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Grada S, Mihu AG, Oatis DA, Marc CC, Chicea LM, Petrescu C, Lupu AM, Olariu TR. Seroprevalence and Associated Risk Factors of Toxoplasma gondii in Patients Diagnosed with Schizophrenia: A Case-Control Cross Sectional Study. Biomedicines 2024; 12:998. [PMID: 38790960 PMCID: PMC11117935 DOI: 10.3390/biomedicines12050998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
The protozoan parasite, Toxoplasma gondii, has been linked to several psychiatric disorders, including schizophrenia. The aim of this study was to assess the prevalence of T. gondii IgG antibodies and risk factors associated with seroprevalence in patients diagnosed with schizophrenia. This seroepidemiological study assessed 196 participants, divided into two groups. The study group consisted of 98 schizophrenic patients and was matched with 98 healthy blood donors. A questionnaire was used to gather information regarding potential risk factors associated with T. gondii seroprevalence. Results revealed a higher seroprevalence of T. gondii IgG antibodies in schizophrenic patients (69.39%, 68/98) when compared to healthy controls (51.02%, 50/98) (OR: 2.18; 95% CI: 1.21-3.9; p = 0.01). Patients with schizophrenia who consumed raw or undercooked meat (80.65%, 25/31) (OR: 3.75; 95% CI: 1.25-11.21, p = 0.02) and those with a lower educational level (77.59%, 45/58) (OR: 3.5; 95% CI: 1.59-7.54, p = 0.002) presented increased T. gondii seropositivity rates versus their control counterparts. Our findings indicate a high T. gondii IgG seroprevalence in patients diagnosed with schizophrenia compared to healthy blood donors. Factors associated with T. gondii seroprevalence were consumption of raw or uncooked meat and a lower educational attainment. This study provided the first data regarding the potential risk factors for toxoplasmosis in Romanian patients diagnosed with schizophrenia and may serve as a foundation for future research and the development of preventive strategies.
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Affiliation(s)
- Sebastian Grada
- Discipline of Parasitology, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.G.); (T.R.O.)
- Center for Diagnosis and Study of Parasitic Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Alin Gabriel Mihu
- “Aurel Ardelean” Institute of Life Sciences, Vasile Goldis Western University of Arad, 86 Rebreanu, 310414 Arad, Romania;
- Department of Biology and Life Sciences, Vasile Goldis Western University, 310300 Arad, Romania
- Patogen Preventia, 300124 Timisoara, Romania
| | - Daniela Adriana Oatis
- “Aurel Ardelean” Institute of Life Sciences, Vasile Goldis Western University of Arad, 86 Rebreanu, 310414 Arad, Romania;
- Department of Infectious Disease, Faculty of Medicine, Vasile Goldis Western University, 310300 Arad, Romania
| | - Constantin Catalin Marc
- Center for Diagnosis and Study of Parasitic Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Biology and Life Sciences, Vasile Goldis Western University, 310300 Arad, Romania
| | - Liana Maria Chicea
- Department II Medical Clinic, “Victor Papilian” Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania;
- Internal Medicine Department, Academic Emergency Hospital, 550245 Sibiu, Romania
| | - Cristina Petrescu
- Discipline of Hygiene, Department of Microbiology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Alina Maria Lupu
- Discipline of Parasitology, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.G.); (T.R.O.)
- Center for Diagnosis and Study of Parasitic Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Patogen Preventia, 300124 Timisoara, Romania
- Clinical Laboratory, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania
| | - Tudor Rares Olariu
- Discipline of Parasitology, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.G.); (T.R.O.)
- Center for Diagnosis and Study of Parasitic Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Patogen Preventia, 300124 Timisoara, Romania
- Clinical Laboratory, Municipal Clinical Emergency Teaching Hospital, 300254 Timisoara, Romania
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Song G, Zhao Q, Chen H, Li M, Zhang Z, Qu Z, Yang C, Lin X, Ma W, Standlee CR. Toxoplasma gondii seropositivity and cognitive functioning in older adults: an analysis of cross-sectional data of the National Health and Nutrition Examination Survey 2011-2014. BMJ Open 2024; 14:e071513. [PMID: 38448067 PMCID: PMC10916126 DOI: 10.1136/bmjopen-2022-071513] [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: 12/30/2022] [Accepted: 02/14/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES This study sought to examine the relationship between Toxoplasma gondii seropositivity and cognitive function in older adults. DESIGN An observational cross-sectional study. SETTING The National Health and Nutrition Examination Survey (NHANES) study took place at participants' homes and mobile examination centres. PARTICIPANTS A total of 2956 older adults aged 60 and above from the NHANES from 2011 to 2014 were included in the study. Exposure of interest: participants had serum Toxoplasma gondii antibody analysed in the laboratory. A value>33 IU/mL was categorised as seropositive for Toxoplasma gondii infection; <27 IU/mL was categorised as seronegative for Toxoplasma gondii infection. PRIMARY AND SECONDARY OUTCOME MEASURES Cognitive tests included the Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD-WL) for immediate and delayed memory, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). RESULTS About half of the 2956 participants (mean age 70.0) were female (51.0%), non-Hispanic White (48.3%), and completed some college or above (48.3%). A total of 703 participants were positive for Toxoplasma gondii infection (23.8%). Adjusted linear regression showed that compared with participants with negative Toxoplasma gondii infection, those with positive Toxoplasma gondii infection had lower CERAD-WL immediate memory (beta (β) -0.16, 95% CI -0.25 to -0.07), CERAD-WL delayed memory (β -0.15, 95% CI -0.24 to -0.06), AFT (β -0.15, 95% CI -0.24 to -0.06), DSST (β -0.34, 95% CI -0.43 to -0.26), and global cognition (β -0.24, 95% CI -0.32 to -0.16) z-scores after controlling for the covariates. CONCLUSIONS Toxoplasma gondii seropositivity is associated with worse immediate and delayed verbal learning, language proficiency, executive functioning, processing speed, sustained attention, working memory, as well as global cognition in older adults. Public health measures aiming at preventing Toxoplasma gondii infection may help preserve cognitive functioning in older adults.
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Affiliation(s)
- Ge Song
- College of Sciences and Technology, University of Houston Downtown, Houston, Texas, USA
| | - Qingxia Zhao
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongyu Chen
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Li
- Kentucky Department for Public Health, Infectious Disease Branch, Frankfort, Kentucky, USA
| | - Zeyu Zhang
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Zhe Qu
- Department of Pediatric Respiratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chao Yang
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xuechun Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Weixia Ma
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Hamouda MM, El-Saied AS, Zaher A, Khalil AF, ElBlihy AA, Nabih N, El-Beshbishi SN. Toxoplasma gondii: Seroprevalence and association with childhood brain tumors in Egypt. Acta Trop 2024; 251:107123. [PMID: 38242223 DOI: 10.1016/j.actatropica.2024.107123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Childhood brain tumors are a significant global health challenge, yet the etiology of these tumors remains elusive. While research has identified potential risk factors, recent studies have explored the involvement of infectious agents, particularly Toxoplasma gondii (T. gondii), in brain tumor development. METHODS This study aimed to explore the prevalence of T. gondii infection in children diagnosed with brain tumors and to investigate the potential association between T. gondii infection and childhood brain tumors in Egypt. A total of 64 children with brain tumors and 92 healthy controls were enrolled in this study. Demographics and risk factors data were collected using structured questionnaires. Serological assay using ELISA technique was performed to detect anti-T. gondii antibodies in both cases and control groups. RESULTS This study revealed a significantly higher seroprevalence of T. gondii infection in brain tumor cases (62.5 %) compared to healthy controls (38 %). Furthermore, a strong association was observed between T. gondii seropositivity and childhood brain tumors (odds ratio: 2.7). Notably, the consumption of unwashed vegetables emerged as a significant risk factor for T. gondii infection in Egypt. Analysis of T. gondii seroprevalence across different subtypes of brain tumors revealed varying rates, with glioma cases displaying a striking 100 % seroprevalence. CONCLUSIONS These findings support the hypothesis that T. gondii infection may be a risk factor for childhood brain tumors and emphasize the need for further research in this area. The study also highlights the potential implications of control of T. gondii infection for prevention and treatment of childhood brain tumors.
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Affiliation(s)
- Marwa M Hamouda
- Medical Parasitology Department, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura 35516, Egypt.
| | - Amany S El-Saied
- Medical Parasitology Department, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura 35516, Egypt
| | - Ahmed Zaher
- Neurosurgery Department, Faculty of Medicine, Mansoura University, Egypt
| | - Amr Farid Khalil
- Neurosurgery Department, Faculty of Medicine, Mansoura University, Egypt
| | - Ayat A ElBlihy
- Medical Parasitology Department, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura 35516, Egypt
| | - Nairmen Nabih
- Medical Parasitology Department, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura 35516, Egypt
| | - Samar N El-Beshbishi
- Medical Parasitology Department, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura 35516, Egypt; Medical Parasitology Department, Faculty of Medicine, New Mansoura University, Egypt
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Getzmann S, Golka K, Bröde P, Reinders J, Kadhum T, Hengstler JG, Wascher E, Gajewski PD. Chronic Toxoplasma gondii Infection Modulates Hearing Ability across the Adult Life Span. Life (Basel) 2024; 14:194. [PMID: 38398703 PMCID: PMC10890099 DOI: 10.3390/life14020194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
While several studies have shown associations between hearing disorders and congenital toxoplasmosis, the present study investigated the impact of chronic, latent Toxoplasma gondii (T. gondii) infection on hearing loss. We used a regression analysis to explore whether latent T. gondii infection modulates changes in hearing thresholds over an age range from 20 to 70 years. We analyzed audiometric data of 162 T. gondii IgG-positive and 430 T. gondii-negative participants, collected in the Dortmund Vital Study (DVS, ClinicalTrials.gov Identifier: NCT05155397), a prospective study on healthy cognitive aging. The regression analysis indicated that latent toxoplasmosis was associated with an accelerated development in hearing loss over the observed age range. Hearing loss was less frequent in IgG-positive than in IgG-negative participants up to the age of about 40 for a low (0.125-1 kHz)-frequency range. For high (2-8 kHz) frequencies, this pattern reversed for ages above 65 years. We discuss these findings on hearing function in the context of a recently proposed model, suggesting that latent toxoplasmosis can differentially affect brain functions across a lifespan.
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Affiliation(s)
- Stephan Getzmann
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), D-44139 Dortmund, Germany; (K.G.); (P.B.); (J.R.); (J.G.H.); (E.W.); (P.D.G.)
| | - Klaus Golka
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), D-44139 Dortmund, Germany; (K.G.); (P.B.); (J.R.); (J.G.H.); (E.W.); (P.D.G.)
| | - Peter Bröde
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), D-44139 Dortmund, Germany; (K.G.); (P.B.); (J.R.); (J.G.H.); (E.W.); (P.D.G.)
| | - Jörg Reinders
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), D-44139 Dortmund, Germany; (K.G.); (P.B.); (J.R.); (J.G.H.); (E.W.); (P.D.G.)
| | - Thura Kadhum
- Clinic for Psychosomatic Rehabilitation, Mittelrhein-Klinik, D-56154 Boppard-Bad Salzig, Germany;
| | - Jan G. Hengstler
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), D-44139 Dortmund, Germany; (K.G.); (P.B.); (J.R.); (J.G.H.); (E.W.); (P.D.G.)
| | - Edmund Wascher
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), D-44139 Dortmund, Germany; (K.G.); (P.B.); (J.R.); (J.G.H.); (E.W.); (P.D.G.)
