1
|
Mendez-Victoriano G, Zhu Y, Middleton F, Massa PT, Ajulu K, Webster MJ, Weickert CS. Increased Parenchymal Macrophages are associated with decreased Tyrosine Hydroxylase mRNA levels in the Substantia Nigra of people with Schizophrenia and Bipolar Disorder. Psychiatry Res 2024; 340:116141. [PMID: 39153291 DOI: 10.1016/j.psychres.2024.116141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 07/09/2024] [Accepted: 08/10/2024] [Indexed: 08/19/2024]
Abstract
Increased activation of inflammatory macrophages and altered expression of dopamine markers are found in the midbrains of people with schizophrenia (SZ). The relationship of midbrain macrophages to dopamine neurons has not been explored, nor is it known if changes in midbrain macrophages are also present in bipolar disorder (BD) or major depressive disorder (MDD). Herein, we determined whether there were differences in CD163+ cell density in the Substantia Nigra (SN), and cerebral peduncles (CP) of SZ, BD, and MDD compared to controls (CTRL). We also analyzed whether CD163 protein and dopamine-synthesizing enzyme tyrosine hydroxylase (TH) mRNA levels differed among diagnostic groups and if they correlated with the density of macrophages. Overall, perivascular CD163+ cell density was higher in the gray matter (SN) than in the white matter (CP). Compared to CTRL, we found increased density of parenchymal CD163+ cells in the SN of the three psychiatric groups and increased CD163 protein levels in SZ. CD163 protein was positively correlated with density of perivascular CD163+ cells. TH mRNA was reduced in SZ and BD and negatively correlated with parenchymal CD163+ cell density. We provide the first quantitative and molecular evidence of an increase in the density of parenchymal macrophages in the midbrain of major mental illnesses and show that the presence of these macrophages may negatively impact dopaminergic neurons.
Collapse
Affiliation(s)
- Gerardo Mendez-Victoriano
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA; Neuroscience Research Australia, Sydney, NSW, Australia; School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Yunting Zhu
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA
| | - Frank Middleton
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA
| | - Paul T Massa
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA
| | - Kachikwulu Ajulu
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA
| | - Maree J Webster
- Laboratory of Brain Research, Stanley Medical Research Institute, 9800 Medical Center Drive, Rockville, MD, USA
| | - Cynthia S Weickert
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA; Neuroscience Research Australia, Sydney, NSW, Australia; School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW 2052, Australia.
| |
Collapse
|
2
|
Carriello MA, Costa DFB, Alvim PHP, Pestana MC, Bicudo DDS, Gomes EMP, Coelho TA, Biava PJ, Berlitz VG, Bianchini AJ, Shiokawa A, Shiokawa N, Sato MT, Massuda R. Retinal layers and symptoms and inflammation in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2024; 274:1115-1124. [PMID: 36928482 DOI: 10.1007/s00406-023-01583-0] [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: 11/11/2022] [Accepted: 02/26/2023] [Indexed: 03/18/2023]
Abstract
Schizophrenia is a neurodevelopmental disorder that affects brain structure and function. The retina, as well as the brain, consists of neuronal and glial cells packed in layers. Cortical volume and brain thickness are associated with inflammatory biomarkers, however, no study has been performed associating inflammatory biomarkers and retina in schizophrenia. our study aims to compare the retinal macular thickness and volume and peripapillary thickness in patients with schizophrenia and controls, and associate it to symptoms of schizophrenia, to interleukin-6 (IL-6) and C Reactive Protein (CRP) levels. Optical coherence tomography was performed to assess retinal layer thickness and volume, and CRP and IL-6 levels were measured in patients with schizophrenia and controls. Positive, negative, and general symptoms of schizophrenia were measured with the Positive and Negative Syndrome Scale (PANSS). A linear regression controlling for confounding factors was performed. 70 subjects were included, 35 patients, and 35 controls matched for sex and age. Patients with schizophrenia presented a significantly lower macular volume (p < 0.05) and thickness (< 0.05) than controls. PANSS positive, general and total scores were associated with retinal nerve fiber layer (RNFL) thickness (p < 0.05). There was no association between inflammatory markers (CRP and IL-6) levels and the retinal layer. A reduction in macular volume and thickness was found in patients with schizophrenia. The severity of schizophrenia symptoms was associated with RNFL thickness. CRP and IL-6 are not associated with retinal thickness/volume in schizophrenia or controls.
Collapse
Affiliation(s)
- Marcelo Alves Carriello
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil.
