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Duarte RRR, Pain O, Bendall ML, de Mulder Rougvie M, Marston JL, Selvackadunco S, Troakes C, Leung SK, Bamford RA, Mill J, O'Reilly PF, Srivastava DP, Nixon DF, Powell TR. Integrating human endogenous retroviruses into transcriptome-wide association studies highlights novel risk factors for major psychiatric conditions. Nat Commun 2024; 15:3803. [PMID: 38778015 PMCID: PMC11111684 DOI: 10.1038/s41467-024-48153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Human endogenous retroviruses (HERVs) are repetitive elements previously implicated in major psychiatric conditions, but their role in aetiology remains unclear. Here, we perform specialised transcriptome-wide association studies that consider HERV expression quantified to precise genomic locations, using RNA sequencing and genetic data from 792 post-mortem brain samples. In Europeans, we identify 1238 HERVs with expression regulated in cis, of which 26 represent expression signals associated with psychiatric disorders, with ten being conditionally independent from neighbouring expression signals. Of these, five are additionally significant in fine-mapping analyses and thus are considered high confidence risk HERVs. These include two HERV expression signatures specific to schizophrenia risk, one shared between schizophrenia and bipolar disorder, and one specific to major depressive disorder. No robust signatures are identified for autism spectrum conditions or attention deficit hyperactivity disorder in Europeans, or for any psychiatric trait in other ancestries, although this is likely a result of relatively limited statistical power. Ultimately, our study highlights extensive HERV expression and regulation in the adult cortex, including in association with psychiatric disorder risk, therefore providing a rationale for exploring neurological HERV expression in complex neuropsychiatric traits.
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Affiliation(s)
- Rodrigo R R Duarte
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Division of Infectious Diseases, Weill Cornell Medicine, Cornell University, New York, NY, USA.
| | - Oliver Pain
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew L Bendall
- Division of Infectious Diseases, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | - Jez L Marston
- Division of Infectious Diseases, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Sashika Selvackadunco
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- MRC London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Claire Troakes
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- MRC London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Szi Kay Leung
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rosemary A Bamford
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jonathan Mill
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Paul F O'Reilly
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Deepak P Srivastava
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Douglas F Nixon
- Division of Infectious Diseases, Weill Cornell Medicine, Cornell University, New York, NY, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Timothy R Powell
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Division of Infectious Diseases, Weill Cornell Medicine, Cornell University, New York, NY, USA.
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2
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Saleki K, Alijanizadeh P, Javanmehr N, Rezaei N. The role of Toll-like receptors in neuropsychiatric disorders: Immunopathology, treatment, and management. Med Res Rev 2024; 44:1267-1325. [PMID: 38226452 DOI: 10.1002/med.22012] [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: 04/08/2022] [Revised: 10/20/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024]
Abstract
Neuropsychiatric disorders denote a broad range of illnesses involving neurology and psychiatry. These disorders include depressive disorders, anxiety, schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, autism spectrum disorders, headaches, and epilepsy. In addition to their main neuropathology that lies in the central nervous system (CNS), lately, studies have highlighted the role of immunity and neuroinflammation in neuropsychiatric disorders. Toll-like receptors (TLRs) are innate receptors that act as a bridge between the innate and adaptive immune systems via adaptor proteins (e.g., MYD88) and downstream elements; TLRs are classified into 13 families that are involved in normal function and illnesses of the CNS. TLRs expression affects the course of neuropsychiatric disorders, and is influenced during their pharmacotherapy; For example, the expression of multiple TLRs is normalized during the major depressive disorder pharmacotherapy. Here, the role of TLRs in neuroimmunology, treatment, and management of neuropsychiatric disorders is discussed. We recommend longitudinal studies to comparatively assess the cell-type-specific expression of TLRs during treatment, illness progression, and remission. Also, further research should explore molecular insights into TLRs regulation and related pathways.
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Affiliation(s)
- Kiarash Saleki
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
- Department of e-Learning, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Parsa Alijanizadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | - Nima Javanmehr
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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3
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Kimbrough BA, Crowson CS, Lennon RJ, Davis JM, Strangfeld A, Myasoedova E. Multiple morbidities are associated with serious infections in patients with rheumatoid arthritis. Semin Arthritis Rheum 2024; 65:152386. [PMID: 38244447 PMCID: PMC10954402 DOI: 10.1016/j.semarthrit.2024.152386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To assess the association between a comprehensive list of morbidities and serious infection (SI) in patients with rheumatoid arthritis (RA). METHODS This study evaluated SI risk associated with 55 comorbidities using a population-based inception cohort including all adult patients with incident RA from 1999 through 2014 with follow up through 2021. Morbidities and SI were ascertained using previously validated international classification of disease (ICD)-9 and ICD-10 codes. Conditional frailty models were utilized to analyze the association between each morbidity and SI: Model 1 adjusted for age, sex, and calendar year; Model 2 adjusted for factors in Model 1 and the Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT) Risk Score of Infections; and Model 3 adjusted for factors in Model 1 and the Mayo SI Risk Score. RESULTS 911 patients (70 % female, mean age 56 years, 66 % seropositive) were included. There were 293 SI among 155 patients (17 %), corresponding to an incidence of 3.9 SI per 100 person-years. Eighteen SI were fatal. Risk of SI was significantly increased in 27 of 55 morbidities in Model 1, 11 morbidities in Model 2, and 23 morbidities in Model 3. Additionally, several morbidities included in the RABBIT and Mayo risk scores continued to have large effect sizes despite adjustment. Serious infection risk increased by 11-16 % per morbidity in the three models. CONCLUSIONS Several morbidities are associated with an increased risk for SI. Future risk scores may include morbidities identified in this study for improved SI risk assessment.
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Affiliation(s)
- Bradly A Kimbrough
- Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Quantitative Health Sciences Division of Clinical Trials and Biostatistics, Mayo Clinic, 200 1st ST SW, Rochester, MN 55905, USA
| | - Ryan J Lennon
- Department of Quantitative Health Sciences Division of Clinical Trials and Biostatistics, Mayo Clinic, 200 1st ST SW, Rochester, MN 55905, USA
| | - John M Davis
- Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Anja Strangfeld
- Epidemiology and Health Services Research, German Rheumatism Research Centre (DRFZ) Berlin and Charite University Medicine, Charitéplatz 1, Berlin 10117, Federal Republic of Germany
| | - Elena Myasoedova
- Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Crick DCP, Khandaker GM, Halligan SL, Burgner D, Mansell T, Fraser A. Comparison of the stability of glycoprotein acetyls and high sensitivity C-reactive protein as markers of chronic inflammation. Immunology 2024; 171:497-512. [PMID: 38148627 DOI: 10.1111/imm.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023] Open
Abstract
It has been suggested that glycoprotein acetyls (GlycA) better reflects chronic inflammation than high sensitivity C-reactive protein (hsCRP), but paediatric/life-course data are sparse. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and UK Biobank, we compared short- (over weeks) and long-term (over years) correlations of GlycA and hsCRP, cross-sectional correlations between GlycA and hsCRP, and associations of pro-inflammatory risk factors with GlycA and hsCRP across the life-course. GlycA showed high short-term (weeks) stability at 15 years (r = 0.75; 95% CI = 0.56, 0.94), 18 years (r = 0.74; 0.64, 0.85), 24 years (r = 0.74; 0.51, 0.98) and 48 years (r = 0.82 0.76, 0.86) and this was comparable to the short-term stability of hsCRP at 24 years. GlycA stability was moderate over the long-term, for example between 15 and 18 years r = 0.52; 0.47, 0.56 and between 15 and 24 years r = 0.37; 0.31, 0.44. These were larger than equivalent correlations of hsCRP. GlycA and concurrently measured hsCRP were moderately correlated at all ages, for example at 15 years (r = 0.44; 0.40, 0.48) and at 18 years (r = 0.55; 0.51, 0.59). We found similar associations of known proinflammatory factors and inflammatory diseases with GlycA and hsCRP. For example, BMI was positively associated with GlycA (mean difference in GlycA per standard deviation change in BMI = 0.08; 95% CI = 0.07, 0.10) and hsCRP (0.10; 0.08, 0.11). This study showed that GlycA has greater long-term stability than hsCRP, however associations of proinflammatory factors with GlycA and hsCRP were broadly similar.