- German Center for Mental Health (DZPG), Partner Site Bochum/Marburg, 44787 Bochum, Germany
| | - Patrick D. Gajewski
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), D-44139 Dortmund, Germany; (K.G.); (P.B.); (J.R.); (J.G.H.); (E.W.); (P.D.G.)
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Sarhan MH, Felemban SG, Alelwani W, Sharaf HM, Abd El-Latif YA, Elgazzar E, Kandil AM, Tellez-Isaias G, Mohamed AA. Zinc Oxide and Magnesium-Doped Zinc Oxide Nanoparticles Ameliorate Murine Chronic Toxoplasmosis. Pharmaceuticals (Basel) 2024; 17:113. [PMID: 38256946 PMCID: PMC10819917 DOI: 10.3390/ph17010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Toxoplasma gondii causes a global parasitic disease. Therapeutic options for eradicating toxoplasmosis are limited. In this study, ZnO and Mg-doped ZnO NPs were prepared, and their structural and morphological chrematistics were investigated. The XRD pattern revealed that Mg-doped ZnO NPs have weak crystallinity and a small crystallite size. FTIR and XPS analyses confirmed the integration of Mg ions into the ZnO framework, producing the high-purity Mg-doped ZnO nanocomposite. TEM micrographs determined the particle size of un-doped ZnO in the range of 29 nm, reduced to 23 nm with Mg2+ replacements. ZnO and Mg-doped ZnO NPs significantly decreased the number of brain cysts (p < 0.05) by 29.30% and 35.08%, respectively, compared to the infected untreated group. The administration of ZnO and Mg-doped ZnO NPs revealed a marked histopathological improvement in the brain, liver, and spleen. Furthermore, ZnO and Mg-doped ZnO NPs reduced P53 expression in the cerebral tissue while inducing CD31 expression, which indicated a protective effect against the infection-induced apoptosis and the restoration of balance between free radicals and antioxidant defense activity. In conclusion, the study proved these nanoparticles have antiparasitic, antiapoptotic, and angiogenetic effects. Being nontoxic compounds, these nanoparticles could be promising adjuvants in treating chronic toxoplasmosis.
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Affiliation(s)
- Mohamed H. Sarhan
- Microbiology Section, Basic Medical Sciences Department, College of Medicine, Shaqra University, Shaqra 11961, Saudi Arabia
- Medical Parasitology Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Shatha G. Felemban
- Medical Laboratory Science Department, Fakeeh College for Medical Sciences, Jeddah 21461, Saudi Arabia;
| | - Walla Alelwani
- Department of Biochemistry, College of Science, University of Jeddah, Jeddah 23890, Saudi Arabia;
| | - Hesham M. Sharaf
- Zoology Department, Faculty of Science, Zagazig University, Zagazig 44519, Egypt; (H.M.S.); (Y.A.A.E.-L.); (A.A.M.)
| | - Yasmin A. Abd El-Latif
- Zoology Department, Faculty of Science, Zagazig University, Zagazig 44519, Egypt; (H.M.S.); (Y.A.A.E.-L.); (A.A.M.)
| | - Elsayed Elgazzar
- Physics Department, Faculty of Science, Suez Canal University, Ismailia 41522, Egypt
| | - Ahmad M. Kandil
- Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo 11651, Egypt;
| | - Guillermo Tellez-Isaias
- Department of Poultry Science, Division of Agriculture, University of Arkansas, Fayetteville, AR 72701, USA
| | - Aya A. Mohamed
- Zoology Department, Faculty of Science, Zagazig University, Zagazig 44519, Egypt; (H.M.S.); (Y.A.A.E.-L.); (A.A.M.)
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Aboukamar WA, Habib S, Tharwat S, Nassar MK, Elzoheiry MA, Atef R, Elmehankar MS. Association between toxoplasmosis and autoimmune rheumatic diseases in Egyptian patients. REUMATOLOGIA CLINICA 2023; 19:488-494. [PMID: 37945182 DOI: 10.1016/j.reumae.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/07/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To explore the association between T. gondii and autoimmune rheumatic diseases (ARDs). METHODS This study involved 82 patients with ARDs: 44 rheumatoid arthritis (RA), 28 systemic lupus erythematosus (SLE), and 10 systemic sclerosis (SSc) and 61 age- and sex-matched controls. Sociodemographic, clinical, and laboratory data were collected, and disease activity was assessed. Exposure to toxoplasmosis risk factors was investigated. Serological tests for anti-Toxoplasma IgM and IgG antibodies were assessed using ELISA. RESULTS In SLE patients, a significant difference of T. gondii IgM versus controls was detected (P=.03). In RA and SLE patients, T. gondii IgG showed a significant difference versus controls (34 (77.3%) P=.001 and 18 (64.3%) P=.03, respectively). There was no significant difference in SSc versus controls. Fetal congenital anomalies displayed a significant difference in IgM seropositive compared to seronegative patients (P=.04). Cat exposure showed a significant difference between IgM and IgG seropositive versus seronegative patients (12 (80.0%) P=.02 and 34 (59.6) P=.04, respectively). There was no significant difference in seropositive patients regarding history of abortion, neuro-psychiatric manifestations, disease activity parameters (ESR, CRP), or different regimens of medications. CONCLUSION Toxoplasma IgM seropositivity is associated with SLE patients. T. gondii IgG seropositivity is associated with both RA and SLE patients. However, Toxoplasma seropositivity had no association with SSc patients. An association between fetal congenital anomalies and IgM seropositivity was demonstrated. A linkage between cat exposure as a risk factor and toxoplasmosis was suggested among ARD patiants. Exploration of impact of toxoplasmosis on ARDs is a necessity through randomized controlled trials.
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Affiliation(s)
- Wafaa A Aboukamar
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Samar Habib
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Kamal Nassar
- Mansoura Nephrology & Dialysis Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Manal A Elzoheiry
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rania Atef
- Medical Student, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Manar S Elmehankar
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Correa Leite PE, de Araujo Portes J, Pereira MR, Russo FB, Martins-Duarte ES, Almeida Dos Santos N, Attias M, Barrantes FJ, Baleeiro Beltrão-Braga PC, de Souza W. Morphological and biochemical repercussions of Toxoplasma gondii infection in a 3D human brain neurospheres model. Brain Behav Immun Health 2021; 11:100190. [PMID: 34589727 PMCID: PMC8474451 DOI: 10.1016/j.bbih.2020.100190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 12/19/2022] Open
Abstract
Background Toxoplasmosis is caused by the parasite Toxoplasma gondii that can infect the central nervous system (CNS), promoting neuroinflammation, neuronal loss, neurotransmitter imbalance and behavioral alterations. T. gondii infection is also related to neuropsychiatric disorders such as schizophrenia. The pathogenicity and inflammatory response in rodents are different to the case of humans, compromising the correlation between the behavioral alterations and physiological modifications observed in the disease. In the present work we used BrainSpheres, a 3D CNS model derived from human pluripotent stem cells (iPSC), to investigate the morphological and biochemical repercussions of T. gondii infection in human neural cells. Methods We evaluated T. gondii ME49 strain proliferation and cyst formation in both 2D cultured human neural cells and BrainSpheres. Aspects of cell morphology, ultrastructure, viability, gene expression of neural phenotype markers, as well as secretion of inflammatory mediators were evaluated for 2 and 4 weeks post infection in BrainSpheres. Results T. gondii can infect BrainSpheres, proliferating and inducing cysts formation, neural cell death, alteration in neural gene expression and triggering the release of several inflammatory mediators. Conclusions BrainSpheres reproduce many aspects of T. gondii infection in human CNS, constituting a useful model to study the neurotoxicity and neuroinflammation mediated by the parasite. In addition, these data could be important for future studies aiming at better understanding possible correlations between psychiatric disorders and human CNS infection with T. gondii. T. gondii infects, proliferates and induce cysts formation in neurospheres. T. gondii infection induces neural cell death in neurospheres. T. gondii infection promotes alteration in neural gene expression in neurospheres. T. gondii infection promotes release of inflammatory mediators in neurospheres.
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Affiliation(s)
- Paulo Emilio Correa Leite
- Institute of Biophysics Carlos Chagas Filho and National Center for Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro, RJ, Brazil.,Directory of Metrology Applied to Life Sciences (Dimav), National Institute of Metrology Quality and Technology (INMETRO), Duque de Caxias, RJ, Brazil
| | - Juliana de Araujo Portes
- Institute of Biophysics Carlos Chagas Filho and National Center for Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro, RJ, Brazil
| | | | - Fabiele Baldino Russo
- Laboratory of Disease Modeling, Department of Microbiology, Institute of Biomedical Science, University of São Paulo, São Paulo, SP, Brazil
| | - Erica S Martins-Duarte
- Institute of Biophysics Carlos Chagas Filho and National Center for Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro, RJ, Brazil.,Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Nathalia Almeida Dos Santos
- Laboratory of Disease Modeling, Department of Microbiology, Institute of Biomedical Science, University of São Paulo, São Paulo, SP, Brazil.,Centre for Stem Cells and Regenerative Medicine, King's College London, Guy's Hospital, London, UK
| | - Marcia Attias
- Institute of Biophysics Carlos Chagas Filho and National Center for Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro, RJ, Brazil
| | - Francisco J Barrantes
- Laboratory of Molecular Neurobiology, Institute for Biomedical Research (BIOMED), UCA-CONICET, Buenos Aires, Argentina
| | - Patricia Cristina Baleeiro Beltrão-Braga
- Laboratory of Disease Modeling, Department of Microbiology, Institute of Biomedical Science, University of São Paulo, São Paulo, SP, Brazil.,Scientific Platform Pasteur-USP, São Paulo, SP, Brazil
| | - Wanderley de Souza
- Institute of Biophysics Carlos Chagas Filho and National Center for Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro, RJ, Brazil
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de Haan L, Sutterland AL, Schotborgh JV, Schirmbeck F, de Haan L. Association of Toxoplasma gondii Seropositivity With Cognitive Function in Healthy People: A Systematic Review and Meta-analysis. JAMA Psychiatry 2021; 78:1103-1112. [PMID: 34259822 PMCID: PMC8281022 DOI: 10.1001/jamapsychiatry.2021.1590] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The parasite Toxoplasma gondii has been associated with behavioral alterations and psychiatric disorders. Studies investigating neurocognition in people with T gondii infection have reported varying results. To systematically analyze these findings, a meta-analysis evaluating cognitive function in healthy people with and without T gondii seropositivity is needed. OBJECTIVE To assess whether and to what extent T gondii seropositivity is associated with cognitive function in otherwise healthy people. DATA SOURCES A systematic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A systematic search of PubMed, MEDLINE, Web of Science, PsycInfo, and Embase was performed to identify studies from database inception to June 7, 2019, that analyzed cognitive function among healthy participants with available data on T gondii seropositivity. Search terms included toxoplasmosis, neurotoxoplasmosis, Toxoplasma gondii, cognition disorder, neuropsychological, and psychomotor performance. STUDY SELECTION Studies that performed cognitive assessment and analyzed T gondii seroprevalence among otherwise healthy participants were included. DATA EXTRACTION AND SYNTHESIS Two researchers independently extracted data from published articles; if needed, authors were contacted to provide additional data. Quantitative syntheses were performed in predefined cognitive domains when 4 independent data sets per domain were available. Study quality, heterogeneity, and publication bias were assessed. MAIN OUTCOMES AND MEASURES Performance on neuropsychological tests measuring cognitive function. RESULTS The systematic search yielded 1954 records. After removal of 533 duplicates, an additional 1363 records were excluded based on a review of titles and abstracts. A total of 58 full-text articles were assessed for eligibility (including reference list screening); 45 articles were excluded because they lacked important data or did not meet study inclusion or reference list criteria. The remaining 13 studies comprising 13 289 healthy participants (mean [SD] age, 46.7 [16.0] years; 6586 men [49.6%]) with and without T gondii seropositivity were included in the meta-analysis. Participants without T gondii seropositivity had favorable functioning in 4 cognitive domains: processing speed (standardized mean difference [SMD], 0.12; 95% CI, 0.05-0.19; P = .001), working memory (SMD, 0.16; 95% CI, 0.06-0.26; P = .002), short-term verbal memory (SMD, 0.18; 95% CI, 0.09-0.27; P < .001), and executive functioning (SMD, 0.15; 95% CI, 0.01-0.28; P = .03). A meta-regression analysis found a significant association between older age and executive functioning (Q = 6.17; P = .01). Little suggestion of publication bias was detected. CONCLUSIONS AND RELEVANCE The study's findings suggested that T gondii seropositivity was associated with mild cognitive impairment in several cognitive domains. Although effect sizes were small, given the ubiquitous prevalence of this infection globally, the association with cognitive impairment could imply a considerable adverse effect at the population level. Further research is warranted to investigate the underlying mechanisms of this association.