| | - Diogo F Bornancin Costa
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Pedro Henrique Pereira Alvim
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Mariana Camargo Pestana
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Duana Dos Santos Bicudo
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Eloisa Maria Pontarolo Gomes
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Tamires Amelotti Coelho
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Patrick Junior Biava
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Vitória Gabriela Berlitz
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Ana J Bianchini
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Aline Shiokawa
- Retina and Vitreous Ophthalmology-Curitiba, Curitiba, Brazil
| | - Naoye Shiokawa
- Retina and Vitreous Ophthalmology-Curitiba, Curitiba, Brazil
| | - Mario Teruo Sato
- Retina and Vitreous Ophthalmology-Curitiba, Curitiba, Brazil
- Department of Ophthalmology, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| | - Raffael Massuda
- Psychotic Disorders Research Program, Department of Psychiatry, Universidade Federal Do Paraná-UFPR, Curitiba, Brazil
| |
Collapse
|
3
|
Li M, Luo G, Qiu Y, Zhang X, Sun X, Li Y, Zhao Y, Sun W, Yang S, Li J. Negative symptoms and neurocognition in drug-naïve schizophrenia: moderating role of plasma neutrophil gelatinase-associated lipocalin (NGAL) and interferon-gamma (INF-γ). Eur Arch Psychiatry Clin Neurosci 2024; 274:1071-1081. [PMID: 37490111 DOI: 10.1007/s00406-023-01650-6] [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: 11/10/2022] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
Previous studies reported that peripheral inflammation was associated with cognitive performance and brain structure in schizophrenia. However, the moderating effect of inflammation has not been extensively studied. This study investigated whether inflammation markers moderated the association between negative symptoms and neurocognition in schizophrenia. This cross-sectional study included 137 drug-naïve schizophrenia patients (DNS) and 67 healthy controls (HC). We performed the Measurements and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) for cognitive assessment and the Positive and Negative Syndrome Scale (PANSS) for psychiatric symptoms. Plasma concentrations of interferon-gamma (IFN-γ), neutrophil gelatinase-associated lipocalin (NGAL), and nuclear factor kappa B (NF-κB) were measured. The MCCB neurocognition score, social cognition score, and total score; the plasma concentrations of NGAL, IFN-γ, and NF-κB were significantly decreased in DNS than in HC (all P's < 0.001). PANSS negative subscale (PNS), PANSS reduced expressive subdomain (RES) negatively correlated with neurocognition score (P = 0.007; P = 0.011, respectively). Plasma concentrations of IFN-γ and NGAL positively correlated with neurocognition score (P = 0.043; P = 0.008, relatively). The interactions of PNS × NGAL; PNS × IFN-γ; RES × IFN-γ accounted for significant neurocognition variance (P = 0.025; P = 0.029, P = 0.007, respectively). Simple slope analysis showed that all the above moderating effects only occurred in patients with near normal IFN-γ and NGAL levels. Plasma concentrations of IFN-γ and NGAL moderated the relationship between negative symptoms (especially RES) and neurocognition in schizophrenia. Treatment targeting inflammation may contribute to neurocognition improvement in schizophrenia.
Collapse
Affiliation(s)
- Meijuan Li
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Guoshuai Luo
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Yuying Qiu
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Xue Zhang
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
- Chifeng Anding Hospital, Chifeng, China
| | - Xiaoxiao Sun
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Yanzhe Li
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Yongping Zhao
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Wei Sun
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Shu Yang
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Jie Li
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China.
| |
Collapse
|
4
|
Schaefer JK, Engert V, Valk SL, Singer T, Puhlmann LM. Mapping pathways to neuronal atrophy in healthy, mid-aged adults: From chronic stress to systemic inflammation to neurodegeneration? Brain Behav Immun Health 2024; 38:100781. [PMID: 38725445 PMCID: PMC11081785 DOI: 10.1016/j.bbih.2024.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/27/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Growing evidence implicates systemic inflammation in the loss of structural brain integrity in natural ageing and disorder development. Chronic stress and glucocorticoid exposure can potentiate inflammatory processes and may also be linked to neuronal atrophy, particularly in the hippocampus and the human neocortex. To improve understanding of emerging maladaptive interactions between stress and inflammation, this study examined evidence for glucocorticoid- and inflammation-mediated neurodegeneration in healthy mid-aged adults. N = 169 healthy adults (mean age = 39.4, 64.5% female) were sampled from the general population in the context of the ReSource Project. Stress, inflammation and neuronal atrophy were quantified using physiological indices of chronic stress (hair cortisol (HCC) and cortisone (HEC) concentration), systemic inflammation (interleukin-6 (IL-6), high-sensitive C-reactive protein (hs-CRP)), the systemic inflammation index (SII), hippocampal volume (HCV) and cortical thickness (CT) in regions of interest. Structural equation models were used to examine evidence for pathways from stress and inflammation to neuronal atrophy. Model fit indices indicated good representation of stress, inflammation, and neurological data through the constructed models (CT model: robust RMSEA = 0.041, robust χ2 = 910.90; HCV model: robust RMSEA <0.001, robust χ2 = 40.95). Among inflammatory indices, only the SII was positively associated with hair cortisol as one indicator of chronic stress (β = 0.18, p < 0.05). Direct and indirect pathways from chronic stress and systemic inflammation to cortical thickness or hippocampal volume were non-significant. In exploratory analysis, the SII was inversely related to mean cortical thickness. Our results emphasize the importance of considering the multidimensionality of systemic inflammation and chronic stress, with various indicators that may represent different aspects of the systemic reaction. We conclude that inflammation and glucocorticoid-mediated neurodegeneration indicated by IL-6 and hs-CRP and HCC and HEC may only emerge during advanced ageing and disorder processes, still the SII could be a promising candidate for detecting associations between inflammation and neurodegeneration in younger and healthy samples. Future work should examine these pathways in prospective longitudinal designs, for which the present investigation serves as a baseline.
