive males, but not in T. gondii-negative males. These findings point toward a gender-specific reciprocal moderation by Phe:Tyr ratio and T. gondii seropositivity of their associations with aggression scores, and lead to experimental interventions geared to manipulating levels of dopamine precursors in selected T. gondii positive individuals with increased propensity for aggression.
Collapse
Affiliation(s)
- Ashwin Jacob Mathai
- Mood and Anxiety Program, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Building, Baltimore, MD 21201, USA; and Saint Elizabeths Hospital-DBH Psychiatry Residency Training Program, Washington DC, USA
| | - Christopher A Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO, USA; and University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, and Center for Neuroscience, Aurora, CO, USA
| | - Thomas B Cook
- Department of Public Health and Mercyhurst Institute for Public Health, Mercyhurst University, Erie, PA, USA
| | - Lisa A Brenner
- Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; and University of Colorado, Anschutz Medical Campus, Departments of Psychiatry, Physical Medicine and Rehabilitation, and Neurology, Aurora, CO, USA
| | - Lena Brundin
- Van Andel Research Institute, Grand Rapids, MI, USA
| | | | - Xiaoqing Peng
- Mood and Anxiety Program, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Building, Baltimore, MD 21201, USA; and Saint Elizabeths Hospital-DBH Psychiatry Residency Training Program, Washington DC, USA
| | - Ina Giegling
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Annette M Hartmann
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Bettina Konte
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Marion Friedl
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Dan Rujescu
- Department of Psychiatry, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Teodor T Postolache
- Mood and Anxiety Program, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Building, Baltimore, MD 21201, USA; Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; and VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA
| |
Collapse
|
43
|
Pandey JP, Namboodiri AM, Elston RC. Immunoglobulin G genotypes and the risk of schizophrenia. Hum Genet 2016; 135:1175-9. [PMID: 27393575 PMCID: PMC5706111 DOI: 10.1007/s00439-016-1706-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/25/2016] [Indexed: 12/20/2022]
Abstract
Genes of the immune system are relevant to the etiology of schizophrenia. However, to our knowledge, no large-scale studies, using molecular methods, have been undertaken to investigate the role of highly polymorphic immunoglobulin GM (γ marker) genes in this disorder. In this investigation, we aimed to determine whether particular GM genotypes were associated with susceptibility to schizophrenia. Using a matched case-control study design, we analyzed DNA samples from 798 subjects-398 patients with schizophrenia and 400 controls-obtained from the U.S. National Institute of Mental Health Repository. GM alleles were determined by the TaqMan(®) genotyping assay. The GM 3/3; 23-/23- genotype was highly significantly associated with susceptibility to schizophrenia (p = 0.0002). Subjects with this genotype were over three times (OR 3.4; 95 % CI 1.7-6.7) as likely to develop schizophrenia as those without this genotype. Our results show that immunoglobulin GM genes are risk factors for the development of schizophrenia. Since GM alleles have been implicated in gluten sensitivity and in immunity to neurotropic viruses associated with cognitive impairment, the results presented here may help unify these two disparate areas of pathology affected in this disorder.
Collapse
Affiliation(s)
- Janardan P Pandey
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Aryan M Namboodiri
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | | |
Collapse
|
44
|
Tomasik J, Rahmoune H, Guest PC, Bahn S. Neuroimmune biomarkers in schizophrenia. Schizophr Res 2016; 176:3-13. [PMID: 25124519 DOI: 10.1016/j.schres.2014.07.025] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/17/2014] [Accepted: 07/20/2014] [Indexed: 02/07/2023]
Abstract
Schizophrenia is a heterogeneous psychiatric disorder with a broad spectrum of clinical and biological manifestations. Due to the lack of objective tests, the accurate diagnosis and selection of effective treatments for schizophrenia remains challenging. Numerous technologies have been employed in search of schizophrenia biomarkers. These studies have suggested that neuroinflammatory processes may play a role in schizophrenia pathogenesis, at least in a subgroup of patients. The evidence indicates alterations in both pro- and anti-inflammatory molecules in the central nervous system, which have also been found in peripheral tissues and may correlate with schizophrenia symptoms. In line with these findings, certain immunomodulatory interventions have shown beneficial effects on psychotic symptoms in schizophrenia patients, in particular those with distinct immune signatures. In this review, we evaluate these findings and their potential for more targeted drug interventions and the development of companion diagnostics. Although currently no validated markers exist for schizophrenia patient stratification or the prediction of treatment efficacy, we propose that utilisation of inflammatory markers for diagnostic and theranostic purposes may lead to novel therapeutic approaches and deliver more effective care for schizophrenia patients.