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Affiliation(s)
- Lies de Haan
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjen L. Sutterland
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jasper V. Schotborgh
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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9
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Yolken R, Prandovszky E, Severance EG, Hatfield G, Dickerson F. The oropharyngeal microbiome is altered in individuals with schizophrenia and mania. Schizophr Res 2021; 234:51-57. [PMID: 32334937 DOI: 10.1016/j.schres.2020.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 01/10/2023]
Abstract
It is being increasingly recognized that human mucosal surfaces are not sterile but are colonized with microorganisms collectively known as the microbiome. The microbiome can alter brain functioning in humans and animals by way of a series of interactions operative in the brain-immune-gut interactome. We characterized the oropharyngeal microbiome in 316 individuals, including 121 with schizophrenia, 62 with mania, 48 with major depressive disorder, and 85 controls without a psychiatric disorder. We found that the oropharyngeal microflora of individuals with schizophrenia and individuals with mania differed from controls in composition and abundance as measured by the weighted UniFrac distance (both p < .003 adjusted for covariates and multiple comparisons). This measure in individuals with major depressive disorder did not differ from that of controls. We also identified five bacterial taxa which differed among the diagnostic groups. Three of the taxa, Neisseria subflava, Weeksellaceae, and Prevotella, were decreased in individuals with schizophrenia or mania as compared to controls, while Streptococci was increased in these groups. One taxa, Schlegelella, was only found in individuals with mania. Neisseria subflava was also positively associated with cognitive functioning as measured by the Repeatable Battery for the Assessment of Neuropsychological Status. There were no taxa significantly altered in individuals with major depression. Individuals with schizophrenia and mania have altered compositions of the oropharyngeal microbiome. An understanding of the biology of the microbiome and its effect on the brain might lead to new insights into the pathogenesis, and ultimately, the prevention and treatment of these disorders.
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Affiliation(s)
- Robert Yolken
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, United States of America.
| | - Emese Prandovszky
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, United States of America
| | - Emily G Severance
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, United States of America
| | - Glen Hatfield
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, United States of America
| | - Faith Dickerson
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, United States of America
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10
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Hodge JM, Coghill AE, Kim Y, Bender N, Smith-Warner SA, Gapstur S, Teras LR, Grimsrud TK, Waterboer T, Egan KM. Toxoplasma gondii infection and the risk of adult glioma in two prospective studies. Int J Cancer 2021; 148:2449-2456. [PMID: 33427315 DOI: 10.1002/ijc.33443] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022]
Abstract
Toxoplasma gondii (T gondii) is a common parasite that shows affinity to neural tissue and may lead to the formation of cysts in the brain. Previous epidemiologic studies have suggested an association between glioma and increased prevalence of T gondii infection, but prospective studies are lacking. Therefore, we examined the association between prediagnostic T gondii antibodies and risk of glioma in two prospective cohorts using a nested case-control study design. Cases and matched controls were selected from the American Cancer Society's Cancer Prevention Study-II Nutrition Cohort (CPSII-NC) (n = 37 cases and 74 controls) and the Norwegian Cancer Registry's Janus Serum Bank (Janus) (n = 323 cases and 323 controls). Blood samples collected prior to diagnosis were analyzed for antibodies to two T gondii surface antigens (p22 and sag-1), with individuals considered seropositive if antibodies to either antigen were detected. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for each cohort. In both cohorts, a suggestive increase in glioma risk was observed among those infected with T gondii (OR: 2.70; 95% CI: 0.96-7.62 for CPSII-NC; OR: 1.32, 95% CI: 0.85-2.07 for Janus), particularly among participants with high antibody titers specific to the sag-1 antigen (CPSII-NC OR: 3.35, 95% CI: 0.99-11.38; Janus OR: 1.79, 95% CI: 1.02-3.14). Our findings provide the first prospective evidence of an association between T gondii infection and risk of glioma. Further studies with larger case numbers are needed to confirm a potential etiologic role for T gondii in glioma.
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Affiliation(s)
- James M Hodge
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Anna E Coghill
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Youngchul Kim
- Department of Biostatistics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Noemi Bender
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), Heidelberg, Germany
| | - Stephanie A Smith-Warner
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Susan Gapstur
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Lauren R Teras
- Department of Population Science, American Cancer Society, Atlanta, Georgia, USA
| | - Tom K Grimsrud
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), Heidelberg, Germany
| | - Kathleen M Egan
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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11
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Toxoplasmosis in a Cohort of Italian Patients With Bipolar and Psychotic Disorders: How Infection May Affect Clinical Features? J Nerv Ment Dis 2020; 208:118-126. [PMID: 31985560 DOI: 10.1097/nmd.0000000000001102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study investigated the seroprevalence of Toxoplasma gondii in a cohort of 101 Italian inpatients affected by mood or schizophrenia-spectrum disorders and compared clinical features between seronegative and seropositive subjects. Patients diagnosed according to DSM-5 criteria underwent clinical assessments and blood collection to test parasite-specific IgG/IgM serum levels. Twenty-eight patients (27.7%) had IgG anti-T. gondii, and none had IgM antibodies. We found higher prevalence rate in patients aged 40 years or older, as compared with younger. No significant association was detected between T. gondii and a specific diagnostic category; however, bipolar disorder (BD)-II showed the highest positivity rate (40.9%). The seropositive status was significantly associated with a lower presence of psychotic symptoms, higher number of total episodes of predominant excitatory polarity, longer illness duration, and lower severity of current episode, particularly anxiety, depressive, and withdrawal/retardation symptoms. These preliminary results seem to point out an association between chronic toxoplasmosis and a specific subtype of BD.
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12
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Barichello T, Giridharan VV, Bhatti G, Sayana P, Doifode T, Macedo D, Quevedo J. Inflammation as a Mechanism of Bipolar Disorder Neuroprogression. Curr Top Behav Neurosci 2020; 48:215-237. [PMID: 33040314 DOI: 10.1007/7854_2020_173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bipolar disorder (BD) is a severe, debilitating psychiatric condition with onset in adolescence or young adulthood and often follows a relapsing and remitting course throughout life. The concept of neuroprogression in BD refers to the progressive path with an identifiable trajectory that takes place with recurrent mood episodes, which eventually leads to cognitive, functional, and clinical deterioration in the course of BD. Understanding the biological basis of neuroprogression helps to explain the subset of BD patients who experience worsening of their disorder over time. Additionally, the study of the neurobiological mechanisms underpinning neuroprogression will help BD staging based on systems biology. Replicated epidemiological studies have suggested inflammatory mechanisms as primary contributors to the neuroprogression of mood disorders. It is known that dysregulated inflammatory/immune pathways are often associated with BD pathophysiology. Hence, in this chapter, we focus on the evidence for the involvement of inflammation and immune regulated pathways in the neurobiological consequences of BD neuroprogression. Herein we put forth the evidence of immune markers from autoimmune disorders, chronic infections, and gut-brain axis that lead to BD neuroprogression. Further, we highlighted the peripheral and central inflammatory components measured along with BD progression.
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Affiliation(s)
- Tatiana Barichello
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA. .,Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil. .,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
| | - Vijayasree Vayalanellore Giridharan
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Gursimrat Bhatti
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Pavani Sayana
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Tejaswini Doifode
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Danielle Macedo
- Neuropsychopharmacology Laboratory, Drug Research, and Development Center, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil.,National Institute for Translational Medicine (INCT-TM, CNPq), Ribeirao Preto, Brazil
| | - Joao Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Laboratory of Neurosciences, Graduate Program in Health Sciences, University of Southern Santa Catarina-UNESC, Criciúma, SC, Brazil.,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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13
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Yolken R, Stallings C, Origoni A, Katsafanas E, Sweeney K, Squire A, Dickerson F. Exposure to household pet cats and dogs in childhood and risk of subsequent diagnosis of schizophrenia or bipolar disorder. PLoS One 2019; 14:e0225320. [PMID: 31790431 PMCID: PMC6886852 DOI: 10.1371/journal.pone.0225320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/02/2019] [Indexed: 12/19/2022] Open
Abstract
Background Serious psychiatric disorders such as schizophrenia and bipolar disorder have been associated with environmental exposures in early life. Contact with household pets such as cats and dogs can serve as a source of environmental exposure during these time periods. Methods We investigated the relationship between exposure to a household pet cat or dog during the first 12 years of life and having a subsequent diagnosis of schizophrenia or bipolar disorder. These studies were performed in a cohort of 396 individuals with schizophrenia, 381 with bipolar disorder, and 594 controls. The hazards of developing schizophrenia or bipolar disorder associated with first exposure to a household pet cat or dog were calculated using Cox Proportional Hazard and multivariate logistic regression models including socio-demographic covariates. Results We found that exposure to a household pet dog was associated with a significantly decreased hazard of having a subsequent diagnosis of schizophrenia (Hazard Ratio .75, p < .002) Furthermore, a significant decreased relative risk of schizophrenia was detected following exposure at birth and during the first years of life. There was no significant relationship between household exposure to a pet dog and bipolar disorder. There were no significant associations between exposure to a household pet cat and subsequent risk of either a schizophrenia or bipolar disorder diagnosis. However, there were trends towards an increased risk of both disorders at defined periods of exposure. Conclusions Exposure to household pets during infancy and childhood may be associated with altered rates of development of psychiatric disorders in later life.