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Affiliation(s)
- Daisy C P Crick
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Golam M Khandaker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
- Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, Melbourne University, Parkville, VIC, Australia
| | - Toby Mansell
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, Melbourne University, Parkville, VIC, Australia
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
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AL-Hasnawi SMJ, Noori MA, AL-Haidari AF, Hussain MJ. Increased Serum Terminal Complements Complex Levels in Attention Deficit Hyperactivity Disorder Children. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:229-236. [PMID: 38680220 PMCID: PMC11053251 DOI: 10.30476/ijms.2023.97556.2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/03/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2024]
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is a widespread neuropsychiatric disorder in both children and adolescents, which is associated with social isolation and poor academic performance. Complement proteins are regarded as a major player in inflammation and disease development for several neuropsychiatric diseases such as schizophrenia and bipolar diseases. As clarified by previous data, increased levels of complement molecules and other immunological markers as cytokines were demonstrated in these disorders. Limited studies have investigated complement proteins particularly terminal complement complex or membrane attack complex (C5b-9) among ADHD patients. The present research aims to elucidate the association between C5b-9 complex protein and ADHD. Methods This is a cross-sectional study. Sera were collected from Al-Hussain Teaching Medical City in Holy Karbala, Iraq, during 2019-2020. Sera were tested for C5-b9 using commercial kits by enzyme-linked immunosorbent assay (ELISA). Results In 90 participants included in the study, a significant increment in C5b-9 levels among ADHD patients (P=0.019) was observed. Patients with positive C5b-9 levels had a 2.76 times higher risk of developing ADHD than control subjects. The diagnostic utility for C5b-9 was statistically significant with 71.11% sensitivity, 55.6% specificity, and a high negative predictive value (97.3%). Conclusion The study concluded elevation of the C5b-9 terminal complements complex levels in ADHD patients, which could point to the association of complement proteins as inflammatory markers with the ADHD disease process.
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Affiliation(s)
| | | | | | - Munther J. Hussain
- Institute of Liver Studies, King’s College London, School of Medicine, King’s College Hospital, London, SE5 9RS, UK
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Chaves-Filho A, Eyres C, Blöbaum L, Landwehr A, Tremblay MÈ. The emerging neuroimmune hypothesis of bipolar disorder: An updated overview of neuroimmune and microglial findings. J Neurochem 2024. [PMID: 38504593 DOI: 10.1111/jnc.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/21/2024]
Abstract
Bipolar disorder (BD) is a severe and multifactorial disease, with onset usually in young adulthood, which follows a progressive course throughout life. Replicated epidemiological studies have suggested inflammatory mechanisms and neuroimmune risk factors as primary contributors to the onset and development of BD. While not all patients display overt markers of inflammation, significant evidence suggests that aberrant immune signaling contributes to all stages of the disease and seems to be mood phase dependent, likely explaining the heterogeneity of findings observed in this population. As the brain's immune cells, microglia orchestrate the brain's immune response and play a critical role in maintaining the brain's health across the lifespan. Microglia are also highly sensitive to environmental changes and respond to physiological and pathological events by adapting their functions, structure, and molecular expression. Recently, it has been highlighted that instead of a single population of cells, microglia comprise a heterogeneous community with specialized states adjusted according to the local molecular cues and intercellular interactions. Early evidence has highlighted the contribution of microglia to BD neuropathology, notably for severe outcomes, such as suicidality. However, the roles and diversity of microglial states in this disease are still largely undermined. This review brings an updated overview of current literature on the contribution of neuroimmune risk factors for the onset and progression of BD, the most prominent neuroimmune abnormalities (including biomarker, neuroimaging, ex vivo studies) and the most recent findings of microglial involvement in BD neuropathology. Combining these different shreds of evidence, we aim to propose a unifying hypothesis for BD pathophysiology centered on neuroimmune abnormalities and microglia. Also, we highlight the urgent need to apply novel multi-system biology approaches to characterize the diversity of microglial states and functions involved in this enigmatic disorder, which can open bright perspectives for novel biomarkers and therapeutic discoveries.
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Affiliation(s)
- Adriano Chaves-Filho
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
- Women Health Research Institute, Vancouver, British Columbia, Canada
- Brain Health Cluster at the Institute on Aging & Lifelong Health (IALH), Victoria, British Columbia, Canada
| | - Capri Eyres
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Leonie Blöbaum
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Antonia Landwehr
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Marie-Ève Tremblay
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
- Women Health Research Institute, Vancouver, British Columbia, Canada
- Brain Health Cluster at the Institute on Aging & Lifelong Health (IALH), Victoria, British Columbia, Canada
- Centre for Advanced Materials and Related Technology (CAMTEC), University of Victoria, Victoria, British Columbia, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada
- Neurology and Neurosurgery Department, McGill University, Montréal, Quebec, Canada
- Department of Molecular Medicine, Université Laval, Québec City, Quebec, Canada
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Iakunchykova O, Leonardsen EH, Wang Y. Genetic evidence for causal effects of immune dysfunction in psychiatric disorders: where are we? Transl Psychiatry 2024; 14:63. [PMID: 38272880 PMCID: PMC10810856 DOI: 10.1038/s41398-024-02778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
The question of whether immune dysfunction contributes to risk of psychiatric disorders has long been a subject of interest. To assert this hypothesis a plethora of correlative evidence has been accumulated from the past decades; however, a variety of technical and practical obstacles impeded on a cause-effect interpretation of these data. With the advent of large-scale omics technology and advanced statistical models, particularly Mendelian randomization, new studies testing this old hypothesis are accruing. Here we synthesize these new findings from genomics and genetic causal inference studies on the role of immune dysfunction in major psychiatric disorders and reconcile these new data with pre-omics findings. By reconciling these evidences, we aim to identify key gaps and propose directions for future studies in the field.
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Affiliation(s)
- Olena Iakunchykova
- Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Esten H Leonardsen
- Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Yunpeng Wang
- Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway.
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8
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Biçer GY, Kurt A, Zor KR. Efficacy of automatic pupillometry as a screening technique to detect autonomic dysfunction in bipolar disorder. Clin Exp Optom 2023; 106:896-900. [PMID: 36436223 DOI: 10.1080/08164622.2022.2145182] [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: 08/11/2022] [Accepted: 11/03/2022] [Indexed: 11/28/2022] Open
Abstract
CLINICAL RELEVANCE Autonomic nervous system abnormalities in the pathophysiology of bipolar disorder are controversial. Pupillary features may be affected as a result of autonomic nervous system abnormalities in bipolar disorder. Small changes in pupillary responses may not be noticeable on clinical examination. Automated pupillemetries can be helpful in demonstrating these changes reliably and quantitatively. BACKGROUND The aim of this study was to compare the static and dynamic pupillary responses of bipolar patients with healthy controls. In addition, pupillary response differences between mania, depression and remission stages were investigated. METHODS The bipolar patient group consisted of 39 eyes of 39 patients with 13 patients in each of the stages: mania, depression and remission. The control group consisted of 39 eyes of 39 healthy volunteers. After the ophthalmic examination, static and dynamic pupillometry measurements were made. The mean pupil dilatation speed was calculated according to dynamic measurements. Static pupillometry measurements including scotopic, mesopic and photopic pupil diameters; the first dynamic measurements at 0th second and pupillary dilatation speed were used for statistical analysis. RESULTS There was no difference static and the first dynamic pupillometry measurements between the bipolar and control groups (p > 0.05 for all parameters), but there was a significant difference in mean pupil dilatation speed (p = 0.041). No significant differences were found between the 3 groups for all static and the first dynamic pupillometry measurements and the mean pupil dilatation speed (p > 0.05). CONCLUSION Static and the first dynamic measurements of bipolar patients were not different from healthy controls. The mean pupil dilatation speed of bipolar patients was significantly lower, but this difference had a low effect size.