Collapse
Affiliation(s)
- Julia K. Schaefer
- Cognitive Neuropsychology, Department of Psychology, Ludwig-Maximilians-Universität München, Germany
| | - Veronika Engert
- Research Group “Social Stress and Family Health”, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Clinic, Friedrich-Schiller University, Jena, Germany
| | - Sofie L. Valk
- Otto Hahn Group Cognitive Neurogenetics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, FZ Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tania Singer
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
| | - Lara M.C. Puhlmann
- Research Group “Social Stress and Family Health”, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
| |
Collapse
|
5
|
North HF, Weissleder C, Bitar M, Barry G, Fullerton JM, Webster MJ, Weickert CS. RNA-sequencing suggests extracellular matrix and vasculature dysregulation could impair neurogenesis in schizophrenia cases with elevated inflammation. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:50. [PMID: 38704390 PMCID: PMC11069512 DOI: 10.1038/s41537-024-00466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
A subgroup of schizophrenia cases with elevated inflammation have reduced neurogenesis markers and increased macrophage density in the human subependymal zone (SEZ; also termed subventricular zone or SVZ) neurogenic niche. Inflammation can impair neurogenesis; however, it is unclear which other pathways are associated with reduced neurogenesis. This research aimed to discover transcriptomic differences between inflammatory subgroups of schizophrenia in the SEZ. Total RNA sequencing was performed on SEZ tissue from schizophrenia cases, designated into low inflammation (n = 13) and high inflammation (n = 14) subgroups, based on cluster analysis of inflammation marker gene expression. 718 genes were differentially expressed in high compared to low inflammation schizophrenia (FDR p < 0.05) and were most significantly over-represented in the pathway 'Hepatic Fibrosis/Hepatic Stellate-Cell Activation'. Genes in this pathway relate to extracellular matrix stability (including ten collagens) and vascular remodelling suggesting increased angiogenesis. Collagen-IV, a key element of the basement membrane and fractones, had elevated gene expression. Immunohistochemistry revealed novel collagen-IV+ fractone bulbs within the human SEZ hypocellular gap. Considering the extracellular matrix's regulatory role in SEZ neurogenesis, fibrosis-related alterations in high inflammation schizophrenia may disrupt neurogenesis. Increased angiogenesis could facilitate immune cell transmigration, potentially explaining elevated macrophages in high inflammation schizophrenia. This discovery-driven analysis sheds light on how inflammation may contribute to schizophrenia neuropathology in the neurogenic niche.
Collapse
Affiliation(s)
- Hayley F North
- Neuroscience Research Australia, Sydney, NSW, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Christin Weissleder
- Neuroscience Research Australia, Sydney, NSW, Australia
- Mechanism and therapy for genetic brain diseases, Institut Imagine, Paris, France
| | | | - Guy Barry
- OncoLife Therapeutics, Yeronga, QLD, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Maree J Webster
- Laboratory of Brain Research, Stanley Medical Research Institute, 9800, Medical Center Drive, Rockville, MD, USA
| | - Cynthia Shannon Weickert
- Neuroscience Research Australia, Sydney, NSW, Australia.
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA.
| |
Collapse
|
6
|
Kiltschewskij DJ, Reay WR, Geaghan MP, Atkins JR, Xavier A, Zhang X, Watkeys OJ, Carr VJ, Scott RJ, Green MJ, Cairns MJ. Alteration of DNA Methylation and Epigenetic Scores Associated With Features of Schizophrenia and Common Variant Genetic Risk. Biol Psychiatry 2024; 95:647-661. [PMID: 37480976 DOI: 10.1016/j.biopsych.2023.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Unpacking molecular perturbations associated with features of schizophrenia is a critical step toward understanding phenotypic heterogeneity in this disorder. Recent epigenome-wide association studies have uncovered pervasive dysregulation of DNA methylation in schizophrenia; however, clinical features of the disorder that account for a large proportion of phenotypic variability are relatively underexplored. METHODS We comprehensively analyzed patterns of DNA methylation in a cohort of 381 individuals with schizophrenia from the deeply phenotyped Australian Schizophrenia Research Bank. Epigenetic changes were investigated in association with cognitive status, age of onset, treatment resistance, Global Assessment of Functioning scores, and common variant polygenic risk scores for schizophrenia. We subsequently explored alterations within genes previously associated with psychiatric illness, phenome-wide epigenetic covariance, and epigenetic scores. RESULTS Epigenome-wide association studies of the 5 primary traits identified 662 suggestively significant (p < 6.72 × 10-5) differentially methylated probes, with a further 432 revealed after controlling for schizophrenia polygenic risk on the remaining 4 traits. Interestingly, we uncovered many probes within genes associated with a variety of psychiatric conditions as well as significant epigenetic covariance with phenotypes and exposures including acute myocardial infarction, C-reactive protein, and lung cancer. Epigenetic scores for treatment-resistant schizophrenia strikingly exhibited association with clozapine administration, while epigenetic proxies of plasma protein expression, such as CCL17, MMP10, and PRG2, were associated with several features of schizophrenia. CONCLUSIONS Our findings collectively provide novel evidence suggesting that several features of schizophrenia are associated with alteration of DNA methylation, which may contribute to interindividual phenotypic variation in affected individuals.