Collapse
Affiliation(s)
- Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK; Department of Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hassan Rahmoune
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Paul C Guest
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK; Department of Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands.
| |
Collapse
|
45
|
Harris SA, Harris EA. Herpes Simplex Virus Type 1 and Other Pathogens are Key Causative Factors in Sporadic Alzheimer's Disease. J Alzheimers Dis 2016; 48:319-53. [PMID: 26401998 PMCID: PMC4923765 DOI: 10.3233/jad-142853] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review focuses on research in epidemiology, neuropathology, molecular biology, and genetics regarding the hypothesis that pathogens interact with susceptibility genes and are causative in sporadic Alzheimer's disease (AD). Sporadic AD is a complex multifactorial neurodegenerative disease with evidence indicating coexisting multi-pathogen and inflammatory etiologies. There are significant associations between AD and various pathogens, including Herpes simplex virus type 1 (HSV-1), Cytomegalovirus, and other Herpesviridae, Chlamydophila pneumoniae, spirochetes, Helicobacter pylori, and various periodontal pathogens. These pathogens are able to evade destruction by the host immune system, leading to persistent infection. Bacterial and viral DNA and RNA and bacterial ligands increase the expression of pro-inflammatory molecules and activate the innate and adaptive immune systems. Evidence demonstrates that pathogens directly and indirectly induce AD pathology, including amyloid-β (Aβ) accumulation, phosphorylation of tau protein, neuronal injury, and apoptosis. Chronic brain infection with HSV-1, Chlamydophila pneumoniae, and spirochetes results in complex processes that interact to cause a vicious cycle of uncontrolled neuroinflammation and neurodegeneration. Infections such as Cytomegalovirus, Helicobacter pylori, and periodontal pathogens induce production of systemic pro-inflammatory cytokines that may cross the blood-brain barrier to promote neurodegeneration. Pathogen-induced inflammation and central nervous system accumulation of Aβ damages the blood-brain barrier, which contributes to the pathophysiology of AD. Apolipoprotein E4 (ApoE4) enhances brain infiltration by pathogens including HSV-1 and Chlamydophila pneumoniae. ApoE4 is also associated with an increased pro-inflammatory response by the immune system. Potential antimicrobial treatments for AD are discussed, including the rationale for antiviral and antibiotic clinical trials.
Collapse
Affiliation(s)
- Steven A Harris
- St. Vincent Medical Group, Northside Internal Medicine, Indianapolis, IN, USA
| | | |
Collapse
|
46
|
Fruchter E, Goldberg S, Fenchel D, Grotto I, Ginat K, Weiser M. The impact of Herpes simplex virus type 1 on cognitive impairments in young, healthy individuals - A historical prospective study. Schizophr Res 2015; 168:292-6. [PMID: 26362735 DOI: 10.1016/j.schres.2015.08.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 08/23/2015] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
Abstract
Herpes simplex virus (HSV) is a highly prevalent neurotropic virus. Although on the whole, chronic, latent or persistent infection is considered to be relatively benign, HSV infections can cause cognitive impairment during and after acute encephalitis. Some studies have documented cognitive impairment in exposed persons that is untraceable to encephalitis. Most studies have focused on these impairments in the mentally ill, mostly among individuals with schizophrenia, and only recently have studies begun to examine the impact of HSV infection on the cognition of healthy individuals. Subjects were a representative, random sample of 612 soldiers before active duty in the Israeli military (Israeli defense force - IDF), 62.2% HSV positive (n=381) and 38.8% HSV negative (n=231). Cognitive functioning and language abilities were compared between these groups, controlling for years of education, immigration status, and gender. Compared to soldiers who were sero-negative, soldiers who were sero-positive for HSV had significantly lower IQ scores (IQ=97.96, SD=15.19 vs IQ=103.23, SD=14.23; p≤0.001, effect size (ES)=0.2), and significantly lower Hebrew language scores (ES=0.1, p≤0.01). The results remained significant after removing subjects with mild depression, anxiety or personality disorders. Although we could not control for socio-economic status directly, our findings indicate that infection with HSV-1 is associated with reduced cognitive functioning in healthy individuals. This finding adds to the growing number of studies in the schizophrenia literature and indicates that many research findings seemingly characteristic of schizophrenia are related to the association between HSV exposure and cognitive functioning in general, and are not illness specific.