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Affiliation(s)
| | - Aydın Kurt
- Department of Psychiatry, Niğde Ömer Halisdemir Education and Research Hospital, Niğde, Turkey
| | - Kürşad Ramazan Zor
- Department of Ophthalmology, Niğde Ömer Halisdemir University, Niğde, Turkey
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Rajkumar RP. Examining the Relationships between the Incidence of Infectious Diseases and Mood Disorders: An Analysis of Data from the Global Burden of Disease Studies, 1990-2019. Diseases 2023; 11:116. [PMID: 37754312 PMCID: PMC10528187 DOI: 10.3390/diseases11030116] [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: 07/13/2023] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
Mood disorders are among the commonest mental disorders worldwide. Epidemiological and clinical evidence suggests that there are close links between infectious diseases and mood disorders, but the strength and direction of these association remain largely unknown. Theoretical models have attempted to explain this link based on evolutionary or immune-related factors, but these have not been empirically verified. The current study examined cross-sectional and longitudinal associations between the incidence of infectious diseases and mood disorders, while correcting for climate and economic factors, based on data from the Global Burden of Disease Studies, 1990-2019. It was found that major depressive disorder was positively associated with lower respiratory infections, while bipolar disorder was positively associated with upper respiratory infections and negatively associated with enteric and tropical infections, both cross-sectionally and over a period of 30 years. These results suggest that a complex, bidirectional relationship exists between these disorders. This relationship may be mediated through the immune system as well as through the gut-brain and lung-brain axes. Understanding the mechanisms that link these groups of disorders could lead to advances in the prevention and treatment of both.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
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10
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Chen Z, Huang Y, Wang B, Peng H, Wang X, Wu H, Chen W, Wang M. T cells: an emerging cast of roles in bipolar disorder. Transl Psychiatry 2023; 13:153. [PMID: 37156764 PMCID: PMC10167236 DOI: 10.1038/s41398-023-02445-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023] Open
Abstract
Bipolar disorder (BD) is a distinctly heterogeneous and multifactorial disorder with a high individual and social burden. Immune pathway dysregulation is an important pathophysiological feature of BD. Recent studies have suggested a potential role for T lymphocytes in the pathogenesis of BD. Therefore, greater insight into T lymphocytes' functioning in patients with BD is essential. In this narrative review, we describe the presence of an imbalance in the ratio and altered function of T lymphocyte subsets in BD patients, mainly in T helper (Th) 1, Th2, Th17 cells and regulatory T cells, and alterations in hormones, intracellular signaling, and microbiomes may be potential causes. Abnormal T cell presence explains the elevated rates of comorbid inflammatory illnesses in the BD population. We also update the findings on T cell-targeting drugs as potentially immunomodulatory therapeutic agents for BD disease in addition to classical mood stabilizers (lithium, valproic acid). In conclusion, an imbalance in T lymphocyte subpopulation ratios and altered function may be involved in the development of BD, and maintaining T cell immune homeostasis may provide an overall therapeutic benefit.
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Affiliation(s)
- Zhenni Chen
- Department of Laboratory Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yiran Huang
- School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
| | - Bingqi Wang
- Department of Laboratory Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Huanqie Peng
- Department of Laboratory Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Xiaofan Wang
- Department of Laboratory Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Hongzheng Wu
- Department of Laboratory Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Wanxin Chen
- Department of Laboratory Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Min Wang
- Department of Laboratory Medicine, the Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
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Safari H, Mashayekhan S. Inflammation and Mental Health Disorders: Immunomodulation as a Potential Therapy for Psychiatric Conditions. Curr Pharm Des 2023; 29:2841-2852. [PMID: 37946352 DOI: 10.2174/0113816128251883231031054700] [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: 03/04/2023] [Accepted: 09/22/2023] [Indexed: 11/12/2023]
Abstract
Mood disorders are the leading cause of disability worldwide and their incidence has significantly increased after the COVID-19 pandemic. Despite the continuous surge in the number of people diagnosed with psychiatric disorders, the treatment methods for these conditions remain limited. A significant number of people either do not respond to therapy or discontinue the drugs due to their severe side effects. Therefore, alternative therapeutic interventions are needed. Previous studies have shown a correlation between immunological alterations and the occurrence of mental health disorders, yet immunomodulatory therapies have been barely investigated for combating psychiatric conditions. In this article, we have reviewed the immunological alterations that occur during the onset of mental health disorders, including microglial activation, an increased number of circulating innate immune cells, reduced activity of natural killer cells, altered T cell morphology and functionality, and an increased secretion of pro-inflammatory cytokines. This article also examines key studies that demonstrate the therapeutic efficacy of anti-inflammatory medications in mental health disorders. These studies suggest that immunomodulation can potentially be used as a complementary therapy for controlling psychiatric conditions after careful screening of candidate drugs and consideration of their efficacy and side effects in clinical trials.
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Affiliation(s)
- Hanieh Safari
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Shohreh Mashayekhan
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
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12
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James LM, Charonis SA, Georgopoulos AP. Schizophrenia, Human Leukocyte Antigen (HLA), and Herpes Viruses: Immunogenetic Associations at the Population Level. Neurosci Insights 2023; 18:26331055231166411. [PMID: 37077512 PMCID: PMC10108429 DOI: 10.1177/26331055231166411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/13/2023] [Indexed: 04/21/2023] Open
Abstract
Several factors have been implicated in schizophrenia (SZ), including human herpes viruses (HHV) and the adaptive immunity Human Leukocyte Antigen (HLA) genes. Here we investigated these issues in 2 complementary ways. In one analysis, we evaluated SZ-HLA and HHV-HLA associations at the level of a single allele by computing (a) a SZ-HLA protection/susceptibility (P/S) score based on the covariance between SZ and 127 HLA allele prevalences in 14 European countries, (b) estimating in silico HHV-HLA best binding affinities for the 9 HHV strains, and (c) evaluating the dependence of P/S score on HHV-HLA binding affinities. These analyses yielded (a) a set of 127 SZ-HLA P/S scores, varying by >200× (maximum/minimum), which could not be accounted for by chance, (b) a set of 127 alleles × 9 HHV best-estimated affinities, varying by >600×, and (c) a set of correlations between SZ-HLA P/S scores and HHV-HLA binding which indicated a prominent role of HHV1. In a subsequent analysis, we extended these findings to the individual person by taking into account the fact that every individual carries 12 HLA alleles and computed (a) the average SZ-HLA P/S scores of 12 randomly chosen alleles (2 per gene), an indicator of HLA-based SZ P/S for an individual, and (b) the average of the corresponding HHV estimated affinities for those alleles, an indicator of overall effectiveness of HHV-HLA binding. We found (a) that HLA protection for SZ was significantly more prominent than susceptibility, and (b) that protective SZ-HLA scores were associated with higher HHV-HLA binding affinities, indicating that HLA binding and subsequent elimination of several HHV strains may confer protection against schizophrenia.