Collapse
Affiliation(s)
- Dylan J Kiltschewskij
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Precision Medicine Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - William R Reay
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Precision Medicine Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Michael P Geaghan
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Joshua R Atkins
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alexandre Xavier
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Centre for Information Based Medicine, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Xiajie Zhang
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Centre for Information Based Medicine, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Oliver J Watkeys
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Rodney J Scott
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Centre for Information Based Medicine, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Melissa J Green
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Murray J Cairns
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Precision Medicine Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia.
| |
Collapse
|
7
|
Chui MKK, Schneider K, Miclau K, LaHue SC, Furman D, Leutwyler H, Newman JC. Associations of Systemic Inflammation and Senescent Cell Biomarkers with Clinical Outcomes in Older Adults with Schizophrenia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.06.24303857. [PMID: 38496401 PMCID: PMC10942530 DOI: 10.1101/2024.03.06.24303857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Individuals with schizophrenia suffer from higher morbidity and mortality throughout life partly due to acceleration of aging-related diseases and conditions. Systemic inflammation is a hallmark of aging and is also observed in schizophrenia. An improved understanding of how inflammation and accelerated aging contribute to long-term health outcomes in schizophrenia could provide more effective treatments to preserve long-term cognitive and physical function. In this pilot cross-sectional study, 24 older adults (≥55 years old) with schizophrenia were assessed on symptoms (Positive and Negative Syndrome Scale), neurocognition (Matrics Consensus Cognitive Battery), mobility (Timed Get Up and Go), and general health (SF-12). Serum levels of 112 different cytokines were measured, from which we derived estimated senescence-associated secretory phenotype (SASP) scores for each participant. Two-tailed Pearson's bivariate correlations were computed to test the associations between schizophrenia clinical outcomes with individual cytokines, and SASP. Higher levels of eotaxin, IL-1α, IL-1β, and IFNα are associated with both worse PANSS negative and depressive symptoms scores. IL-1α and IL-1β negatively associated with general physical health whereas eotaxin negatively associated with mobility and global cognition. Overall, we found that specific inflammatory cytokines, but not composite measurements of SASP, are associated with clinical outcomes in older adults with schizophrenia.
Collapse
Affiliation(s)
- M K Kirsten Chui
- Buck Institute for Research on Aging, Novato CA, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | | | - Katherine Miclau
- School of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Sara C LaHue
- Buck Institute for Research on Aging, Novato CA, USA
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA
| | - David Furman
- Buck Artificial Intelligence Platform, the Buck Institute for Research on Aging, Novato, CA, USA
- Stanford 1000 Immunomes Project, Stanford University School of Medicine, Stanford, CA, USA
- Instituto de Investigaciones en Medicina Traslacional (IIMT), Universidad Austral, CONICET, Pilar, Argentina
| | - Heather Leutwyler
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco CA, USA
| | - John C Newman
- Buck Institute for Research on Aging, Novato CA, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Division of Geriatrics, School of Medicine, University of California San Francisco, San Francisco CA, USA
| |
Collapse
|
8
|
Weickert TW, Ji E, Galletly C, Boerrigter D, Morishima Y, Bruggemann J, Balzan R, O’Donnell M, Liu D, Lenroot R, Weickert CS, Kindler J. Toll-Like Receptor mRNA Levels in Schizophrenia: Association With Complement Factors and Cingulate Gyrus Cortical Thinning. Schizophr Bull 2024; 50:403-417. [PMID: 38102721 PMCID: PMC10919782 DOI: 10.1093/schbul/sbad171] [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] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND HYPOTHESES Previous studies revealed innate immune system activation in people with schizophrenia (SZ), potentially mediated by endogenous pathogen recognition receptors, notably Toll-like receptors (TLR). TLRs are activated by pathogenic molecules like bacterial lipopolysaccharides (TLR1 and TLR4), viral RNA (TLR3), or both (TLR8). Furthermore, the complement system, another key component of innate immunity, has previously been linked to SZ. STUDY DESIGN Peripheral mRNA levels of TLR1, TLR3, TLR4, and TLR8 were compared between SZ and healthy controls (HC). We investigated their relationship with immune activation through complement expression and cortical thickness of the cingulate gyrus, a region susceptible to immunological hits. TLR mRNA levels and peripheral complement receptor mRNA were extracted from 86 SZ and 77 HC white blood cells; structural MRI scans were conducted on a subset. STUDY RESULTS We found significantly higher TLR4 and TLR8 mRNA levels and lower TLR3 mRNA levels in SZ compared to HC. TLRs and complemental factors were significantly associated in SZ and HC, with the strongest deviations of TLR mRNA levels in the SZ subgroup having elevated complement expression. Cortical thickness of the cingulate gyrus was inversely associated with TLR8 mRNA levels in SZ, and with TLR4 and TLR8 levels in HC. CONCLUSIONS The study underscores the role of innate immune activation in schizophrenia, indicating a coordinated immune response of TLRs and the complement system. Our results suggest there could be more bacterial influence (based on TLR 4 levels) as opposed to viral influence (based on TLR3 levels) in schizophrenia. Specific TLRs were associated with brain cortical thickness reductions of limbic brain structures.