Collapse
Affiliation(s)
- Eyal Fruchter
- IDF Medical Corps, Mental Health Center, Israel; USC - School of Social Work, C.I.R. Los Angeles, CA, USA
| | - Shira Goldberg
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Daphna Fenchel
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Itamar Grotto
- Ministry of Health, Jerusalem, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Keren Ginat
- IDF Medical Corps, Mental Health Center, Israel
| | - Mark Weiser
- IDF Medical Corps, Mental Health Center, Israel; Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| |
Collapse
|
47
|
Guo J, Liu C, Wang Y, Feng B, Zhang X. Role of T helper lymphokines in the immune-inflammatory pathophysiology of schizophrenia: Systematic review and meta-analysis. Nord J Psychiatry 2015; 69:364-72. [PMID: 25529895 DOI: 10.3109/08039488.2014.986761] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Schizophrenia is highly complex multifactorial psychiatric disorder with poorly defined etiopathophysiology, which also has manifestations in the immune system. AIMS The aim of this review is to meta-analyze the available evidence regarding the role of immune activation indicated by the T helper cells in order to evaluate etiopathophysiological links between the immune system and schizophrenia. METHODS A literature search was performed in multiple electronic databases for relevant research papers published between 1990 and May 2014. Meta-analyses were conducted under both random- (REM) and fixed-effect models (FEM) by calculating weighted mean differences with 95% confidence intervals. Heterogeneity was assessed with the I(2) index. RESULTS Twenty-one studies were selected after observing inclusion and exclusion criteria. In vitro interferon-gamma (INF-γ) and interleukin (IL)-2 production was significantly lower in the schizophrenic patients compared with non-schizophrenic control individuals under both FEM and REM. Serum levels of IL-2 and serum/in vitro IL-4 were not significantly different in both groups under both FEM and REM. Overall Th1:Th2 ratio (INF-γ:IL-4 and IL-2:IL-4) in the serum samples was significantly deflected towards Th2 under both models in the serum samples (- 0.33 [- 0.59 to - 0.06]; P < 0.03, FEM and - 2.44 [- 4.27 to - 0.60]; P < 0.009, REM) but in vitro production Th1:Th2 ratio (INF-γ:IL-4 and IL-2:IL-4) was deflected towards Th1 under both the models (1.11 [0.45-1.78]; P < 0.002, FEM and 6.68 [0.72-12.64]; P < 0.03, REM). CONCLUSIONS Whereas the Th1:Th2 ratio in the serum samples deflected towards T2, in vitro Th1:Th2 ratio favored Th1 when the individual study data were meta-analyzed.
Collapse
Affiliation(s)
- Jing Guo
- Jing Guo, M.D., Clinical Laboratory, The 261st Hospital of The People's Liberation Army , Beijing , China
| | | | | | | | | |
Collapse
|
48
|
Abstract
Molecular profiling studies have helped increase the understanding of the immune processes thought to be involved in the etiology and pathophysiology of psychiatric disorders such as schizophrenia. Current therapeutic interventions with first- and second-generation antipsychotics are suboptimal. Poor response rates and debilitating side effects often lead to poor treatment compliance. This highlights the pressing need to identify more effective treatments as well as objective biomarker based tests, which can help predict treatment response and identify diagnostic subpopulations. Such tests could enable early detection of patients who will benefit from particular therapeutic interventions. In this review, we discuss studies relating to dysfunctions of the immune system in patients with schizophrenia and the effects of antipsychotic medication on the molecular components of these systems. Immune system dysfunction may in part be related to genetic risk factors for schizophrenia, but there is substantial evidence that a wide range of environmental factors ranging from exposure to infectious agents such as influenza and Toxoplasma gondii to HPA axis dysfunction play an important role in the etiopathogenesis of schizophrenia. Ongoing research efforts, testing therapeutic efficacy of anti-inflammatory agents used as add-on medications are also discussed. From a therapeutic perspective, these represent the initial steps toward novel treatment approaches and more effective patient care in the field of mental health.