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Affiliation(s)
- Robert Yolken
- Stanley Division of Developmental Neurovirology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Cassie Stallings
- Sheppard Pratt Health System, Baltimore, Maryland, United States of America
| | - Andrea Origoni
- Sheppard Pratt Health System, Baltimore, Maryland, United States of America
| | - Emily Katsafanas
- Sheppard Pratt Health System, Baltimore, Maryland, United States of America
| | - Kevin Sweeney
- Sheppard Pratt Health System, Baltimore, Maryland, United States of America
| | - Amalia Squire
- Sheppard Pratt Health System, Baltimore, Maryland, United States of America
| | - Faith Dickerson
- Sheppard Pratt Health System, Baltimore, Maryland, United States of America
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14
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Snijders GJLJ, van Mierlo HC, Boks MP, Begemann MJH, Sutterland AL, Litjens M, Ophoff RA, Kahn RS, de Witte LD. The association between antibodies to neurotropic pathogens and bipolar disorder : A study in the Dutch Bipolar (DB) Cohort and meta-analysis. Transl Psychiatry 2019; 9:311. [PMID: 31748521 PMCID: PMC6868237 DOI: 10.1038/s41398-019-0636-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 05/08/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022] Open
Abstract
Exposure to neurotropic pathogens has been hypothesized to be a risk factor for the development of bipolar disorder (BD). However, evidence so far is inconsistent. We, therefore, analyzed the seroprevalence and titer levels of IgG antibodies against several herpesviruses and Toxoplasma gondii (T. gondii) in plasma of 760 patients with a bipolar disorder, 144 first-degree matched relatives and 132 controls of the Dutch Bipolar (DB) Cohort using ELISA. In addition, we performed a literature-based meta-analysis on the seroprevalence of IgG antibodies against these pathogens (n = 14). Our results in the DB Cohort and subsequent meta-analysis (n = 2364 BD patients, n = 5101 controls) show no association between exposure to herpesviruses and bipolar disorder (HSV-1 [adjusted OR 0.842, 95% CI 0.567-1.230], HSV-2 [adjusted OR 0.877, 95% CI 0.437-1.761], CMV [adjusted OR 0.884 95% CI 0.603-1.295], EBV [adjusted OR 0.968 95% CI 0.658-1.423]). In the DB Cohort, we did not find an association between bipolar disorder and T. gondii titer or seroprevalence either [adjusted OR 1.018, 95% CI 0.672-1.542]. The overall OR was not significant for T. gondii [OR: 1.4, 95% CI 0.95-1.90, p = 0.09), but subgroup analyses in age groups below 40 years showed a significantly increased seroprevalence of T. gondii IgGs in BD [OR: 1.8 (95% CI 1.10-2.89, p = 0.021]. Our meta-analysis indicates that T. gondii exposure may be a risk factor for BD in certain subpopulations.
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Affiliation(s)
- Gijsje J L J Snijders
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Hans C van Mierlo
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco P Boks
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J H Begemann
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arjen L Sutterland
- Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Manja Litjens
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel A Ophoff
- Center for Neurobehavioral Genetics, University of California Los Angeles, Los Angeles, CA, USA
| | - René S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lot D de Witte
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Sutterland AL, Kuin A, Kuiper B, van Gool T, Leboyer M, Fond G, de Haan L. Driving us mad: the association of Toxoplasma gondii with suicide attempts and traffic accidents - a systematic review and meta-analysis. Psychol Med 2019; 49:1608-1623. [PMID: 31010440 DOI: 10.1017/s0033291719000813] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Unnatural causes of death due to traffic accidents (TA) and suicide attempts (SA) constitute a major burden on global health, which remained stable in the last decade despite widespread efforts of prevention. Recently, latent infection with Toxoplasma gondii (T. gondii) has been suggested to be a biological risk factor for both TA and SA. Therefore, a systematic search concerning the relationship of T. gondii infection with TA and/or SA according to PRISMA guidelines in Medline, Pubmed and PsychInfo was conducted collecting papers up to 11 February 2019 (PROSPERO #CRD42018090206). The random-effect model was applied and sensitivity analyses were subsequently performed. Lastly, the population attributable fraction (PAF) was calculated. We found a significant association for antibodies against T. gondii with TA [odds ratio (OR) = 1.69; 95% confidence interval (CI) 1.20-2.38, p = 0.003] and SA (OR = 1.39; 95% CI 1.10-1.76, p = 0006). Indication of publication bias was found for TA, but statistical adjustment for this bias did not change the OR. Heterogeneity between studies on SA was partly explained by type of control population used (ORhealthy controls = 1.9, p < 0.001 v. ORpsychiatric controls = 1.06, p = 0.87) and whether subjects with schizophrenia only were analysed (ORschizophrenia = 0.87, p = 0.62 v. ORvarious = 1.8, p < 0.001). The association was significantly stronger with higher antibody titres in TA and in studies that did not focus on schizophrenia subjects concerning SA. PAF of a T. gondii infection was 17% for TA and 10% for SA. This indicates that preventing T. gondii infection may play a role in the prevention of TA or SA, although uncertainty remains whether infection and outcome are truly causally related.
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Affiliation(s)
- Arjen L Sutterland
- Department of Psychiatry,Amsterdam UMC, University of Amsterdam,Meibergdreef 5 1105 AZ, Amsterdam,The Netherlands
| | - Anne Kuin
- Department of Psychiatry,Amsterdam UMC, University of Amsterdam,Meibergdreef 5 1105 AZ, Amsterdam,The Netherlands
| | - Bouke Kuiper
- Department of Psychiatry,Amsterdam UMC, University of Amsterdam,Meibergdreef 5 1105 AZ, Amsterdam,The Netherlands
| | - Tom van Gool
- Department of Parasitology,Amsterdam UMC, University of Amsterdam,Meibergdreef 9 1105 AZ, Amsterdam,The Netherlands
| | | | | | - Lieuwe de Haan
- Department of Psychiatry,Amsterdam UMC, University of Amsterdam,Meibergdreef 5 1105 AZ, Amsterdam,The Netherlands
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16
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Burgdorf KS, Trabjerg BB, Pedersen MG, Nissen J, Banasik K, Pedersen OB, Sørensen E, Nielsen KR, Larsen MH, Erikstrup C, Bruun-Rasmussen P, Westergaard D, Thørner LW, Hjalgrim H, Paarup HM, Brunak S, Pedersen CB, Torrey EF, Werge T, Mortensen PB, Yolken RH, Ullum H. Large-scale study of Toxoplasma and Cytomegalovirus shows an association between infection and serious psychiatric disorders. Brain Behav Immun 2019; 79:152-158. [PMID: 30685531 DOI: 10.1016/j.bbi.2019.01.026] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/11/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Common infectious pathogens have been associated with psychiatric disorders, self-violence and risk-taking behavior. METHODS This case-control study reviews register data on 81,912 individuals from the Danish Blood Donor Study to identify individuals who have a psychiatric diagnosis (N = 2591), have attempted or committed suicide (N = 655), or have had traffic accidents (N = 2724). For all cases, controls were frequency matched by age and sex, resulting in 11,546 participants. Plasma samples were analyzed for immunoglobulin G (IgG) antibodies against Toxoplasma gondii and cytomegalovirus (CMV). RESULTS T. gondii was detected in 25·9% of the population and was associated with schizophrenia (odds ratio [OR], 1·47; 95% confidence interval [CI], 1·03-2·09). Accounting for temporality, with pathogen exposure preceding outcome, the association was even stronger (IRR, 2·78; 95% CI, 1·27-6·09). A very weak association between traffic accident and toxoplasmosis (OR, 1·11; 95% CI, 1·00-1·23, p = 0.054) was found. CMV was detected in 60·8% of the studied population and was associated with any psychiatric disorder (OR, 1·17; 95% CI, 1·06-1·29), but also with a smaller group of neurotic, stress-related, and somatoform disorders (OR, 1·27; 95% CI, 1·12-1·44), and with attempting or committing suicide (OR, 1·31; 95% CI, 1·10-1·56). Accounting for temporality, any psychiatric disorder (IRR, 1·37; 95% CI, 1·08-1·74) and mood disorders (IRR, 1·43; 95% CI, 1·01-2·04) were associated with exposure to CMV. No association between traffic accident and CMV (OR, 1·06; 95% CI, 0·97-1·17) was found. CONCLUSIONS This large-scale serological study is the first study to examine temporality of pathogen exposure and to provide evidence of a causal relationship between T. gondii and schizophrenia, and between CMV and any psychiatric disorder.
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Affiliation(s)
| | - Betina B Trabjerg
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - Marianne Giørtz 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
| | - Janna Nissen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, 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
| | - Margit Hørup Larsen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, 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
| | - Lise Wegner Thørner
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark,; Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, 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
| | - 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 H Yolken
- Stanley Division of Developmental Neurovirology, Stanley Neurovirology Laboratory, Johns Hopkins University, USA
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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17
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Wang AW, Avramopoulos D, Lori A, Mulle J, Conneely K, Powers A, Duncan E, Almli L, Massa N, McGrath J, Schwartz AC, Goes FS, Weng L, Wang R, Yolken R, Ruczinski I, Gillespie CF, Jovanovic T, Ressler K, Pulver AE, Pearce BD. Genome-wide association study in two populations to determine genetic variants associated with Toxoplasma gondii infection and relationship to schizophrenia risk. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:133-147. [PMID: 30610941 DOI: 10.1016/j.pnpbp.2018.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/20/2018] [Accepted: 12/30/2018] [Indexed: 01/10/2023]
Abstract
T. gondii (TOXO) infects over one billion people worldwide, yet the literature lacks a Genome Wide Association Study (GWAS) focused on genetic variants controlling the persistence of TOXO infection. To identify putative T. gondii susceptibility genes, we performed a GWAS using IgG seropositivity as the outcome variable in a discovery sample (n = 790) from an Ashkenazi dataset, and a second sample of predominately African Americans (The Grady Trauma Project, n = 285). We also performed a meta-analyses of the 2 cohorts. None of the SNPs in these analyses was statistically significant after Bonferroni correction for multiple comparisons. In the Ashkenazi population, the gene region of CHIA (chitinase) showed the most nominally significant association with TOXO. Prior studies have shown that the production of chitinase by macrophages in the brain responding to TOXO infection is crucial for controlling the burden of T. gondii cysts. We found a surprising number of genes involved in neurodevelopment and psychiatric disorders among our top hits even though our outcome variable was TOXO infection. In the meta-analysis combining the Ashkenazi and Grady Trauma Project samples, there was enrichment for genes implicated in schizophrenia spectrum disorders (p < .05). Upon limiting our sample to those without mental illness, two schizophrenia related genes (CNTNAP2, GABAR2) still had significant TOXO-associated variants at the p < .05 level, but did not pass the genome wide significance threshold after correction for multiple comparisons. Using Ingenuity Systems molecular network analysis, we identified molecular nodes suggesting that while different genetic variants associated with TOXO in the two population samples, the molecular pathways for TOXO susceptibility nevertheless converged on common pathways. Molecular nodes in these common pathways included NOTCH1, CD44, and RXRA. Prior studies show that CD44 participates in TOXO-induced immunopathology and that RXRA is instrumental in regulating T-helper immune responses. These data provide new insights into the pathophysiology of this common neurotropic parasite.
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Affiliation(s)
- Alex W Wang
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - Dimitrios Avramopoulos
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Adriana Lori
- Department of Human Genetics, Emory University, Atlanta, GA, United States
| | - Jennifer Mulle
- Department of Human Genetics, Emory University, Atlanta, GA, United States
| | - Karen Conneely
- Department of Human Genetics, Emory University, Atlanta, GA, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Erica Duncan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States; Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, United States
| | - Lynn Almli
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Nicholas Massa
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, United States; Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, United States
| | - John McGrath
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ann C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Fernando S Goes
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lei Weng
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - Ruihua Wang
- McKusick Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Robert Yolken
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ingo Ruczinski
- Bloomberg School of Public Heath, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Charles F Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Kerry Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States; Department of Psychiatry, Harvard School of Medicine, 25 Shattuck St, Boston, MA 02115, United States
| | - Ann E Pulver
- Bloomberg School of Public Heath, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brad D Pearce
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, United States.