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Affiliation(s)
- Lisa M James
- The HLA Research Group, Department of Veterans Affairs Health Care System, Brain Sciences Center, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Lisa M James, Brain Sciences Center (11B), Minneapolis VAHCS, One Veterans Drive, Minneapolis, MN 55417, USA.
| | - Spyros A Charonis
- The HLA Research Group, Department of Veterans Affairs Health Care System, Brain Sciences Center, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Apostolos P Georgopoulos
- The HLA Research Group, Department of Veterans Affairs Health Care System, Brain Sciences Center, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA
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13
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Werner MCF, Wirgenes KV, Shadrin AA, Lunding SH, Rødevand L, Hjell G, Ormerod MBEG, Haram M, Agartz I, Djurovic S, Melle I, Aukrust P, Ueland T, Andreassen OA, Steen NE. Limited association between infections, autoimmune disease and genetic risk and immune activation in severe mental disorders. Prog Neuropsychopharmacol Biol Psychiatry 2022; 116:110511. [PMID: 35063598 DOI: 10.1016/j.pnpbp.2022.110511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low-grade inflammation may be part of the underlying mechanism of schizophrenia and bipolar disorder. We investigated if genetic susceptibility, infections or autoimmunity could explain the immune activation. METHODS Seven immune markers were selected based on indicated associations to severe mental disorders (IL-1Ra, sIL-2R, IL-18, sgp130, sTNFR-1, APRIL, ICAM-1) and measured in plasma of patients with schizophrenia (SCZ, N = 732) and bipolar spectrum disorders (BD, N = 460) and healthy controls (HC, N = 938). Information on rate of infections and autoimmune diseases were obtained from Norwegian national health registries for a twelve-year period. Polygenic risk scores (PRS) of SCZ and BD were calculated from genome-wide association studies. Analysis of covariance were used to test effects of infection rate, autoimmune disease and PRS on differences in immune markers between patients and HC. RESULTS Infection rate differed between all groups (BD > HC > SCZ, all p < 0.001) whereas autoimmune disease was more frequent in BD compared to SCZ (p = 0.004) and HC (p = 0.003). sIL-2R was positively associated with autoimmune disease (p = 0.001) and negatively associated with PRS of SCZ (p = 0.006) across SCZ and HC; however, associations represented only small changes in the difference of sIL-2R levels between SCZ and HC. CONCLUSION There were few significant associations between rate of infections, autoimmune disease or PRS and altered immune markers in SCZ and BD, and the detected associations represented only small changes in the immune aberrations. The findings suggest that most of the low-grade inflammation in SCZ and BD is explained by other factors than the underlying PRS, autoimmunity and infection rates.
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Affiliation(s)
- Maren Caroline Frogner Werner
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Katrine Verena Wirgenes
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Alexey A Shadrin
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Synve Hoffart Lunding
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Linn Rødevand
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gabriela Hjell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry, Ostfold Hospital, Graalum, Norway
| | | | - Marit Haram
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen - Thrombosis Research and Expertise Center (TREC), University of Tromsø, Tromsø, Norway
| | - Ole Andreas Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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14
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Massrali A, Adhya D, Srivastava DP, Baron-Cohen S, Kotter MR. Virus-Induced Maternal Immune Activation as an Environmental Factor in the Etiology of Autism and Schizophrenia. Front Neurosci 2022; 16:834058. [PMID: 35495047 PMCID: PMC9039720 DOI: 10.3389/fnins.2022.834058] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/01/2022] [Indexed: 12/22/2022] Open
Abstract
Maternal immune activation (MIA) is mediated by activation of inflammatory pathways resulting in increased levels of cytokines and chemokines that cross the placental and blood-brain barriers altering fetal neural development. Maternal viral infection is one of the most well-known causes for immune activation in pregnant women. MIA and immune abnormalities are key players in the etiology of developmental conditions such as autism, schizophrenia, ADHD, and depression. Experimental evidence implicating MIA in with different effects in the offspring is complex. For decades, scientists have relied on either MIA models or human epidemiological data or a combination of both. MIA models are generated using infection/pathogenic agents to induce an immunological reaction in rodents and monitor the effects. Human epidemiological studies investigate a link between maternal infection and/or high levels of cytokines in pregnant mothers and the likelihood of developing conditions. In this review, we discuss the importance of understanding the relationship between virus-mediated MIA and neurodevelopmental conditions, focusing on autism and schizophrenia. We further discuss the different methods of studying MIA and their limitations and focus on the different factors contributing to MIA heterogeneity.
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Affiliation(s)
- Aïcha Massrali
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Dwaipayan Adhya
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Deepak P. Srivastava
- Department of Basic and Clinical Neuroscience, King’s College London, London, United Kingdom
| | - Simon Baron-Cohen
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Mark R. Kotter
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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15
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Douglas KM, Inder ML, Crowe MT, Jordan J, Carlye D, Lacey C, Beaglehole B, Mulder R, Eggleston K, Donovan KA, Frampton CMA, Bowie CR, Porter RJ. Randomised controlled trial of Interpersonal and Social Rhythm Therapy and group-based Cognitive Remediation versus Interpersonal and Social Rhythm Therapy alone for mood disorders: study protocol. BMC Psychiatry 2022; 22:115. [PMID: 35164720 PMCID: PMC8845377 DOI: 10.1186/s12888-022-03747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with mood disorders frequently experience cognitive impairment, which impacts on the long-term trajectory of the disorders, including being associated with persisting difficulties in occupational and psychosocial functioning, residual mood symptoms, and relapse. Current first-line treatments for mood disorders do little to improve cognitive function. Targeting cognition in clinical research is thus considered a priority. This protocol outlines a prospectively-registered randomised controlled trial (RCT) which examines the impact of adding group-based Cognitive Remediation (CR) to Interpersonal and Social Rhythm Therapy (IPSRT-CR) for individuals with mood disorders. METHODS This is a pragmatic, two-arm, single-blinded RCT comparing IPSRT-CR with IPSRT alone for adults (n = 100) with mood disorders (Major Depressive Disorder or Bipolar Disorder) with subjective cognitive difficulties, on discharge from Specialist Mental Health Services in Christchurch, New Zealand. Both treatment arms will receive a 12-month course of individual IPSRT (full dose = 24 sessions). At 6 months, randomisation to receive, or not, an 8-week group-based CR programme (Action-based Cognitive Remediation - New Zealand) will occur. The primary outcome will be change in Global Cognition between 6 and 12 months (treatment-end) in IPSRT-CR versus IPSRT alone. Secondary outcomes will be change in cognitive, functional, and mood outcomes at 6, 12, 18, and 24 months from baseline and exploratory outcomes include change in quality of life, medication adherence, rumination, and inflammatory markers between treatment arms. Outcome analyses will use an intention-to-treat approach. Sub-group analyses will assess the impact of baseline features on CR treatment response. Participants' experiences of their mood disorder, including treatment, will be examined using qualitative analysis. DISCUSSION This will be the first RCT to combine group-based CR with an evidence-based psychotherapy for adults with mood disorders. The trial may provide valuable information regarding how we can help promote long-term recovery from mood disorders. Many issues have been considered in developing this protocol, including: recruitment of the spectrum of mood disorders, screening for cognitive impairment, dose and timing of the CR intervention, choice of comparator treatment, and choice of outcome measures. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12619001080112 . Registered on 6 August 2019.
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Affiliation(s)
- Katie M. Douglas
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree L. Inder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie T. Crowe
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Dave Carlye
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Cameron Lacey
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.29980.3a0000 0004 1936 7830Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Roger Mulder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Kate Eggleston
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katherine A. Donovan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Christopher M. A. Frampton
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher R. Bowie
- grid.410356.50000 0004 1936 8331Department of Psychology, Queen’s University, Kingston, ON Canada
| | - Richard J. Porter
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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16
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Angrand L, Boukouaci W, Lajnef M, Richard JR, Andreazza A, Wu CL, Bouassida J, Rafik I, Foiselle M, Mezouad E, Naamoune S, Chami L, Mihoub O, Salah S, Benchaaben A, Le Corvoisier P, Barau C, Costes B, Yolken R, Crepeaux G, Leboyer M, Tamouza R. Low peripheral mitochondrial DNA copy number during manic episodes of bipolar disorders is associated with disease severity and inflammation. Brain Behav Immun 2021; 98:349-356. [PMID: 34500035 DOI: 10.1016/j.bbi.2021.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022] Open
Abstract
Mitochondria (Mt) are intra-cellular components essential for cellular energy processes whose dysfunction may induce premature cellular senescence and/or inflammation, both observed in bipolar disorders (BD). We investigated mitochondrial DNA copy number (mtDNAcn) levels in patients with BD being in manic, depressive or euthymic phase and in healthy controls (HC) both characterized for the levels of blood-based inflammatory markers and stigma of pathogens. 312 patients with BD were compared to 180 HC. mtDNAcn were measured using a digital droplet PCR. Serum levels of 14 inflammatory molecules and 3 anti-infectious IgG stigma were respectively evaluated by electro-chemiluminescence, ELISA and dedicated immunoassays. The statistical analyses were performed using Spearman's correlation, Wilcoxon signed-rank and Kruskal-Wallis rank sum tests. P-values were adjusted for multiple testing with Benjamini-Hochberg method. We found low levels of mtDNAcn in BD patients as compared to HC (P = 0.008) especially during manic episodes (P = 0.0002). We also observed that low levels of mtDNAcn are negatively correlated with mood and psychotic scales (PANSS, YMRS and CGI) (adjusted P (Adj P) = 0.02, 0.003 and 0.05 respectively) and positively with the GAF severity scale (Adj P = 0.002). They were also correlated with high levels of both intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 (Adj P = 0.003 and 0.001) along with a trend toward increased IL-2, IL-10 and B2M circulating levels (Adj P = 0.05). Here, we report correlations between marker of mitochondria functioning and both clinical scales and inflammatory markers in BD patients experiencing manic episodes. If replicated, these finding might allow to predict transition between disease phases and to design accurate therapeutic options.