Collapse
|
49
|
Itzhaki RF, Klapper P. Comment on "cytomegalovirus infection and risk of Alzheimer disease in older black and white individuals," journal of infectious diseases, 8 august 2014. J Infect Dis 2015; 211:2023-4. [PMID: 25635119 DOI: 10.1093/infdis/jiv051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/22/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Paul Klapper
- Faculty of Medical and Human Sciences, University of Manchester, United Kingdom
| |
Collapse
|
50
|
D’Aiuto L, Prasad KM, Upton CH, Viggiano L, Milosevic J, Raimondi G, McClain L, Chowdari K, Tischfield J, Sheldon M, Moore JC, Yolken RH, Kinchington PR, Nimgaonkar VL. Persistent infection by HSV-1 is associated with changes in functional architecture of iPSC-derived neurons and brain activation patterns underlying working memory performance. Schizophr Bull 2015; 41:123-32. [PMID: 24622295 PMCID: PMC4266288 DOI: 10.1093/schbul/sbu032] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Herpes simplex virus, type 1 (HSV-1) commonly produces lytic mucosal lesions. It invariably initiates latent infection in sensory ganglia enabling persistent, lifelong infection. Acute HSV-1 encephalitis is rare and definitive evidence of latent infection in the brain is lacking. However, exposure untraceable to encephalitis has been repeatedly associated with impaired working memory and executive functions, particularly among schizophrenia patients. METHODS Patterns of HSV-1 infection and gene expression changes were examined in human induced pluripotent stem cell (iPSC)-derived neurons. Separately, differences in blood oxygenation level-dependent (BOLD) responses to working memory challenges using letter n-back tests were investigated using functional magnetic resonance imaging (fMRI) among schizophrenia cases/controls. RESULTS HSV-1 induced lytic changes in iPSC-derived glutamatergic neurons and neuroprogenitor cells. In neurons, HSV-1 also entered a quiescent state following coincubation with antiviral drugs, with distinctive changes in gene expression related to functions such as glutamatergic signaling. In the fMRI studies, main effects of schizophrenia (P = .001) and HSV-1 exposure (1-back, P = 1.76 × 10(-4); 2-back, P = 1.39 × 10(-5)) on BOLD responses were observed. We also noted increased BOLD responses in the frontoparietal, thalamus, and midbrain regions among HSV-1 exposed schizophrenia cases and controls, compared with unexposed persons. CONCLUSIONS The lytic/quiescent cycles in iPSC-derived neurons indicate that persistent neuronal infection can occur, altering cellular function. The fMRI studies affirm the associations between nonencephalitic HSV-1 infection and functional brain changes linked with working memory impairment. The fMRI and iPSC studies together provide putative mechanisms for the cognitive impairments linked to HSV-1 exposure.
Collapse
Affiliation(s)
- Leonardo D’Aiuto
- Department of Psychiatry, WPIC, University of Pittsburgh, School of Medicine, Pittsburgh PA;,These authors contributed equally to the article
| | - Konasale M. Prasad
- Department of Psychiatry, WPIC, University of Pittsburgh, School of Medicine, Pittsburgh PA;,These authors contributed equally to the article
| | - Catherine H. Upton
- Department of Psychiatry, WPIC, University of Pittsburgh, School of Medicine, Pittsburgh PA
| | - Luigi Viggiano
- Department of Biology, University of Bari “Aldo Moro”, Bari, Italy
| | - Jadranka Milosevic
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Giorgio Raimondi
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lora McClain
- Department of Psychiatry, WPIC, University of Pittsburgh, School of Medicine, Pittsburgh PA
| | - Kodavali Chowdari
- Department of Psychiatry, WPIC, University of Pittsburgh, School of Medicine, Pittsburgh PA
| | - Jay Tischfield
- Department of Genetics and The Human Genome Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Michael Sheldon
- Department of Genetics and The Human Genome Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Jennifer C. Moore
- Department of Genetics and The Human Genome Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Robert H. Yolken
- Stanley Division of Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul R. Kinchington
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA;,Department of Molecular Genetics & Biochemistry, University of Pittsburgh, Pittsburgh, PA
| | - Vishwajit L. Nimgaonkar
- Department of Psychiatry, WPIC, University of Pittsburgh, School of Medicine, Pittsburgh PA;,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA,*To whom correspondence should be addressed; Western Psychiatric Institute and Clinic, TDH 441, 3811 O’Hara St, Pittsburgh, PA 15213, US; tel: 412-246-6353, fax: 412-246-6350, e-mail:
| |
Collapse
|