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18
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Chen X, Chen B, Hou X, Zheng C, Yang X, Ke J, Hu X, Tan F. Association between Toxoplasma gondii infection and psychiatric disorders in Zhejiang, Southeastern China. Acta Trop 2019; 192:82-86. [PMID: 30731066 DOI: 10.1016/j.actatropica.2019.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 12/13/2022]
Abstract
Increased rates of exposure to Toxoplasma gondii have been found in patients with psychiatric disorders globally, but there is scarce information about the epidemiology of T. gondii infection in psychiatric patients in Zhejiang Province, Southeastern China. In a case-control survey, we measured IgG and IgM class antibodies against T. gondii in 798 patients from a public psychiatric hospital in the city of Wenzhou, Zhejiang Province, and in 681 non-psychiatric controls from the general population in the same region. Subjects in each group were matched by sex and age with an enzyme-linked immunoassay. Seroprevalence of anti-Toxoplasma IgG antibodies in psychiatric patients (13.3%, 106/798) was significantly higher than in the control population (9.4%, 64/681) (P = 0.022). Anti-Toxoplasma IgM antibodies were also significantly higher in the psychiatric patients (4.1%, 33/798) than in the control group (1.9%, 13/681) (P = 0.016). Additionally, we found significantly elevated seropositive rates of anti-Toxoplasma IgG and IgM in patients with schizophrenia, as well as those with bipolar disorder. The identification of specific anti-Toxoplasma antibodies in psychiatric patients may be useful for assessing infection and timely initiation of treatment.
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Affiliation(s)
- Xiaojian Chen
- Department of Clinical laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bi Chen
- Department of Clinical laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiangqing Hou
- Department of Preventive Medicine, School of Public Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Cunqing Zheng
- Department of Clinical laboratory, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, China
| | - Xunjun Yang
- Department of Clinical laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiangqiong Ke
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xin Hu
- School of Medical laboratory science and school of life science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Feng Tan
- Department of Parasitology, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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19
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Lack of circulating toxoplasma gondii DNA in seropositive patients with bipolar or schizophrenia spectrum disorders. Psychiatry Res 2019; 273:706-711. [PMID: 31207856 DOI: 10.1016/j.psychres.2019.01.104] [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: 05/23/2018] [Revised: 01/21/2019] [Accepted: 01/30/2019] [Indexed: 12/12/2022]
Abstract
Toxoplasmosis has been previously associated with an increased risk of having Schizophrenia or Bipolar disorder in several epidemiological studies. The aim of this observational, cross-sectional study was to examine the seroprevalence of Toxoplasma infection in a cohort of Italian psychiatric inpatients and to verify the presence of circulating Toxoplasma gondii DNA in the seropositive subjects. Sixty-three patients affected by bipolar or schizoaffective disorders according to DSM-5 criteria were enrolled. The presence of Toxoplasma infection was firstly examined using an indirect serological method (ELFA), and three different direct PCR-based methods were performed to detect circulating DNA in the seropositive patients. The seroprevalence of infection was 28.6%, with a significant association between higher age and the infection status. PCR, nested-PCR and Real-Time PCR revealed no positive samples for Toxoplasma gondii. This result is in contrast with recent data from case-control studies that detected parasite genome in patients with different neuropsychiatric diagnosis without clinical evidence of acute toxoplasmosis. Our findings are to be interpreted with caution, because of the small sample size, the heterogeneity of enrolled patients and the observational nature of the study. Further studies are needed to better define the clinical features correlated to the seropositive status in neuropsychiatric patients.
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20
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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.
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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
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21
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Wang T, Sun X, Qin W, Zhang X, Wu L, Li Y, Zhou C, Zhou H, He S, Cong H. From inflammatory reactions to neurotransmitter changes: Implications for understanding the neurobehavioral changes in mice chronically infected with Toxoplasma gondii. Behav Brain Res 2018; 359:737-748. [PMID: 30253194 DOI: 10.1016/j.bbr.2018.09.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/01/2018] [Accepted: 09/17/2018] [Indexed: 11/18/2022]
Abstract
Toxoplasma gondii is a protozoan parasite that can cause a latent infection in the central nervous system, leading to neurobehavioral abnormalities in the host. However, the mechanism underlying these changes remains relatively unexplored. In this study, we detected behavioral changes, pathological injury, secretion of neurotransmitters and related signal pathway in mice infected by T. gondii using behavioral test, histopathology, immunofluorescence staining, western blotting, HPLC and real time PCR. Mice showed neurobehavioral disturbances two months after infection with T. gondii. Histopathology revealed the activation of astrocytes and microglia, apoptosis of neurons and decreases in synapses in the brain of infected mice. Excessive secretion of cytokines and chemokines was detected in the brains of mice infected by T. gondii compared to uninfected mice. Furthermore, T. gondii infection led to abnormalities in neurotransmitters and the activation of NF-κB and dopamine (DA) signaling pathways in the infected mice. In conclusion, excessive activation of the inflammation in the brain could induce neuronal apoptosis in mice chronically infected with T. gondii. Dysregulation of the dopaminergic neurotransmitter could provide an explanation of neurobehavioral disorders in infected hosts.
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Affiliation(s)
- Ting Wang
- Department of Human Parasitology, Shandong University, School of Medicine, Jinan, Shandong, PR China
| | - Xiahui Sun
- Department of Human Parasitology, Shandong University, School of Medicine, Jinan, Shandong, PR China
| | - Wen Qin
- University hospital, Shandong University, Jinan, Shandong, PR China
| | - Xiaoli Zhang
- Department of Histology and Embryology, Shandong University, School of Medicine, Jinan, Shandong, PR China
| | - Leilei Wu
- Department of Human Parasitology, Shandong University, School of Medicine, Jinan, Shandong, PR China
| | - Yan Li
- Department of Human Parasitology, Shandong University, School of Medicine, Jinan, Shandong, PR China
| | - Chunxue Zhou
- Department of Human Parasitology, Shandong University, School of Medicine, Jinan, Shandong, PR China
| | - Huaiyu Zhou
- Department of Human Parasitology, Shandong University, School of Medicine, Jinan, Shandong, PR China
| | - Shenyi He
- Department of Human Parasitology, Shandong University, School of Medicine, Jinan, Shandong, PR China
| | - Hua Cong
- Department of Human Parasitology, Shandong University, School of Medicine, Jinan, Shandong, PR China.
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22
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Flegr J, Šebánková B, Příplatová L, Chvátalová V, Kaňková Š. Lower performance of Toxoplasma-infected, Rh-negative subjects in the weight holding and hand-grip tests. PLoS One 2018; 13:e0200346. [PMID: 30001377 PMCID: PMC6042735 DOI: 10.1371/journal.pone.0200346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Toxoplasma, a protozoan parasite of cats, infects many species of intermediate and paratenic hosts, including about one-third of humans worldwide. After a short phase of acute infection, the tissue cysts containing slowly dividing bradyzoites are formed in various organs and toxoplasmosis proceeds spontaneously in its latent form. In immunocompetent subjects, latent toxoplasmosis was considered asymptomatic. However, dozens of studies performed on animals and humans in the past twenty years have shown that it is accompanied by a broad spectrum of specific behavioural, physiological and even morphological changes. In human hosts, the changes often go in the opposite direction in men and women, and are mostly weaker or non-existent in Rh-positive subjects. METHODS Here, we searched for the indices of lower endurance of the infected subjects by examining the performance of nearly five hundred university students tested for toxoplasmosis and Rh phenotype in two tests, a weight holding test and a grip test. RESULTS The results confirmed the existence of a negative association of latent toxoplasmosis with the performance of students, especially Rh-negative men, in these tests. Surprisingly, but in an accordance with some already published data, Toxoplasma-infected, Rh-positive subjects expressed a higher, rather than lower, performance in our endurance tests. DISCUSSION Therefore, the results only partly support the hypothesis for the lower endurance of Toxoplasma infected subjects as the performance of Rh-positive subjects (representing majority of population) correlated positively with the Toxoplasma infection.
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Affiliation(s)
- Jaroslav Flegr
- Division of Biology, Faculty of Science, Charles University, Prague, Viničná, Czech Republic
| | - Blanka Šebánková
- Division of Biology, Faculty of Science, Charles University, Prague, Viničná, Czech Republic
| | - Lenka Příplatová
- Division of Biology, Faculty of Science, Charles University, Prague, Viničná, Czech Republic
| | - Veronika Chvátalová
- Division of Biology, Faculty of Science, Charles University, Prague, Viničná, Czech Republic
| | - Šárka Kaňková
- Division of Biology, Faculty of Science, Charles University, Prague, Viničná, Czech Republic
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23
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Abstract
PURPOSE OF REVIEW Bipolar disorder (BD) medical comorbidity presents significant clinical and public health concerns with serious impact on health. The aim of this article is to present an updated narrative review of original research articles (case control, longitudinal cohort, and cross-sectional studies) and meta-analyses published in English language journals from January 2013 to May 2017 focusing on general medical comorbidity in BD, including the added risks of iatrogenic factors relevant to the treatment of BD. RECENT FINDINGS We found numerous patterns of association between BD and various medical disorders involving multiple organ systems. One pattern indicated reciprocal increase in the rate of each comorbid condition, such as an increased rate of BD in asthma or migraine, and likewise an increase in the rate of asthma or migraine in patients with BD. A second pattern was a predominantly unidirectional increase in the rate of BD in patients with certain medical disorders, such as multiple sclerosis or cerebellar diseases. A third pattern was a predominantly unidirectional increased rate of medical disorders in patients with BD. One study suggested the potential involvement of genetic mechanisms for the association between BD and migraine. Most of the studies had cross-sectional or retrospective designs, and many relied on analysis of large administrative databases inviting multiple potential biases. Our review highlights the association between BD and a variety of medical disorders. Further research is needed to elucidate the potential underlying etiopathological mechanisms that contribute to observed comorbidities. The results of this review also emphasize the need for comprehensive screening for medical disorders in BD and for adoption of an integrated model of care to address these complex comorbidities.
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Affiliation(s)
- Aktriti Sinha
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Anam Shariq
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Khaled Said
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Abhinav Sharma
- Homewood Health Center, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - D Jeffrey Newport
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Ihsan M Salloum
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
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24
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Dickerson F, Origoni A, Schroeder J, Adamos M, Katsafanas E, Khushalani S, Savage CLG, Schweinfurth LAB, Stallings C, Sweeney K, Yolken R. Natural cause mortality in persons with serious mental illness. Acta Psychiatr Scand 2018; 137:371-379. [PMID: 29603145 DOI: 10.1111/acps.12880] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify the determinants of natural cause mortality in a cohort of individuals with serious mental illness assessed prospectively. METHOD Persons with schizophrenia (n = 789) and bipolar disorder (n = 498), mean age of 38 (s.d. 12.6) years, underwent an in-person clinical assessment. They also had a blood sample drawn from which infectious disease markers were measured. Mortality was subsequently determined utilizing data from the National Death Index following a period of up to 16.9 years. RESULTS A total of 6.8% (87 of 1287) of persons died of natural causes. Mortality was predicted in a multivariate model by baseline cigarette smoking (RR = 6.29, 95% CI 1.41, 3.72, P = 0.00076); divorced or widowed status (RR = 1.90, CI 1.21, 2.99); reduced cognitive score (RR = 0.73, CI 0.61, 0.87); receipt of antidepressant medication (RR = 1.74, CI 1.12, 2.71); elevated levels of antibodies to Epstein-Barr virus (EBV) (RR = 1.29, CI 1.01, 1.66); and a genitourinary (RR = 1.82, CI 1.16, 2.86), respiratory (RR = 1.82, CI 1.16, 2.86), or cardiac (RR = 2.09, CI 1.33, 3.29) condition. There was an additive effect of smoking and both a cardiac and a respiratory condition but not elevated EBV antibody levels. CONCLUSION Smoking is a modifiable behaviour which is associated with mortality in this population.
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Affiliation(s)
- F Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - A Origoni
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - J Schroeder
- Schroeder Statistical Consulting, Ellicott City, MD, USA
| | - M Adamos
- Congruent Counseling Services, Columbia, MD, USA
| | - E Katsafanas
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - S Khushalani
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - C L G Savage
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - L A B Schweinfurth
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - C Stallings
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - K Sweeney
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - R Yolken
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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25
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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: 71] [Impact Index Per Article: 10.1] [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.