Collapse
Affiliation(s)
- Thomas W Weickert
- Neuroscience Research Australia, Schizophrenia Research Institute, Randwick, NSW 2031, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031Australia
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY 13210, USA
| | - Ellen Ji
- Psychiatric University Hospital Zurich, Zurich, Switzerland
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Ramsay Health Care (SA) Mental Health, Adelaide, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Danny Boerrigter
- Neuroscience Research Australia, Schizophrenia Research Institute, Randwick, NSW 2031, Australia
| | - Yosuke Morishima
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Jason Bruggemann
- Neuroscience Research Australia, Schizophrenia Research Institute, Randwick, NSW 2031, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031Australia
- Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, Australia
- Speciality of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ryan Balzan
- School of Psychology, Flinders University, Adelaide, SA, Australia
| | - Maryanne O’Donnell
- Neuroscience Research Australia, Schizophrenia Research Institute, Randwick, NSW 2031, Australia
- Kiloh Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Dennis Liu
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Ramsay Health Care (SA) Mental Health, Adelaide, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Rhoshel Lenroot
- Neuroscience Research Australia, Schizophrenia Research Institute, Randwick, NSW 2031, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031Australia
- Department of Psychiatry, University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Cynthia Shannon Weickert
- Neuroscience Research Australia, Schizophrenia Research Institute, Randwick, NSW 2031, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031Australia
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY 13210, USA
| | - Jochen Kindler
- Neuroscience Research Australia, Schizophrenia Research Institute, Randwick, NSW 2031, Australia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| |
Collapse
|
9
|
Zhang Y, Tang W, Tang B, Fan K, Zhao K, Fang X, Lin H. Altered mitochondrial lymphocyte in overweight schizophrenia patients treated with atypical antipsychotics and its association with cognitive function. Front Immunol 2024; 14:1325495. [PMID: 38235140 PMCID: PMC10791827 DOI: 10.3389/fimmu.2023.1325495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
Objective Increasing evidence indicated that schizophrenia and obesity are associated with altered mitochondrial and immune function. In this study, we investigated the levels of CRP (C-reactive protein) and mitochondrial lymphocytes in chronically treated schizophrenia patients with atypical antipsychotic medications and further explored the relationship between mitochondrial lymphocyte and weight gain as well as cognitive function in these patients. Methods We evaluated the mitochondrial lymphocyte count of 97 patients (53 overweight, 44 non-overweight) and 100 healthy controls using mitochondrial fluorescence staining and flow cytometry (NovoCyte, Agilent Technologies, US). The serum CRP was measured by high-sensitivity enzyme-linked immunosorbent assay (ELISA). Clinical symptoms and cognitive function of the patients were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results The results showed that mitochondrial lymphocyte counts of CD3+ T, CD3+CD4+ T, and CD3+CD8+ T cells in schizophrenia patients were higher than in the control group (p < 0.05). Additionally, overweight patients had significantly higher mitochondrial lymphocyte counts of CD3+ T and CD3+CD4+ T cells compared to schizophrenia patients with normal weight. Stratified analysis by gender revealed that there was a statistically significant difference in CD3+CD4+ mitochondrial lymphocyte count in male patients (p = 0.014) and a marginal trend toward significance in female patients (p = 0.058). Furthermore, the mitochondrial lymphocyte counts of CD3+ T and CD3+CD4+ T cells, as well as CRP levels, were positively correlated with BMI in schizophrenia patients, but the mitochondrial lymphocyte counts of CD3+CD4+ T cells were negatively correlated with the language scale in the RBANS. Conclusion Our study results provide evidence for the association between altered mitochondrial T lymphocyte and weight gain as well as cognitive impairment in schizophrenia patients treated with atypical antipsychotic medications.
Collapse
Affiliation(s)
- Yaoyao Zhang
- Department of Psychiatry, The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, Zhejiang, China
| | - Wei Tang
- Department of Psychiatry, The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, Zhejiang, China
| | - Bei Tang
- Department of Education, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kaili Fan
- Department of Psychiatry, Wenzhou Seventh People’s Hospital, Wenzhou, Zhejiang, China
| | - Ke Zhao
- Department of Psychiatry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinyu Fang
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Lin
- Department of Psychiatry, The Second People`s Hospital of YuHuan, Taizhou, Zhejiang, China
| |
Collapse
|
10
|
Weickert TW, Weickert CS. A path to novel, effective treatments for schizophrenia. Neuropsychopharmacology 2024; 49:321-322. [PMID: 37580457 PMCID: PMC10700505 DOI: 10.1038/s41386-023-01705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Thomas W Weickert
- Department of Neuroscience and Physiology, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, 13210, USA.
- Neuroscience Research Australia, Sydney, NSW, 2031, Australia.
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA.
| | - Cynthia Shannon Weickert
- Department of Neuroscience and Physiology, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, 13210, USA
- Neuroscience Research Australia, Sydney, NSW, 2031, Australia
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2031, Australia
| |
Collapse
|
11
|
Parker N, Cheng W, Hindley GFL, O'Connell KS, Karthikeyan S, Holen B, Shadrin AA, Rahman Z, Karadag N, Bahrami S, Lin A, Steen NE, Ueland T, Aukrust P, Djurovic S, Dale AM, Smeland OB, Frei O, Andreassen OA. Genetic Overlap Between Global Cortical Brain Structure, C-Reactive Protein, and White Blood Cell Counts. Biol Psychiatry 2024; 95:62-71. [PMID: 37348803 DOI: 10.1016/j.biopsych.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/02/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND For many brain disorders, a subset of patients jointly exhibit alterations in cortical brain structure and elevated levels of circulating immune markers. This may be driven in part by shared genetic architecture. Therefore, we investigated the phenotypic and genetic associations linking global cortical surface area and thickness with blood immune markers (i.e., white blood cell counts and plasma C-reactive protein levels). METHODS Linear regression was used to assess phenotypic associations in 30,823 UK Biobank participants. Genome-wide and local genetic correlations were assessed using linkage disequilibrium score regression and local analysis of covariance annotation. The number of shared trait-influencing genetic variants was estimated using MiXeR. Shared genetic architecture was assessed using a conjunctional false discovery rate framework, and mapped genes were included in gene-set enrichment analyses. RESULTS Cortical structure and blood immune markers exhibited predominantly inverse phenotypic associations. There were modest genome-wide genetic correlations, the strongest of which were for C-reactive protein levels (rg_surface_area = -0.13, false discovery rate-corrected p = 4.17 × 10-3; rg_thickness = -0.13, false discovery rate-corrected p = 4.00 × 10-2). Meanwhile, local genetic correlations showed a mosaic of positive and negative associations. White blood cells shared on average 46.24% and 38.64% of trait-influencing genetic variants with surface area and thickness, respectively. Additionally, surface area shared 55 unique loci with the blood immune markers while thickness shared 15. Overall, monocyte count exhibited the largest genetic overlap with cortical brain structure. A series of gene enrichment analyses implicated neuronal-, astrocytic-, and schizophrenia-associated genes. CONCLUSIONS The findings indicate shared genetic underpinnings for cortical brain structure and blood immune markers, with implications for neurodevelopment and understanding the etiology of brain-related disorders.