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Affiliation(s)
- Loïc Angrand
- Univ Paris Est-Creteil, Faculté de Santé, INSERM U955, IMRB, Laboratoire de Biologie du système neuromusculaire, F-94010 Creteil, France; Ecole Nationale Vétérinaire d'Alfort, IMRB, F-94700 Maisons-Alfort, France; Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Wahid Boukouaci
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Mohamed Lajnef
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Jean-Romain Richard
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Ana Andreazza
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Chieng-Lien Wu
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Jihène Bouassida
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Ismail Rafik
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Marianne Foiselle
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Esma Mezouad
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Soumia Naamoune
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Leila Chami
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Ons Mihoub
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Sofiane Salah
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Arij Benchaaben
- Université Paris Est Creteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, F-94010 Creteil, France
| | - Philippe Le Corvoisier
- Inserm, Centre d'Investigation Clinique 1430 et AP-HP, Hôpitaux Universitaires Henri Mondor, Univ Paris Est Creteil, F-94010 Créteil, France
| | - Caroline Barau
- Plateforme de Ressources Biologiques, HU Henri Mondor, F-94010 Creteil, France
| | - Bruno Costes
- Univ Paris Est Creteil, IMRB, INSERM, U955, F-94010 Créteil, France
| | - Robert Yolken
- Johns Hopkins school of medicine, Baltimore, MD, USA
| | - Guillemette Crepeaux
- Univ Paris Est-Creteil, Faculté de Santé, INSERM U955, IMRB, Laboratoire de Biologie du système neuromusculaire, F-94010 Creteil, France; Ecole Nationale Vétérinaire d'Alfort, IMRB, F-94700 Maisons-Alfort, France
| | - Marion Leboyer
- Univ Paris Est Creteil, INSERM, IMRB Translational Neuropsychiatry laboratory, AP-HP, DMU IMPACT & FHU ADAPT, Fondation FondaMental, F-94010, Creteil, France
| | - Ryad Tamouza
- Univ Paris Est Creteil, INSERM, IMRB Translational Neuropsychiatry laboratory, AP-HP, DMU IMPACT & FHU ADAPT, Fondation FondaMental, F-94010, Creteil, France.
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Natural killer cells in first-episode psychosis: an innate immune signature? Mol Psychiatry 2021; 26:5297-5306. [PMID: 33456051 DOI: 10.1038/s41380-020-01008-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
Accumulating evidence majorly implicates immune dysfunction in the etiology of psychotic disorders. In particular, altered numbers and functions of natural killer (NK) cells have been described in psychosis, but interpretation has often been confounded by a number of biases, including treatment. Eighty-one first-episode psychosis (FEP) patients who subsequently received a diagnosis of either schizophrenia (SZ; n = 30) or bipolar disorder (BP; n = 31) over a five-year follow-up period were investigated for their NK cell phenotype and compared to 61 healthy controls (HCs). We found a similar proportion of CD3-CD56+ NK cells in FEP patients and HCs. The frequency of NK cells expressing the late cell activation marker HLA-DR was significantly increased in FEP patients compared to HCs, especially in patients with BP (p < 0.0001) and, to a lesser degree, in patients with SZ (p = 0.0128). Interestingly, the expression of the activating NKG2C receptor, known to be associated with infections, was higher in patients with SZ and BP than in HCs (p < 0.0001) and correlated with HLA-DR expression, altogether defining adaptive NK cells. In terms of NK cell function, we observed a suppressed capacity of SZ-derived NK cells to mount cytotoxic responses in the presence of target cells, while NK cells from patients with BP show an inability to produce IFN-γ, a cytokine pivotal to NK function. This study strongly suggests major dysfunction of NK cells in FEP with functioning impairment correlated with psychotic, manic, and depressive symptoms in subsequently diagnosed patients with SZ and BP.
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18
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Al Garhy M, Al Dhufairi A, Abdulrahman H, Al Maskari B, Ahmed N, Al Khamashi S, Kaid A, Shalash H. Mental Health Services during the
COVID
‐19 pandemic in Abu Dhabi,
UAE. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2021. [DOI: 10.1002/pnp.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mohamed Al Garhy
- Dr Al Garhy, Dr Al Dhufairi, Dr Abdelrahman and Dr Al Maskari are all Psychiatrists; Dr Mahmoud is a Resident Psychiatrist; Dr Al Khanbashi and Mrs Salem are Clinical Psychologists, and Mrs Shalash is a Social Worker, all at Behavioral Science Pavilion in Sheikh Khalifa Medical City, Abu Dhabi
| | - Aisha Al Dhufairi
- Dr Al Garhy, Dr Al Dhufairi, Dr Abdelrahman and Dr Al Maskari are all Psychiatrists; Dr Mahmoud is a Resident Psychiatrist; Dr Al Khanbashi and Mrs Salem are Clinical Psychologists, and Mrs Shalash is a Social Worker, all at Behavioral Science Pavilion in Sheikh Khalifa Medical City, Abu Dhabi
| | - Hadir Abdulrahman
- Dr Al Garhy, Dr Al Dhufairi, Dr Abdelrahman and Dr Al Maskari are all Psychiatrists; Dr Mahmoud is a Resident Psychiatrist; Dr Al Khanbashi and Mrs Salem are Clinical Psychologists, and Mrs Shalash is a Social Worker, all at Behavioral Science Pavilion in Sheikh Khalifa Medical City, Abu Dhabi
| | - Buthina Al Maskari
- Dr Al Garhy, Dr Al Dhufairi, Dr Abdelrahman and Dr Al Maskari are all Psychiatrists; Dr Mahmoud is a Resident Psychiatrist; Dr Al Khanbashi and Mrs Salem are Clinical Psychologists, and Mrs Shalash is a Social Worker, all at Behavioral Science Pavilion in Sheikh Khalifa Medical City, Abu Dhabi
| | - Nada Ahmed
- Dr Al Garhy, Dr Al Dhufairi, Dr Abdelrahman and Dr Al Maskari are all Psychiatrists; Dr Mahmoud is a Resident Psychiatrist; Dr Al Khanbashi and Mrs Salem are Clinical Psychologists, and Mrs Shalash is a Social Worker, all at Behavioral Science Pavilion in Sheikh Khalifa Medical City, Abu Dhabi
| | - Saad Al Khamashi
- Dr Al Garhy, Dr Al Dhufairi, Dr Abdelrahman and Dr Al Maskari are all Psychiatrists; Dr Mahmoud is a Resident Psychiatrist; Dr Al Khanbashi and Mrs Salem are Clinical Psychologists, and Mrs Shalash is a Social Worker, all at Behavioral Science Pavilion in Sheikh Khalifa Medical City, Abu Dhabi
| | - Ahlam Kaid
- Dr Al Garhy, Dr Al Dhufairi, Dr Abdelrahman and Dr Al Maskari are all Psychiatrists; Dr Mahmoud is a Resident Psychiatrist; Dr Al Khanbashi and Mrs Salem are Clinical Psychologists, and Mrs Shalash is a Social Worker, all at Behavioral Science Pavilion in Sheikh Khalifa Medical City, Abu Dhabi
| | - Hannen Shalash
- Dr Al Garhy, Dr Al Dhufairi, Dr Abdelrahman and Dr Al Maskari are all Psychiatrists; Dr Mahmoud is a Resident Psychiatrist; Dr Al Khanbashi and Mrs Salem are Clinical Psychologists, and Mrs Shalash is a Social Worker, all at Behavioral Science Pavilion in Sheikh Khalifa Medical City, Abu Dhabi
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Ramesh R, Sundaresh A, Rajkumar RP, Negi VS, Vijayalakshmi MA, Krishnamoorthy R, Tamouza R, Leboyer M, Kamalanathan AS. DNA hydrolysing IgG catalytic antibodies: an emerging link between psychoses and autoimmunity. NPJ SCHIZOPHRENIA 2021; 7:13. [PMID: 33637732 PMCID: PMC7910540 DOI: 10.1038/s41537-021-00143-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/15/2021] [Indexed: 11/09/2022]
Abstract
It is not uncommon to observe autoimmune comorbidities in a significant subset of patients with psychotic disorders, namely schizophrenia (SCZ) and bipolar disorder (BPD). To understand the autoimmune basis, the DNA abyzme activity mediated by serum polyclonal IgG Abs were examined in psychoses patients, quantitatively, by an in-house optimized DNase assay. A similar activity exhibited by IgG Abs from neuropsychiatric-systemic lupus erythematosus (NP-SLE) patients was used as a comparator. Our data revealed that the IgG DNase activity of SCZ was close to that of NP-SLE and it was twofold higher than the healthy controls. Interestingly, the association between DNase activity with PANSS (positive, general and total scores) and MADRS were noted in a subgroup of SCZ and BPD patients, respectively. In our study group, the levels of IL-6 and total IgG in BPD patients were higher than SCZ and healthy controls, indicating a relatively inflammatory nature in BPD, while autoimmune comorbidity was mainly observed in SCZ patients.