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26
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Use of Human Neurons Derived via Cellular Reprogramming Methods to Study Host-Parasite Interactions of Toxoplasma gondii in Neurons. Cells 2017; 6:cells6040032. [PMID: 28946615 PMCID: PMC5755492 DOI: 10.3390/cells6040032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 12/31/2022] Open
Abstract
Toxoplasma gondii is an intracellular protozoan parasite, with approximately one-third of the worlds' population chronically infected. In chronically infected individuals, the parasite resides in tissue cysts in neurons in the brain. The chronic infection in immunocompetant individuals has traditionally been considered to be asymptomatic, but increasing evidence indicates that chronic infection is associated with diverse neurological disorders such as schizophrenia, cryptogenic epilepsy, and Parkinson's Disease. The mechanisms by which the parasite exerts affects on behavior and other neuronal functions are not understood. Human neurons derived from cellular reprogramming methods offer the opportunity to develop better human neuronal models to study T. gondii in neurons. Results from two studies using human neurons derived via cellular reprogramming methods indicate these human neuronal models provide better in vitro models to study the effects of T. gondii on neurons and neurological functions. In this review, an overview of the current neural reprogramming methods will be given, followed by a summary of the studies using human induced pluripotent stem cell (hiPSC)-derived neurons and induced neurons (iNs) to study T. gondii in neurons. The potential of these neural reprogramming methods for further study of the host-parasite interactions of T. gondii in neurons will be discussed.
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27
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Dickerson F, Adamos M, Katsafanas E, Khushalani S, Origoni A, Savage C, Schweinfurth L, Stallings C, Sweeney K, Alaedini A, Uhde M, Severance E, Wilcox HC, Yolken R. The association between immune markers and recent suicide attempts in patients with serious mental illness: A pilot study. Psychiatry Res 2017; 255:8-12. [PMID: 28505469 DOI: 10.1016/j.psychres.2017.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/25/2017] [Accepted: 05/04/2017] [Indexed: 11/28/2022]
Abstract
Previous studies have identified elevations in markers of gastrointestinal inflammation in schizophrenia and mood disorders but studies have not measured the association between these markers and recent suicide attempts. We assessed 210 patients receiving treatment for schizophrenia, bipolar disorder, or major depression. We employed the Columbia Suicide Severity Rating Scale to identify recent and lifetime suicide attempts (actual, aborted, and interrupted). Psychiatric participants and a control group of 72 individuals without a psychiatric disorder had a blood sample drawn from which were measured specific markers of gastrointestinal inflammation and also C-Reactive protein (CRP). A total of 20 (10%) of psychiatric participants had a suicide attempt in the previous one month and 95 (45%) an attempt during their lifetime but not in the previous one month. The recent attempters had significantly elevated levels of antibodies to yeast mannan from Saccharomyces cerevisiae (ASCA), the food antigen gliadin, and bacterial lipopolysaccharide (LPS) compared with the non-psychiatric group when adjusting for demographic and clinical variables. These markers were not elevated in individuals with a past, but not recent, suicide attempt history. Our study indicates that there is evidence of gastrointestinal inflammation in some individuals who have had a recent suicide attempt.
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Affiliation(s)
- Faith Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
| | - Maria Adamos
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Emily Katsafanas
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Sunil Khushalani
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Andrea Origoni
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Christina Savage
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Lucy Schweinfurth
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Cassie Stallings
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Kevin Sweeney
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Armin Alaedini
- Department of Medicine, Columbia University, New York, NY, USA
| | - Melanie Uhde
- Department of Medicine, Columbia University, New York, NY, USA
| | - Emily Severance
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert Yolken
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, Baltimore, MD, USA
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28
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Kannan G, Gressitt KL, Yang S, Stallings CR, Katsafanas E, Schweinfurth LA, Savage CLG, Adamos MB, Sweeney KM, Origoni AE, Khushalani S, Bahn S, Leweke FM, Dickerson FB, Yolken RH, Pletnikov MV, Severance EG. Pathogen-mediated NMDA receptor autoimmunity and cellular barrier dysfunction in schizophrenia. Transl Psychiatry 2017; 7:e1186. [PMID: 28763062 PMCID: PMC5611729 DOI: 10.1038/tp.2017.162] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 12/15/2022] Open
Abstract
Autoantibodies that bind the N-methyl-D-aspartate receptor (NMDAR) may underlie glutamate receptor hypofunction and related cognitive impairment found in schizophrenia. Exposure to neurotropic pathogens can foster an autoimmune-prone environment and drive systemic inflammation leading to endothelial barrier defects. In mouse model cohorts, we demonstrate that infection with the protozoan parasite, Toxoplasma gondii, caused sustained elevations of IgG class antibodies to the NMDAR in conjunction with compromised blood-gut and blood-brain barriers. In human cohorts, NMDAR IgG and markers of barrier permeability were significantly associated with T. gondii exposure in schizophrenia compared with controls and independently of antipsychotic medication. Combined T. gondii and NMDAR antibody seropositivity in schizophrenia resulted in higher degrees of cognitive impairment as measured by tests of delayed memory. These data underscore the necessity of disentangling the heterogeneous pathophysiology of schizophrenia so that relevant subsets eligible for NMDAR-related treatment can be identified. Our data aid to reconcile conflicting reports regarding a role of pathological NMDAR autoantibodies in this disorder.
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Affiliation(s)
- G Kannan
- Department of Psychiatry, Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K L Gressitt
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Yang
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C R Stallings
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - E Katsafanas
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - L A Schweinfurth
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - C L G Savage
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - M B Adamos
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - K M Sweeney
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - A E Origoni
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - S Khushalani
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - S Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - F M Leweke
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - F B Dickerson
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - R H Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M V Pletnikov
- Department of Psychiatry, Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Molecular Immunology and Microbiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E G Severance
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Neurophysiological Changes Induced by Chronic Toxoplasma gondii Infection. Pathogens 2017; 6:pathogens6020019. [PMID: 28513566 PMCID: PMC5488653 DOI: 10.3390/pathogens6020019] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/08/2017] [Accepted: 05/12/2017] [Indexed: 01/13/2023] Open
Abstract
Although the parasite Toxoplasma gondii is one of the most pervasive neurotropic pathogens in the world, the host-parasite interactions during CNS infection and the consequences of neurological infection are just beginning to be unraveled. The chronic stages of infection have been considered dormant, although several studies have found correlations of infection with an array of host behavioral changes. These may facilitate parasite transmission and impact neurological diseases. During infection, in addition to the presence of the parasites within neurons, host-mediated neuroimmune and hormonal responses to infection are also present. T. gondii induces numerous changes to host neurons during infection and globally alters host neurological signaling pathways, as discussed in this review. Understanding the neurophysiological changes in the host brain is imperative to understanding the parasitic mechanisms and to delineate the effects of this single-celled parasite on health and its contribution to neurological disease.
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Dickerson F, Wilcox HC, Adamos M, Katsafanas E, Khushalani S, Origoni A, Savage C, Schweinfurth L, Stallings C, Sweeney K, Yolken R. Suicide attempts and markers of immune response in individuals with serious mental illness. J Psychiatr Res 2017; 87:37-43. [PMID: 27988332 DOI: 10.1016/j.jpsychires.2016.11.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 12/11/2022]
Abstract
Previous studies have identified elevations in antibodies to Toxoplasma gondii in individuals with a history of suicide attempts but studies have not measured the association between suicide attempts and a panel of antibody markers. We assessed 162 patients receiving treatment for schizophrenia, bipolar disorder, or major depression on the Columbia Suicide Severity Rating Scale for suicide attempt history and other clinical measures. All participants had a blood sample drawn from which were measured antibodies to Toxoplasma gondii and other neurotropic infectious agents. A total of 72 (44%) of participants had a lifetime suicide attempt; these individuals had elevated levels of IgM class antibodies to Toxoplasma gondii and Cytomegalovirus (CMV). We also found an association between the levels of these antibodies and the number of suicide attempts. There was a particularly strong odds of a suicide attempt history in individuals who had elevated levels of IgM antibodies to both Toxoplasma gondii and to CMV suggesting an additive risk associated with the antibodies. These findings remained significant when adjusting for current cigarette smoking and history of drug/alcohol use which were also associated with suicide attempts. We did not find an association between a suicide attempt history and IgG class antibodies to Toxoplasma gondii, CMV, or IgM or IgG antibodies to the Epstein Barr Virus or other antigens tested. The identification of blood-based antibody markers should provide for more personalized methods for the assessment and treatment, and ultimately prevention, of suicide attempts in individuals with serious mental illnesses.
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Affiliation(s)
- Faith Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA.
| | - Holly C Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Maria Adamos
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Emily Katsafanas
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Sunil Khushalani
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Andrea Origoni
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Christina Savage
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Lucy Schweinfurth
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Cassie Stallings
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Kevin Sweeney
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Robert Yolken
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, Baltimore, MD, USA
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31
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Massa NM, Duncan E, Jovanovic T, Kerley K, Weng L, Gensler L, Lee SS, Norrholm S, Powers A, Almli LM, Gillespie CF, Ressler K, Pearce BD. Relationship between Toxoplasma gondii seropositivity and acoustic startle response in an inner-city population. Brain Behav Immun 2017; 61:176-183. [PMID: 27884623 PMCID: PMC5316358 DOI: 10.1016/j.bbi.2016.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/10/2016] [Accepted: 11/20/2016] [Indexed: 01/09/2023] Open
Abstract
Toxoplasma gondii (TOXO) is a neuroinvasive protozoan parasite that induces the formation of persistent cysts in mammalian brains. It infects approximately 1.1million people in the United States annually. Latent TOXO infection is implicated in the etiology of psychiatric disorders, especially schizophrenia (SCZ), and has been correlated with modestly impaired cognition. The acoustic startle response (ASR) is a reflex seen in all mammals. It is mediated by a simple subcortical circuit, and provides an indicator of neural function. We previously reported the association of TOXO with slowed acoustic startle latency, an index of neural processing speed, in a sample of schizophrenia and healthy control subjects. The alterations in neurobiology with TOXO latent infection may not be specific to schizophrenia. Therefore we examined TOXO in relation to acoustic startle in an urban, predominately African American, population with mixed psychiatric diagnoses, and healthy controls. Physiological and diagnostic data along with blood samples were collected from 364 outpatients treated at an inner-city hospital. TOXO status was determined with an ELISA assay for TOXO-specific IgG. A discrete titer was calculated based on standard cut-points as an indicator of seropositivity, and the TOXO-specific IgG concentration served as serointensity. A series of linear regression models were used to assess the association of TOXO seropositivity and serointensity with ASR magnitude and latency in models adjusting for demographics and psychiatric diagnoses (PTSD, major depression, schizophrenia, psychosis, substance abuse). ASR magnitude was 11.5% higher in TOXO seropositive subjects compared to seronegative individuals (p=0.01). This effect was more pronounced in models with TOXO serointensity that adjusted for sociodemographic covariates (F=7.41, p=0.0068; F=10.05, p=0.0017), and remained significant when psychiatric diagnoses were stepped into the models. TOXO showed no association with startle latency (t=0.49, p=0.63) in an unadjusted model, nor was TOXO associated with latency in models that included demographic factors. After stepping in individual psychiatric disorders, we found a significant association of latency with a diagnosis of PTSD (F=5.15, p=0.024), but no other psychiatric diagnoses, such that subjects with PTSD had longer startle latency. The mechanism by which TOXO infection is associated with high startle magnitude is not known, but possible mechanisms include TOXO cyst burden in the brain, parasite recrudescence, or molecular mimicry of a host epitope by TOXO. Future studies will focus on the neurobiology underlying the effects of latent TOXO infection as a potential inroad to the development of novel treatment targets for psychiatric disease.