Collapse
Affiliation(s)
- Nadine Parker
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Weiqiu Cheng
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guy F L Hindley
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Psychosis Studies, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Kevin S O'Connell
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sandeep Karthikeyan
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Børge Holen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alexey A Shadrin
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Zillur Rahman
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Naz Karadag
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Shahram Bahrami
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Aihua Lin
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway; KG Jebsen Thrombosis Research and Expertise Centre, University of Tromsø, Tromsø, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Disease, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California; Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Neurosciences, University of California San Diego, La Jolla, California; Department of Radiology, University of California San Diego, La Jolla, California
| | - Olav B Smeland
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Oleksandr Frei
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| |
Collapse
|
12
|
Weickert TW, Jacomb I, Lenroot R, Lappin J, Weinberg D, Brooks WS, Brown D, Pellen D, Kindler J, Mohan A, Wakefield D, Lloyd AR, Stanton C, O'Donnell M, Liu D, Galletly C, Shannon Weickert C. Adjunctive canakinumab reduces peripheral inflammation markers and improves positive symptoms in people with schizophrenia and inflammation: A randomized control trial. Brain Behav Immun 2024; 115:191-200. [PMID: 37848096 DOI: 10.1016/j.bbi.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Clinical trials of anti-inflammatories in schizophrenia do not show clear and replicable benefits, possibly because patients were not recruited based on elevated inflammation status. Interleukin 1-beta (IL-1β) mRNA and protein levels are increased in serum, plasma, cerebrospinal fluid, and brain of some chronically ill patients with schizophrenia, first episode psychosis, and clinical high-risk individuals. Canakinumab, an approved anti-IL-1β monoclonal antibody, interferes with the bioactivity of IL-1β and interrupts downstream signaling. However, the extent to which canakinumab reduces peripheral inflammation markers, such as, high sensitivity C-reactive protein (hsCRP) and symptom severity in schizophrenia patients with inflammation is unknown. TRIAL DESIGN We conducted a randomized, placebo-controlled, double-blind, parallel groups, 8-week trial of canakinumab in chronically ill patients with schizophrenia who had elevated peripheral inflammation. METHODS Twenty-seven patients with schizophrenia or schizoaffective disorder and elevated peripheral inflammation markers (IL-1β, IL-6, hsCRP and/or neutrophil to lymphocyte ratio: NLR) were randomized to a one-time, subcutaneous injection of canakinumab (150 mg) or placebo (normal saline) as an adjunctive antipsychotic treatment. Peripheral blood hsCRP, NLR, IL-1β, IL-6, IL-8 levels were measured at baseline (pre injection) and at 1-, 4- and 8-weeks post injection. Symptom severity was assessed at baseline and 4- and 8-weeks post injection. RESULTS Canakinumab significantly reduced peripheral hsCRP over time, F(3, 75) = 5.16, p = 0.003. Significant hsCRP reductions relative to baseline were detected only in the canakinumab group at weeks 1, 4 and 8 (p's = 0.0003, 0.000002, and 0.004, respectively). There were no significant hsCRP changes in the placebo group. Positive symptom severity scores were significantly reduced at week 8 (p = 0.02) in the canakinumab group and week 4 (p = 0.02) in the placebo group. The change in CRP between week 8 and baseline (b = 1.9, p = 0.0002) and between week 4 and baseline (b = 6.0, p = 0.001) were highly significant predictors of week 8 change in PANSS Positive Symptom severity scores. There were no significant changes in negative symptoms, general psychopathology or cognition in either group. Canakinumab was well tolerated and only 7 % discontinued. CONCLUSIONS Canakinumab quickly reduces peripheral hsCRP serum levels in patients with schizophrenia and inflammation; after 8 weeks of canakinumab treatment, the reductions in hsCRP are related to reduced positive symptom severity. Future studies should consider increased doses or longer-term treatment to confirm the potential benefits of adjunctive canakinumab in schizophrenia. Australian and New Zealand Clinical Trials Registry number: ACTRN12615000635561.