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Affiliation(s)
- Rajendran Ramesh
- Centre for BioSeparation Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Aparna Sundaresh
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - M A Vijayalakshmi
- Centre for BioSeparation Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | | | - Ryad Tamouza
- Fondation FondaMental, Créteil, France.,Department of Psychiatry and Addictology, Mondor University Hospital, AP-HP, DMU IMPACT, Créteil, France.,University Paris-Est-Créteil, UPEC, Creteil, France.,INSERM, U955, Mondor Institute for Biomedical Research, IMRB, Translational Psychiatry, Créteil, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Department of Psychiatry and Addictology, Mondor University Hospital, AP-HP, DMU IMPACT, Créteil, France.,University Paris-Est-Créteil, UPEC, Creteil, France.,INSERM, U955, Mondor Institute for Biomedical Research, IMRB, Translational Psychiatry, Créteil, France
| | - A S Kamalanathan
- Centre for BioSeparation Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India.
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20
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Misiak B, Bartoli F, Carrà G, Małecka M, Samochowiec J, Jarosz K, Banik A, Stańczykiewicz B. Chemokine alterations in bipolar disorder: A systematic review and meta-analysis. Brain Behav Immun 2020; 88:870-877. [PMID: 32278851 DOI: 10.1016/j.bbi.2020.04.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022] Open
Abstract
We aimed to perform a systematic review and meta-analysis of studies examining the levels of chemokines in peripheral blood of patients with bipolar disorder (BD) and healthy controls. Meta-analysis was based on random-effects models with Hedges' g as the effect size estimate. We included 13 eligible studies (1221 BD patients and 663 controls). The following chemokines were analysed: interleukin-8 (IL-8), monocyte-chemoattractant protein-1 (MCP-1), eotaxin-1, eotaxin-2 and interferon-γ-induced protein 10 (IP-10). The levels of IL-8 (N = 8, g = 0.26, 95%CI: 0.11-0.41, p < 0.001), MCP-1 (N = 8, g = 0.40, 95%CI: 0.18-0.63), eotaxin-1 (N = 3, g = 0.55, 95%CI: 0.21-0.89, p = 0.001) and IP-10 (N = 4, g = 0.95, 95%CI: 0.67-1.22, p < 0.001) were significantly higher in BD patients as compared with controls. Subgroup analyses revealed that elevated levels of IL-8 (N = 5, g = 0.75, 95%CI: 0.42-1.07, p < 0.001) and MCP-1 (N = 4, g = 0.57, 95%CI: 0.28-0.86, p < 0.001) appeared only in BD patients during their depressive phase. Illness duration was associated with significantly lower levels of IL-8 in meta-regression analysis. In turn, elevated levels of IP-10 were present during euthymia (N = 2, g = 0.76, 95%CI: 0.43-1.10, p < 0.001) but not depression (N = 2, g = 1.81, 95%CI: -0.16 to 3.77, p = 0.072). The analysis of eotaxin-1 levels was mainly based on studies of euthymic BD patients (N = 3). Our results suggest that chemokine alterations in BD might be related to mood state. Elevated levels of IL-8 and MCP-1 might be specific to depression. Available evidence indicates that increased levels of eotaxin-1 and IP-10 appear in euthymia; however, more studies are needed to address these alterations in other mood states.
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Affiliation(s)
- Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland.
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Department of Mental Health & Addiction, ASST Nord Milano, Milano, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Department of Mental Health & Addiction, ASST Nord Milano, Milano, Italy; Division of Psychiatry, University College London, London, UK
| | - Monika Małecka
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Konrad Jarosz
- Department of Clinical Nursing, Pomeranian Medical University, Żołnierska 48 Street, 71-210 Szczecin, Poland
| | - Anna Banik
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, Ostrowskiego 30b Street, 53-238 Wroclaw, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
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21
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Chevance A, Gourion D, Hoertel N, Llorca PM, Thomas P, Bocher R, Moro MR, Laprévote V, Benyamina A, Fossati P, Masson M, Leaune E, Leboyer M, Gaillard R. [Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review]. L'ENCEPHALE 2020; 46:S3-S13. [PMID: 32312567 PMCID: PMC7130411 DOI: 10.1016/j.encep.2020.03.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. METHODS Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. RESULTS We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.
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Affiliation(s)
- A Chevance
- Université de Paris, CRESS, Inserm, INRA, 75004 Paris, France.
| | - D Gourion
- HEC Paris (Jouy-en-Josas), Paris, France
| | - N Hoertel
- Centre ressource régional de psychiatrie du sujet âgé (CRRPSA), service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, DMU psychiatrie et addictologie, Inserm U1266, institut de psychiatrie et neurosciences de Paris, centre université de Paris, AP-HP, Paris, France
| | - P-M Llorca
- Université Clermont-Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - P Thomas
- Laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), université de Lille, CNRS UMR 9193, CHU de Lille, Lille, France
| | | | - M-R Moro
- Université de Paris, collège national des universitaires de psychiatrie (CNUP), Inserm, CESP, Paris, France
| | - V Laprévote
- Pôle hospitalo-universitaire de psychiatrie d'adultes et d'addictologie du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Faculté de médecine, université de Lorraine, Nancy, France
| | - A Benyamina
- Département de psychiatrie et d'addictologie, hôpital Paul-Brousse, AP-HP, 94800 Villejuif, France; Unité psychiatrie-comorbidités-addictions-unité de recherche, PSYCOMADD université Paris Sud, université Paris Saclay, AP-HP, Paris, France
| | - P Fossati
- Service de psychiatrie adultes, Sorbonne université, groupe hospitalier Pitié-Salpêtrière, ICM, Inserm U1127, AP-HP, Paris, France
| | - M Masson
- SHU, GHU psychiatrie et neurosciences, Nightingale Hospitals-Paris, clinique du Château-de-Garches, Paris, France
| | - E Leaune
- Centre hospitalier Le Vinatier, Bron, France; Université Lyon, Lyon, France
| | - M Leboyer
- Université Paris Est Créteil, Inserm, Fondation FondaMental, AP-HP, Paris, France
| | - R Gaillard
- Université de Paris, GHU psychiatrie et neurosciences, Paris, France
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22
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Chevance A, Gourion D, Hoertel N, Llorca PM, Thomas P, Bocher R, Moro MR, Laprévote V, Benyamina A, Fossati P, Masson M, Leaune E, Leboyer M, Gaillard R. Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review. L'ENCEPHALE 2020; 46:193-201. [PMID: 32370982 PMCID: PMC7174154 DOI: 10.1016/j.encep.2020.04.005] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. METHODS The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. RESULTS We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units". These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.