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Affiliation(s)
- Nick M Massa
- Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - Erica Duncan
- Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, United States; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Kimberly Kerley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Lei Weng
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - Lauren Gensler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Samuel S Lee
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Seth Norrholm
- Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, United States; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Lynn M Almli
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Charles F Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Kerry Ressler
- Department of Psychiatry, Harvard School of Medicine, 25 Shattuck St, Boston, MA 02115, United States
| | - Bradley D Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States.
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Bipolar Disorder With Psychotic Features and Ocular Toxoplasmosis: A Possible Pathogenetic Role of the Parasite? J Nerv Ment Dis 2017; 205:192-195. [PMID: 27741079 DOI: 10.1097/nmd.0000000000000496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recent evidence suggests the involvement of Toxoplasma gondii infection in the emergence of psychotic and affective disorders. In this report, we describe the case of a young Brazilian woman affected by recurrent ocular toxoplasmosis and presenting with a manic episode with psychotic features in the context of a diagnosis of Bipolar Disorder (BD), type I. We observed a relationship between ocular manifestations and the clinical course of bipolar illness, confirmed by molecular analyses (nested-PCR), as well as by the high level of T. gondii specific IgG. This case report is the first showing the presence of circulating parasite DNA at the time of occurrence of psychiatric symptoms, thus providing further support for a possible role of the parasite in the pathogenesis of some cases of BD.
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de Barros JLVM, Barbosa IG, Salem H, Rocha NP, Kummer A, Okusaga OO, Soares JC, Teixeira AL. Is there any association between Toxoplasma gondii infection and bipolar disorder? A systematic review and meta-analysis. J Affect Disord 2017; 209:59-65. [PMID: 27889597 DOI: 10.1016/j.jad.2016.11.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/22/2016] [Accepted: 11/14/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND The relationship between Toxoplasma gondii infection and the development of bipolar disorder (BD) has long been investigated, yet to date it is still poorly understood and documented. The aim of this review is to derive a summary estimate of the strength of the association between infection with T. gondii and BD from the available published studies. METHODS A systematic review was performed using PubMed, LILACS, PsycINFO, and Embase databases. Studies which included a proportion of seropositive BD patients and controls were further examined in a meta-analysis. RESULTS One hundred eighteen citations were initially retrieved. Thirteen studies were included in our systematic review. Eight out of these thirteen studies were included in our meta-analysis. Statistical analyses showed that T. gondii infection is associated with with BD (OR=1.26). LIMITATIONS Small sample size was the major limitation among the studies that carried out serological analyses. In addition, the available studies did not have enough information on disease status/severity or type of bipolar disorder. Also, it was not possible to analyze pregnancy status or perinatal infection. Future studies addressing the aforementioned topics are clearly needed. CONCLUSIONS Despite heterogeneous results, patients with BD are more likely to be infected by T. gondii than controls. Early T. gondii infection might predispose the development of BD. T.gondii infection is becoming clinically relevant in psychiatric disorders and future mechanistic studies are required to elucidate the underlying pathophysiological mechanisms.
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Affiliation(s)
- João Luís Vieira Monteiro de Barros
- Biology Department, The College of Idaho, Caldwell, Idaho, USA; Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Izabela Guimarães Barbosa
- Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Haitham Salem
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Natalia Pessoa Rocha
- Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Arthur Kummer
- Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Olaoluwa O Okusaga
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Jair C Soares
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Antonio Lucio Teixeira
- Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA; Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA.
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Del Grande C, Galli L, Schiavi E, Dell'Osso L, Bruschi F. Is Toxoplasma gondii a Trigger of Bipolar Disorder? Pathogens 2017; 6:pathogens6010003. [PMID: 28075410 PMCID: PMC5371891 DOI: 10.3390/pathogens6010003] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/16/2016] [Accepted: 01/04/2017] [Indexed: 11/16/2022] Open
Abstract
Toxoplasma gondii, a ubiquitous intracellular parasite, has a strong tropism for the brain tissue, where it forms intracellular cysts within the neurons and glial cells, establishing a chronic infection. Although latent toxoplasmosis is generally assumed to be asymptomatic in immunocompetent individuals, it is now clear that it can induce behavioral manipulations in mice and infected humans. Moreover, a strong relation has emerged in recent years between toxoplasmosis and psychiatric disorders. The link between T. gondii and schizophrenia has been the most widely documented; however, a significant association with bipolar disorder (BD) and suicidal/aggressive behaviors has also been detected. T. gondii may play a role in the etiopathogenesis of psychiatric disorders affecting neurotransmitters, especially dopamine, that are implicated in the emergence of psychosis and behavioral Toxoplasma-induced abnormalities, and inducing brain inflammation by the direct stimulation of inflammatory cytokines in the central nervous system. Besides this, there is increasing evidence for a prominent role of immune dysregulation in psychosis and BD. The aim of this review is to describe recent evidence suggesting a link between Toxoplasma gondii and BD, focusing on the interaction between immune responses and this infectious agent in the etiopathogenesis of psychiatric symptoms.
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Affiliation(s)
- Claudia Del Grande
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56127 Pisa, Italy.
| | - Luca Galli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Elisa Schiavi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56127 Pisa, Italy.
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56127 Pisa, Italy.
| | - Fabrizio Bruschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
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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.
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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.
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Abstract
Human infections with foodborne pathogenic organisms are relatively well described in terms of their overt physical symptoms, such as diarrhea, abdominal cramps, vomiting, fever, and associated sequelae. Indeed, some of these are key for diagnosis and treatment, although it should be noted that, for some foodborne pathogens, the physical symptoms might be more diffuse, particularly those associated with some of the foodborne parasites. In contrast, the impact of these pathogens on mental health is less well described, and symptoms such as depression, anxiety, and general malaise are usually ignored when foodborne infections are recorded. Despite this, it is generally accepted that there are several psychiatric disorders of unknown etiology that may be associated with microbial pathogens. Depression, autism, hypochondriasis and anxiety, schizophrenia, and Tourette syndrome probably have multiple contributing causes, among which foodborne pathogens may play a decisive or contributory role, possibly sharing pathophysiological pathways with other environmental triggers. This review focuses on foodborne parasites and bacterial pathogens. Some foodborne parasites, such as metacestodes of Taenia solium and tissue cysts (bradyzoites) of Toxoplasma gondii , may affect mental health by directly infecting the brain. In contrast, bacterial infections and other parasitic infections may contribute to mental illness via the immune system and/or by influencing neurotransmission pathways. Thus, cytokines, for example, have been associated with depression and schizophrenia. However, infectious disease models for psychiatry require a more complete understanding of the relationship between psychiatric disorders and microbial triggers. This article reviews the current state of knowledge on the role of foodborne parasitic and bacterial pathogens in mental illness and identifies some of the gaps that should be addressed to improve diagnosis and treatment of mental health issues that are not solely related to psychiatric factors.
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Affiliation(s)
- Declan J Bolton
- Food Safety Department, Teagasc Food Research Centre, Ashtown, Dublin 15, Ireland
| | - Lucy J Robertson
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), 0454 Oslo, Norway
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Gao YM, Ding H, Lamberton PHL, Lu DB. Prevalence of Toxoplasma gondii in pet dogs in mainland China: A meta-analysis. Vet Parasitol 2016; 229:126-130. [PMID: 27809967 DOI: 10.1016/j.vetpar.2016.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 09/03/2016] [Accepted: 10/08/2016] [Indexed: 11/20/2022]
Abstract
Toxoplasmosis, caused by Toxoplasma gondii, is one of the most common zoonosis in the world, and can cause severe adverse consequences in pregnant women and immunosuppressed people. Throughout the world dogs are popular companion animals, however they are also important intermediate host of T. gondii and may play an instrumental role in mechanically transmitting Toxoplasma infection to humans. Therefore, an assessment of the level of T. gondii infection in pet dogs is of public health importance. To estimate the overall serological prevalence of toxoplasmosis in pet dogs in mainland China, we performed a meta-analysis using five bibliographic databases: CNKI, WanFang, VIP Chinese Journal Databases, PubMed and Google Scholar. A total of 60 articles, including data on 78719 pet dogs, published between 1998 and 2016 fulfilled the final eligibility criteria. The overall seroprevalence of T. gondii infection in pet dogs was 11.1% (95% CI: 10.1% to 12.1%). The seroprevalence of toxoplasmosis in >one-year-old dogs was 1.59 times more than that in ≤one-year-old group (RR=1.59, 95%CI=1.15, 2.21). There was no significant difference observed in pooled seroprevalence between male and female dogs (RR=1.02, 95%CI=0.91, 1.16). In terms of geographical regions, the lowest seroprevalence of toxoplasmosis infection (5.8%) was in North China and the highest (16.8%) was in Southwest of China. Results from this study showed that toxoplasmosis is common in pet dogs in mainland China, indicating that control measures by owners may reduce human exposure to T. gondii via dog contacts.
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Affiliation(s)
- Yu-Meng Gao
- Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou 215123, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, 215123, China.
| | - Huan Ding
- Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou 215123, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, 215123, China.
| | - Poppy H L Lamberton
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, GLQQ, United Kingdom; Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, United Kingdom.
| | - Da-Bing Lu
- Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou 215123, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, 215123, China.
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Dickerson F, Adamos MB, Katsafanas E, Khushalani S, Origoni A, Savage CLG, Schroeder J, Schweinfurth LAB, Stallings C, Sweeney K, Yolken R. The association among smoking, HSV-1 exposure, and cognitive functioning in schizophrenia, bipolar disorder, and non-psychiatric controls. Schizophr Res 2016; 176:566-571. [PMID: 27262384 DOI: 10.1016/j.schres.2016.05.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/22/2016] [Accepted: 05/25/2016] [Indexed: 12/21/2022]
Abstract
Previous investigations have found that smokers with schizophrenia demonstrate reduced performance on cognitive tasks compared to non-smokers. However previous studies have not taken into account other environmental factors associated with cognitive functioning such as exposure to Herpes Simplex Virus type 1 (HSV-1). We examined these factors in a sample consisting of individuals with schizophrenia (n=773), bipolar disorder (n=493), or controls without a psychiatric disorders (n=548). Participants were assessed on a cognitive battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and had a blood sample drawn to measure seropositivity to HSV-1. Within each group linear regression models were constructed to determine whether cigarette smoking and HSV-1 seropositivity were jointly associated with cognitive functioning after adjusting for relevant covariates. Within the schizophrenia group, the effect size of lower total cognitive score was -0.279 (p<0.0001) for individuals who were both smokers and HSV-1 seropositive and a significant effect was found in all cognitive domains. The odds of being in the highest quartile of RBANS Total score were significantly lower for smokers (OR=0.58, 95% CI 0.41, 0.82, p=0.002). Smoking was not as consistently associated with levels of cognitive functioning in the bipolar disorder or the non-psychiatric control group. While experimental studies show that nicotine transiently improves functioning on sensory gating and attention tasks known to be deficient in schizophrenia, long-term nicotine exposure via smoking appears to have an adverse effect on cognitive functioning.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Robert Yolken
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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39
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Ene L, Marcotte TD, Umlauf A, Grancea C, Temereanca A, Bharti A, Achim CL, Letendre S, Ruta SM. Latent toxoplasmosis is associated with neurocognitive impairment in young adults with and without chronic HIV infection. J Neuroimmunol 2016; 299:1-7. [PMID: 27725106 DOI: 10.1016/j.jneuroim.2016.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 12/11/2022]
Abstract
We evaluated the impact of latent toxoplasmosis (LT) on neurocognitive (NC) and neurobehavioural functioning in young adults with and without chronic HIV infection, using a standardised NC test battery, self-reported Beck Depression Inventory, Frontal System Behavior Scale, MINI-International Neuropsychiatric Interview and risk-assessment battery. 194 young adults (median age 24years, 48.2% males) with chronic HIV infection (HIV+) since childhood and 51 HIV seronegative (HIV-) participants were included. HIV+ individuals had good current immunological status (median CD4: 479 cells/μl) despite a low CD4 nadir (median: 93 cells/μl). LT (positive anti-Toxoplasma IgG antibodies) was present in one third of participants. The impairment rates in the HIV- with and without Toxo were not significantly different (p=0.17). However, we observed an increasing trend (p<0.001) in impairment rates with HIV and LT status: HIV-/LT- (6.1%); HIV-/LT+ (22%), HIV+/LT- (31%), HIV+/LT+ (49%). In a multivariable analysis using the entire study group there were main effects on cognition for HIV and also for LT. Within the HIV+ group LT was associated with worse performance globally (p=0.006), in memory (p=0.009), speed of information processing (p=0.01), verbal (p=0.02) and learning (p=0.02) domains. LT was not associated with depressive symptoms, frontal systems dysfunction or risk behaviors in any of the groups. HIV participants with lower Toxoplasma antibody concentration had worse NC performance, with higher GDS values (p=0.03) and worse learning (p=0.002), memory (p=0.006), speed of information processing (p=0.01) T scores. Latent Toxoplasmosis may contribute to NC impairment in young adults, including those with and without chronic HIV infection.