Collapse
Affiliation(s)
- Thomas W Weickert
- Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Isabella Jacomb
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Rhoshel Lenroot
- Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Julia Lappin
- School of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - William S Brooks
- Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - David Brown
- NSW Health Pathology-ICPMR, Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Pellen
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jochen Kindler
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Adith Mohan
- School of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Denis Wakefield
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew R Lloyd
- Viral Immunology Systems Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Clive Stanton
- Neuroscience Research Australia, Sydney, New South Wales, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Maryanne O'Donnell
- Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Dennis Liu
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Locah Health Network, Adelaide, South Australia, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Locah Health Network, Adelaide, South Australia, Australia
| | - Cynthia Shannon Weickert
- Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Shao S, Zou Y, Kennedy KG, Dimick MK, MacIntosh BJ, Goldstein BI. Higher Levels of C-reactive Protein Are Associated With Higher Cortical Surface Area and Lower Cortical Thickness in Youth With Bipolar Disorder. Int J Neuropsychopharmacol 2023; 26:867-878. [PMID: 37947206 PMCID: PMC10726415 DOI: 10.1093/ijnp/pyad063] [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: 03/15/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Inflammation is implicated in the neuropathology of bipolar disorder (BD). The association of C-reactive protein (CRP) with brain structure has been examined in relation to BD among adults but not youth. METHODS Participants included 101 youth (BD, n = 55; control group [CG], n = 46; aged 13-20 years). Blood samples were assayed for levels of CRP. T1-weighted brain images were acquired to obtain cortical surface area (SA), volume, and thickness for 3 regions of interest (ROI; whole-brain cortical gray matter, prefrontal cortex, orbitofrontal cortex [OFC]) and for vertex-wise analyses. Analyses included CRP main effects and interaction effects controlling for age, sex, and intracranial volume. RESULTS In ROI analyses, higher CRP was associated with higher whole-brain SA (β = 0.16; P = .03) and lower whole-brain (β = -0.31; P = .03) and OFC cortical thickness (β = -0.29; P = .04) within the BD group and was associated with higher OFC SA (β = 0.17; P = .03) within the CG. In vertex-wise analyses, higher CRP was associated with higher SA and lower cortical thickness in frontal and parietal regions within BD. A significant CRP-by-diagnosis interaction was found in frontal and temporal regions, whereby higher CRP was associated with lower neurostructural metrics in the BD group but higher neurostructural metrics in CG. CONCLUSIONS This study found that higher CRP among youth with BD is associated with higher SA but lower cortical thickness in ROI and vertex-wise analyses. The study identified 2 regions in which the association of CRP with brain structure differs between youth with BD and the CG. Future longitudinal, repeated-measures studies incorporating additional inflammatory markers are warranted.
Collapse
Affiliation(s)
- Suyi Shao
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada (Ms Shao, Drs Zou and Goldstein)
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yi Zou
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Dr Sandra Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Juchnowicz D, Dzikowski M, Rog J, Waszkiewicz N, Karakuła KH, Zalewska A, Maciejczyk M, Karakula-Juchnowicz H. The usefulness of a complete blood count in the prediction of the first episode of schizophrenia diagnosis and its relationship with oxidative stress. PLoS One 2023; 18:e0292756. [PMID: 37824542 PMCID: PMC10569548 DOI: 10.1371/journal.pone.0292756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
A complete blood count (CBC) is a routinely performed blood examination. Only a few studies assess the relationship between CBC and oxidative stress (OS) in schizophrenia (SZ). The aim of the study was to assess the utility of CBC in the prediction of SZ diagnosis, and the relationship between CBC and OS. The study included: 47 individuals with the first episode of psychosis (26 drug-naive: FEP-nt; 21 patients under antipsychotic treatment: FEP-t) and 30 healthy persons (control group, HC). CBC and oxidative stress-related parameters were assessed in blood samples. The FEP group had higher levels of WBC, MCHC, NEU, MONO, EOZ, BASO, and %EOZ compared to HC (p<0.05). Various relationships between OS and CBC were found, and this connection was significantly different between healthy individuals and patients. The most promising C&RT model for discriminating FEP from HC was combining monocytes, eosinophils, and neutrophils (accuracy: 77%, 95%CI = 0.67-0.87). The analysis singled out WBC and HT (accuracy: 74%, 95%CI = 0.64-0.90) as the most promising to distinguish FEP-nt from HC; WBC and %Neu to allocate to FEP-t or HC group (accuracy: 87%, 95%CI = 0.64-0.90); RDW-SD and LYMPH (accuracy: 86%, 95% CI = 0.75-97) for distinguishing FEP-nt from FEP-t. CBC could be a promising, cheap tool to determine abnormalities related to schizophrenia. However, more studies with larger sample sizes are required.
Collapse
Affiliation(s)
- Dariusz Juchnowicz
- Department of Psychiatric Nursing, Medical University of Lublin, Lublin, Poland
| | - Michał Dzikowski
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
| | - Joanna Rog
- Laboratory of Human Metabolism Research, Department of Dietetics, Warsaw University of Life Sciences, Warsaw, Poland
| | | | - Kaja Hanna Karakuła
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
| | - Anna Zalewska
- Department of Restorative Dentistry and Experimental Dentistry Laboratory, Medical University of Bialystok, Bialystok, Poland
| | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland
| | - Hanna Karakula-Juchnowicz
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
15
|
Arya S, Kamyab A, Sanatkar SA, Pourmehdiardebili M, Ebrahimi A, Kamyab P, Alavi K, Zarei Z, Ahmadkhaniha HR. Evaluating the association of vitamin D3, parathyroid hormone, and C-reactive protein serum levels in patients with an acute psychotic episode: a cross-sectional study in tertiary centre in Iran. BMC Psychiatry 2023; 23:724. [PMID: 37803327 PMCID: PMC10557165 DOI: 10.1186/s12888-023-05234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The high impact of vitamin D on brain development and its relationship with inflammatory markers in the clinical course of psychiatric disorders have compelled researchers to investigate the potential association between vitamin D levels, C-reactive protein (CRP) levels, and the incidence of mental disorders. In the present study, we aimed to compare the serum levels of vitamin D and its related markers, including calcium, phosphorus, and parathyroid hormone (PTH), along with CRP, in 3 groups of patients with acute psychotic episodes, including schizophrenia, bipolar disorder, and methamphetamine-induced psychosis, with a standard control group of the Iranian population. METHODS This descriptive cross-sectional study was conducted at a psychiatric hospital in Tehran, Iran, and involved a total of 185 subjects. The subjects included four groups: acute phase of schizophrenia (n = 49), acute manic episodes of bipolar disorder (n = 43), methamphetamine-induced psychotic disorder (n = 46), and control group (n = 47). Among 138 patients in acute psychotic episodes, 33 patients were in their first episode of psychosis, while 105 patients were in acute exacerbation of their chronic psychotic disorders. The Brief Psychiatric Rating Scale (BPRS) was measured by an expert attending psychiatrist for all patients. Then, serum levels of calcium, phosphorus, parathormone, vitamin D, and CRP were assessed in all study groups. RESULTS Among our 185 study subjects, it was observed that individuals with higher education levels and those who were married had a lower prevalence of mental disorders. In all patient groups, the serum levels of CRP were significantly higher, and PTH levels were significantly lower than in the control group (p < 0.001). The serum levels of calcium, phosphorus, and vitamin D were not statistically significantly different between the patient and control groups of the study. In chronic psychotic patients, CRP levels were significantly higher (p < 0.031), and vitamin D levels were significantly lower (p < 0.044) compared to first-episode psychotic patients. CONCLUSION This study suggests that CRP levels are significantly higher and PHT level is significantly lower in acute psychotic patients. Moreover, vitamin D levels were significantly lower in chronic psychotic patients compared to first-episode psychotic patients.