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Affiliation(s)
- A Chevance
- Université de Paris, CRESS, Inserm, INRA, 75004 Paris, France.
| | - D Gourion
- Psychiatre libéral, HEC, Paris (Jouy-en-Josas), France
| | - N Hoertel
- Centre ressource régional de psychiatrie du sujet âgé (CRRPSA), Service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, DMU psychiatrie et addictologie, AP-HP, Centre-Université de Paris, Inserm U1266, Institut de psychiatrie et neurosciences de Paris, France
| | - P-M Llorca
- CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
| | - P Thomas
- CHU Lille, Université de Lille, CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), Lille, France
| | | | - M-R Moro
- Université de Paris, Présidente du Collège National des Universitaires de Psychiatrie (CNUP), Inserm, CESP, Paris, France
| | - V Laprévote
- Pôle hospitalo-universitaire de psychiatrie d'adultes et d'addictologie du Grand-Nancy, Centre Psychothérapique de Nancy, Faculté de Médecine, Université de Lorraine, Nancy, France
| | - A Benyamina
- AP-HP, Hôpital Paul Brousse, Département de Psychiatrie et d'Addictologie, Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche, PSYCOMADD Université Paris Sud - AP-HP, Université Paris Saclay, 94800 Villejuif, France
| | - P Fossati
- Service de psychiatrie adultes, APHP, Sorbonne université, Groupe Hospitalier pitié Salpêtrière, ICM, Inserm U1127, Paris, France
| | - M Masson
- Nightingale Hospitals-Paris, Clinique du Château de Garches, SHU, GHU Psychiatrie et neurosciences, Paris, France
| | - E Leaune
- Centre Hospitalier Le Vinatier, Université Lyon, Bron, Lyon, France
| | - M Leboyer
- AP-HP, Université Paris Est Créteil, Inserm, Fondation FondaMental, Paris, France
| | - R Gaillard
- Université de Paris, GHU Psychiatrie et neurosciences, Président de la sous-section 49-03 du Conseil National des Universités (CNU), Paris, France
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23
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Resende R, Fernandes T, Pereira AC, De Pascale J, Marques AP, Oliveira P, Morais S, Santos V, Madeira N, Pereira CF, Moreira PI. Mitochondria, endoplasmic reticulum and innate immune dysfunction in mood disorders: Do Mitochondria-Associated Membranes (MAMs) play a role? Biochim Biophys Acta Mol Basis Dis 2020; 1866:165752. [PMID: 32119897 DOI: 10.1016/j.bbadis.2020.165752] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 02/07/2023]
Abstract
Mood disorders like major depression and bipolar disorder (BD) are among the most prevalent forms of mental illness. Current knowledge of the neurobiology and pathophysiology of these disorders is still modest and clear biological markers are still missing. Thus, a better understanding of the underlying pathophysiological mechanisms to identify potential therapeutic targets is a prerequisite for the design of new drugs as well as to develop biomarkers that help in a more accurate and earlier diagnosis. Multiple pieces of evidence including genetic and neuro-imaging studies suggest that mood disorders are associated with abnormalities in endoplasmic-reticulum (ER)-related stress responses, mitochondrial function and calcium signalling. Furthermore, deregulation of the innate immune response has been described in patients diagnosed with mood disorders, including depression and BD. These disease-related events are associated with functions localized to a subdomain of the ER, known as Mitochondria-Associated Membranes (MAMs), which are lipid rafts-like domains that connect mitochondria and ER, both physically and biochemically. This review will outline the current understanding of the role of mitochondria and ER dysfunction under pathological brain conditions, particularly in major depressive disorder (MDD) and BD, that support the hypothesis that MAMs can act in these mood disorders as the link connecting ER-related stress response and mitochondrial impairment, as well as a mechanisms behind sterile inflammation arising from deregulation of innate immune responses. The role of MAMs in the pathophysiology of these pathologies and its potential relevance as a potential therapeutic target will be discussed.
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Affiliation(s)
- R Resende
- Center for Neuroscience and Cellular Biology (CNC), University of Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Portugal.
| | - T Fernandes
- Center for Neuroscience and Cellular Biology (CNC), University of Coimbra, Portugal
| | - A C Pereira
- Center for Neuroscience and Cellular Biology (CNC), University of Coimbra, Portugal
| | - J De Pascale
- Center for Neuroscience and Cellular Biology (CNC), University of Coimbra, Portugal
| | - A P Marques
- Center for Neuroscience and Cellular Biology (CNC), University of Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Portugal
| | - P Oliveira
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra (CHUC), Portugal; Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal
| | - S Morais
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra (CHUC), Portugal; Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal
| | - V Santos
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra (CHUC), Portugal; Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal
| | - N Madeira
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra (CHUC), Portugal; Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal
| | - C F Pereira
- Center for Neuroscience and Cellular Biology (CNC), University of Coimbra, Portugal; Institute of Biochemistry, Faculty of Medicine, University of Coimbra, Portugal
| | - P I Moreira
- Center for Neuroscience and Cellular Biology (CNC), University of Coimbra, Portugal; Institute of Physiology, Faculty of Medicine, University of Coimbra, Portugal
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24
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Maia A, Oliveira J, Lajnef M, Mallet L, Tamouza R, Leboyer M, Oliveira-Maia AJ. Oxidative and nitrosative stress markers in obsessive-compulsive disorder: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 139:420-433. [PMID: 30873609 DOI: 10.1111/acps.13026] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a chronic, prevalent, and highly impairing psychiatric illness. Although the pathophysiology of OCD remains unknown, pathways involved in oxidative and nitrosative stress (O&NS) have been implicated. The present study aims to systematically review the literature for quantitative evidence that patients with OCD have altered measures of blood O&NS markers. METHODS Independent random-effects meta-analyses using standardized mean differences were conducted to assess each marker separately. Additionally, data from multiple markers were pooled together in a meta-analysis for measures of oxidant activity and another for measures of antioxidant activity. RESULTS Thirteen studies met inclusion criteria, involving 433 OCD patients and 459 controls. Eleven blood O&NS markers were eligible for independent quantitative analyses. We found that, in OCD patients, the oxidant markers 8-hydroxydeoxyguanosine and malondialdehyde, and the antioxidants glutathione peroxidase and superoxide dismutase, were significantly increased while total antioxidant status, vitamin C, and vitamin E were significantly decreased, when comparing with controls. Regarding pooled meta-analyses, we found a statistically significant increase in oxidant markers, but non-significant results regarding antioxidant markers. CONCLUSIONS Our meta-analysis suggests that OCD patients have a systemic oxidative imbalance that is not adequately buffered by the antioxidant system. Additional studies are needed in order to support this association.