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Affiliation(s)
- L Ene
- "Dr. Victor Babes" Hospital for Infectious and Tropical Diseases, Bucharest, Romania.
| | - T D Marcotte
- University of California San Diego, La Jolla, CA, USA
| | - A Umlauf
- University of California San Diego, La Jolla, CA, USA
| | - C Grancea
- "Stefan S. Nicolau" Institute of Virology, Bucharest, Romania
| | - A Temereanca
- "Stefan S. Nicolau" Institute of Virology, Bucharest, Romania
| | - A Bharti
- University of California San Diego, La Jolla, CA, USA
| | - C L Achim
- University of California San Diego, La Jolla, CA, USA
| | - S Letendre
- University of California San Diego, La Jolla, CA, USA
| | - S M Ruta
- "Stefan S. Nicolau" Institute of Virology, Bucharest, Romania
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Affiliation(s)
- Jason P Gigley
- Department of Molecular Biology, University of Wyoming, Laramie, Wyoming, United States of America
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Passeri E, Jones-Brando L, Bordón C, Sengupta S, Wilson AM, Primerano A, Rapoport JL, Ishizuka K, Kano SI, Yolken RH, Sawa A. Infection and characterization of Toxoplasma gondii in human induced neurons from patients with brain disorders and healthy controls. Microbes Infect 2015; 18:153-8. [PMID: 26432947 DOI: 10.1016/j.micinf.2015.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/29/2015] [Accepted: 09/11/2015] [Indexed: 12/21/2022]
Abstract
Toxoplasma gondii is a protozoan parasite capable of establishing persistent infection within the brain. Serological studies in humans have linked exposure to Toxoplasma to neuropsychiatric disorders. However, serological studies have not elucidated the related molecular mechanisms within neuronal cells. To address this question, we used human induced neuronal cells derived from peripheral fibroblasts of healthy individuals and patients with genetically-defined brain disorders (i.e. childhood-onset schizophrenia with disease-associated copy number variations). Parasite infection was characterized by differential detection of tachyzoites and tissue cysts in induced neuronal cells. This approach may aid study of molecular mechanisms underlying individual predisposition to Toxoplasma infection linked to neuropathology of brain disorders.
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Affiliation(s)
- Eleonora Passeri
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
| | - Lorraine Jones-Brando
- Pediatrics, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
| | - Claudia Bordón
- Pediatrics, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
| | - Srona Sengupta
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
| | - Ashley M Wilson
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
| | - Amedeo Primerano
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
| | - Judith L Rapoport
- National Institute of Mental Health, Magnuson Clinical Center, Room 3N202, MSC 1600, Bethesda, MD 20814, USA
| | - Koko Ishizuka
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
| | - Shin-ichi Kano
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
| | - Robert H Yolken
- Pediatrics, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA.
| | - Akira Sawa
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA.
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42
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Flegr J. Neurological and Neuropsychiatric Consequences of Chronic Toxoplasma Infection. CURRENT CLINICAL MICROBIOLOGY REPORTS 2015. [DOI: 10.1007/s40588-015-0024-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hamdani N, Daban-Huard C, Lajnef M, Gadel R, Le Corvoisier P, Delavest M, Carde S, Lépine JP, Jamain S, Houenou J, Galeh B, Richard JR, Aoki M, Charron D, Krishnamoorthy R, Yolken R, Dickerson F, Tamouza R, Leboyer M. Cognitive deterioration among bipolar disorder patients infected by Toxoplasma gondii is correlated to interleukin 6 levels. J Affect Disord 2015; 179:161-6. [PMID: 25863913 DOI: 10.1016/j.jad.2015.03.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cognitive deficits are present in a large majority of Bipolar Disorder (BD) patients and known to be a marker of bad prognosis. Because, these deficits encompass several domains and no specific medical treatment seems to be effective, it is important to better understand the mechanisms underlying cognitive deterioration. As Toxoplasma gondii is known to induce the synthesis of pro-inflammatory cytokines such as IL-6, we will explore here the possible role of T. gondii in the cognitive decline observed in BD. METHODS 42 euthymic BD patients and 36 controls were assessed for episodic verbal memory using the CVLT and for working memory and verbal ability using the WAIS III. Patients and controls were also screened for seropositivity to T. gondii and evaluated for the levels of IL-6 transcripts. RESULTS The seropositivity for T. gondii was significantly higher in BD patients as compared to controls (p=0.005). The cognitive deterioration index (DI) was higher in BD patients (p=5.10(-6)) and correlated to high IL-6 mRNA expression only among those infected by T. gondii (rho=0.43, p=0.01). Among deteriorated patients (defined by scores above 0.10 according to Weschler׳s definition), the IL-6 mRNA expression was twice greater (p=0.01). LIMITATIONS Our results are to be interpreted with caution because of our small sample size and the cross-sectional design. CONCLUSIONS A long-term exposure to inflammation, measured here with IL-6 mRNA expression in T. gondii infected BD may alter cognitive functioning. IL-6 could thus be a useful predictive marker of cognitive deterioration in BD and may help to design personalized treatment.
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Affiliation(s)
- Nora Hamdani
- Inserm U955, Equipe 15 « Psychiatrie Génétique », Créteil F-94000, France; AP-HP, DHU Pe-PSY, Université Paris Est Créteil, Groupe Henri Mondor - Albert Chenevier, Pôle de psychiatrie et d׳Addictologie, Créteil F-94000, France; Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France.
| | - Claire Daban-Huard
- Inserm U955, Equipe 15 « Psychiatrie Génétique », Créteil F-94000, France; AP-HP, DHU Pe-PSY, Université Paris Est Créteil, Groupe Henri Mondor - Albert Chenevier, Pôle de psychiatrie et d׳Addictologie, Créteil F-94000, France; Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France
| | - Mohamed Lajnef
- Inserm U955, Equipe 15 « Psychiatrie Génétique », Créteil F-94000, France; AP-HP, DHU Pe-PSY, Université Paris Est Créteil, Groupe Henri Mondor - Albert Chenevier, Pôle de psychiatrie et d׳Addictologie, Créteil F-94000, France; Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France
| | - Rémi Gadel
- Inserm U955, Equipe 15 « Psychiatrie Génétique », Créteil F-94000, France; AP-HP, DHU Pe-PSY, Université Paris Est Créteil, Groupe Henri Mondor - Albert Chenevier, Pôle de psychiatrie et d׳Addictologie, Créteil F-94000, France; Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France
| | - Philippe Le Corvoisier
- CIC 006Henri Mondor INSERM & Plateforme de Ressources Biologiques, Université Paris Est Créteil, AP-HP, France
| | - Marine Delavest
- Neurospin, UNIACT Lab, Psychiatry Team, CEA Saclay, France; AP-HP, Université Paris Diderot, Service de Psychiatrie, Hôpital Lariboisiere Fernand Widal, F-75010 Paris, France
| | - Soufiane Carde
- Inserm U955, Equipe 15 « Psychiatrie Génétique », Créteil F-94000, France; AP-HP, DHU Pe-PSY, Université Paris Est Créteil, Groupe Henri Mondor - Albert Chenevier, Pôle de psychiatrie et d׳Addictologie, Créteil F-94000, France; Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France; Neurospin, UNIACT Lab, Psychiatry Team, CEA Saclay, France
| | - Jean-Pierre Lépine
- Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France; AP-HP, Université Paris Diderot, Service de Psychiatrie, Hôpital Lariboisiere Fernand Widal, F-75010 Paris, France
| | - Stéphane Jamain
- Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France; AP-HP, Université Paris Diderot, Service de Psychiatrie, Hôpital Lariboisiere Fernand Widal, F-75010 Paris, France
| | - Josselin Houenou
- Inserm U955, Equipe 15 « Psychiatrie Génétique », Créteil F-94000, France; AP-HP, DHU Pe-PSY, Université Paris Est Créteil, Groupe Henri Mondor - Albert Chenevier, Pôle de psychiatrie et d׳Addictologie, Créteil F-94000, France; Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France; Neurospin, UNIACT Lab, Psychiatry Team, CEA Saclay, France
| | - Bijan Galeh
- CIC 006Henri Mondor INSERM & Plateforme de Ressources Biologiques, Université Paris Est Créteil, AP-HP, France
| | - Jean-Romain Richard
- Inserm U955, Equipe 15 « Psychiatrie Génétique », Créteil F-94000, France; Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France
| | - Masayuki Aoki
- Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France; Jean Dausset Dept & INSERM, UMRS 940, Hôpital Saint Louis, Univ Paris Diderot, Paris F75010, France
| | - Dominique Charron
- Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France; Jean Dausset Dept & INSERM, UMRS 940, Hôpital Saint Louis, Univ Paris Diderot, Paris F75010, France
| | | | - Robert Yolken
- Stanley Laboratory of Developmental Neurovirology, Johns Hopkins University Medical Center, Baltimore, USA
| | - Faith Dickerson
- Stanley Laboratory of Developmental Neurovirology, Johns Hopkins University Medical Center, Baltimore, USA
| | - Ryad Tamouza
- Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France; Stanley Research Program, Sheppard Pratt, Baltimore, MD, USA
| | - Marion Leboyer
- Inserm U955, Equipe 15 « Psychiatrie Génétique », Créteil F-94000, France; AP-HP, DHU Pe-PSY, Université Paris Est Créteil, Groupe Henri Mondor - Albert Chenevier, Pôle de psychiatrie et d׳Addictologie, Créteil F-94000, France; Fondation Fondamental, Fondation de coopération scientifique, Créteil F94000, France
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Buckley PF. Clinical news. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2015; 9:10-12. [PMID: 25872463 DOI: 10.3371/csrp.bu.041215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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45
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Golka K, Falkenstein M, Gajewski PD. The protozoan Toxoplasma gondii: neurotoxicological relevance beyond the typical clinical pictures. Arch Toxicol 2015; 89:485-7. [DOI: 10.1007/s00204-015-1465-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/12/2015] [Indexed: 11/27/2022]
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