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Affiliation(s)
- A Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - J Oliveira
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - M Lajnef
- INSERM U955, Translational Psychiatry, Université Paris-Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France
| | - L Mallet
- Fondation Fondamental, Créteil, France.,CNRS, INSERM, Institut du cerveau et de la moelle épinière, Sorbonne Universités, UPMC Univ Paris 06, Paris, France.,Assistance Publique-Hôpitaux de Paris, Pôle de psychiatrie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Université Paris-Est Créteil, Créteil, France.,Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - R Tamouza
- Fondation Fondamental, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Pôle de psychiatrie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Université Paris-Est Créteil, Créteil, France
| | - M Leboyer
- INSERM U955, Translational Psychiatry, Université Paris-Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Pôle de psychiatrie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Université Paris-Est Créteil, Créteil, France
| | - A J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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25
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Fries GR, Walss-Bass C, Bauer ME, Teixeira AL. Revisiting inflammation in bipolar disorder. Pharmacol Biochem Behav 2019; 177:12-19. [DOI: 10.1016/j.pbb.2018.12.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/05/2018] [Accepted: 12/20/2018] [Indexed: 01/11/2023]
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26
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Druart M, Le Magueresse C. Emerging Roles of Complement in Psychiatric Disorders. Front Psychiatry 2019; 10:573. [PMID: 31496960 PMCID: PMC6712161 DOI: 10.3389/fpsyt.2019.00573] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/22/2019] [Indexed: 12/12/2022] Open
Abstract
The complement system consists of more than 30 proteins that have long been known to participate to the immune defence against pathogens and to the removal of damaged cells. Their role, however, extends beyond immunity and clearance of altered "self" components in the periphery. In particular, complement proteins can be induced by all cell types in the brain. Recent discoveries highlight the role of complement in normal and pathological brain development. Specifically, the complement system mediates synaptic pruning, a developmental process whereby supernumerary synapses are eliminated in the immature brain. The complement system has been implicated in pathological synapse elimination in schizophrenia, West Nile virus infection, and lupus, all of which are associated with psychiatric manifestations. Complement also contributes to synapse loss in neurodegenerative conditions. This review provides a brief overview of the well-studied role of complement molecules in immunity. The contribution of complement to embryonic and adult neurogenesis, neuronal migration, and developmental synaptic elimination in the normal brain is reviewed. We discuss the role of complement in synapse loss in psychiatric and neurological diseases and evaluate the therapeutic potential of complement-targeting drugs for brain disorders.
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Affiliation(s)
- Mélanie Druart
- INSERM UMR-S 1270, Paris, France.,Science and Engineering Faculty, Sorbonne Université, Paris, France.,Institut du Fer à Moulin, Paris, France
| | - Corentin Le Magueresse
- INSERM UMR-S 1270, Paris, France.,Science and Engineering Faculty, Sorbonne Université, Paris, France.,Institut du Fer à Moulin, Paris, France
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Conway F, Brown AS. Maternal Immune Activation and Related Factors in the Risk of Offspring Psychiatric Disorders. Front Psychiatry 2019; 10:430. [PMID: 31316403 PMCID: PMC6611212 DOI: 10.3389/fpsyt.2019.00430] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/31/2019] [Indexed: 12/25/2022] Open
Abstract
Maternal immune activation (MIA) at the time of gestation has been linked to increased risk of neurodevelopmental psychiatric disorders. Animal and human models have been used to evaluate the relationship between MIA and these outcomes. Given that each of these two disciplines of study have their benefits and limitations, a translational perspective is expected to illuminate more than by the use of any single approach. In this article, we discuss this translational framework and explore how it may be enhanced by the utilization of epigenetic studies and by investigating the microbiome. In this perspectives piece, we focus on the impact of epidemiologic studies, animal models, and preclinical studies in the literature on MIA as well as the potential for greater integration between fields.
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Affiliation(s)
- Fiona Conway
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, United States
| | - Alan S Brown
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, United States
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Brown AS, Meyer U. Maternal Immune Activation and Neuropsychiatric Illness: A Translational Research Perspective. Am J Psychiatry 2018; 175:1073-1083. [PMID: 30220221 PMCID: PMC6408273 DOI: 10.1176/appi.ajp.2018.17121311] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epidemiologic studies, including prospective birth cohort investigations, have implicated maternal immune activation in the etiology of neuropsychiatric disorders. Maternal infectious pathogens and inflammation are plausible risk factors for these outcomes and have been associated with schizophrenia, autism spectrum disorder, and bipolar disorder. Concurrent with epidemiologic research are animal models of prenatal immune activation, which have documented behavioral, neurochemical, neuroanatomic, and neurophysiologic disruptions that mirror phenotypes observed in these neuropsychiatric disorders. Epidemiologic studies of maternal immune activation offer the advantage of directly evaluating human populations but are limited in their ability to uncover pathogenic mechanisms. Animal models, on the other hand, are limited in their generalizability to psychiatric disorders but have made significant strides toward discovering causal relationships and biological pathways between maternal immune activation and neuropsychiatric phenotypes. Incorporating these risk factors in reverse translational animal models of maternal immune activation has yielded a wealth of data supporting the predictive potential of epidemiologic studies. To further enhance the translatability between epidemiology and basic science, the authors propose a complementary approach that includes deconstructing neuropsychiatric outcomes of maternal immune activation into key pathophysiologically defined phenotypes that are identifiable in humans and animals and that evaluate the interspecies concordance regarding interactions between maternal immune activation and genetic and epigenetic factors, including processes involving intergenerational disease transmission. [AJP AT 175: Remembering Our Past As We Envision Our Future October 1857: The Pathology of Insanity J.C. Bucknill: "In the brain the state of inflammation itself either very quickly ceases or very soon causes death; but when it does cease it leaves behind it consequences which are frequently the causes of insanity, and the conditions of cerebral atrophy." (Am J Psychiatry 1857; 14:172-193 )].
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Affiliation(s)
- Alan S. Brown
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Urs Meyer
- Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
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Oliveira J, Oliveira‐Maia AJ, Tamouza R, Brown AS, Leboyer M. Infectious and immunogenetic factors in bipolar disorder. Acta Psychiatr Scand 2017; 136:409-423. [PMID: 28832904 PMCID: PMC7159344 DOI: 10.1111/acps.12791] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Despite the evidence supporting the association between infection and bipolar disorder (BD), the genetic vulnerability that mediates its effects has yet to be clarified. A genetic origin for the immune imbalance observed in BD, possibly involved in the mechanisms of pathogen escape, has, however, been suggested in recent studies. METHOD Here, we present a critical review based on a systematic literature search of articles published until December 2016 on the association between BD and infectious/immunogenetic factors. RESULTS We provide evidence suggesting that infectious insults could act as triggers of maladaptive immune responses in BD and that immunogenetic vulnerability may amplify the effects of such environmental risk factors, increasing susceptibility to subsequent environmental encounters. Quality of evidence was generally impaired by scarce attempt of replication, small sample sizes and lack of high-quality environmental measures. CONCLUSION Infection has emerged as a potential preventable cause of morbidity in BD, urging the need to better investigate components of the host-pathogen interaction in patients and at-risk subjects, and thus opening the way to novel therapeutic opportunities.
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Affiliation(s)
- J. Oliveira
- Champalimaud Clinical CentreChampalimaud Centre for the UnknownLisboaPortugal,Centro Hospitalar Psiquiátrico de LisboaLisboaPortugal
| | - A. J. Oliveira‐Maia
- Champalimaud Clinical CentreChampalimaud Centre for the UnknownLisboaPortugal,Department of Psychiatry and Mental HealthCentro Hospitalar de Lisboa OcidentalLisboaPortugal,Champalimaud ResearchChampalimaud Centre for the UnknownLisboaPortugal,Faculdade de Ciências MédicasNOVA Medical SchoolUniversidade Nova de LisboaLisboaPortugal
| | - R. Tamouza
- Hôpital Saint LouisINSERM U1160Université Paris DiderotParisFrance,Fondation FondamentalCréteilFrance
| | - A. S. Brown
- Columbia University Medical CenterNew YorkNYUSA
| | - M. Leboyer
- Fondation FondamentalCréteilFrance,Department of PsychiatryAP‐HP, DHU PePSYHôpital Henri MondorUniversité Paris‐Est‐CréteilCréteilFrance,Translational PsychiatryINSERM U955CréteilFrance
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