Collapse
Affiliation(s)
- Shahrzad Arya
- Research Center for Addiction and Risky Behaviors, Iran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Alireza Ebrahimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parnia Kamyab
- Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Kaveh Alavi
- Department of Psychiatry, Mental Health Research Center, School of Behavioral Sciences & Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Zhina Zarei
- Research Center for Addiction and Risky Behaviors, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Ahmadkhaniha
- Research Center for Addiction and Risky Behaviors, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
16
|
Savitz J, Goeckner BD, Ford BN, Kent Teague T, Zheng H, Harezlak J, Mannix R, Tugan Muftuler L, Brett BL, McCrea MA, Meier TB. The effects of cytomegalovirus on brain structure following sport-related concussion. Brain 2023; 146:4262-4273. [PMID: 37070698 PMCID: PMC10545519 DOI: 10.1093/brain/awad126] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Abstract
The neurotrophic herpes virus cytomegalovirus is a known cause of neuropathology in utero and in immunocompromised populations. Cytomegalovirus is reactivated by stress and inflammation, possibly explaining the emerging evidence linking it to subtle brain changes in the context of more minor disturbances of immune function. Even mild forms of traumatic brain injury, including sport-related concussion, are major physiological stressors that produce neuroinflammation. In theory, concussion could predispose to the reactivation of cytomegalovirus and amplify the effects of physical injury on brain structure. However, to our knowledge this hypothesis remains untested. This study evaluated the effect of cytomegalovirus serostatus on white and grey matter structure in a prospective study of athletes with concussion and matched contact-sport controls. Athletes who sustained concussion (n = 88) completed MRI at 1, 8, 15 and 45 days post-injury; matched uninjured athletes (n = 73) completed similar visits. Cytomegalovirus serostatus was determined by measuring serum IgG antibodies (n = 30 concussed athletes and n = 21 controls were seropositive). Inverse probability of treatment weighting was used to adjust for confounding factors between athletes with and without cytomegalovirus. White matter microstructure was assessed using diffusion kurtosis imaging metrics in regions previously shown to be sensitive to concussion. T1-weighted images were used to quantify mean cortical thickness and total surface area. Concussion-related symptoms, psychological distress, and serum concentration of C-reactive protein at 1 day post-injury were included as exploratory outcomes. Planned contrasts compared the effects of cytomegalovirus seropositivity in athletes with concussion and controls, separately. There was a significant effect of cytomegalovirus on axial and radial kurtosis in athletes with concussion but not controls. Cytomegalovirus positive athletes with concussion showed greater axial (P = 0.007, d = 0.44) and radial (P = 0.010, d = 0.41) kurtosis than cytomegalovirus negative athletes with concussion. Similarly, there was a significant association of cytomegalovirus with cortical thickness in athletes with concussion but not controls. Cytomegalovirus positive athletes with concussion had reduced mean cortical thickness of the right hemisphere (P = 0.009, d = 0.42) compared with cytomegalovirus negative athletes with concussion and showed a similar trend for the left hemisphere (P = 0.036, d = 0.33). There was no significant effect of cytomegalovirus on kurtosis fractional anisotropy, surface area, symptoms and C-reactive protein. The results raise the possibility that cytomegalovirus infection contributes to structural brain abnormalities in the aftermath of concussion perhaps via an amplification of concussion-associated neuroinflammation. More work is needed to identify the biological pathways underlying this process and to clarify the clinical relevance of this putative viral effect.
Collapse
Affiliation(s)
- Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK 74119, USA
| | - Bryna D Goeckner
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Bart N Ford
- Department of Pharmacology and Physiology, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA
| | - T Kent Teague
- Department of Psychiatry, The University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA
- Department of Surgery, The University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, OK 74135, USA
| | - Haixia Zheng
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| |
Collapse
|
17
|
Alexandros Lalousis P, Schmaal L, Wood SJ, L E P Reniers R, Cropley VL, Watson A, Pantelis C, Suckling J, Barnes NM, Pariante C, Jones PB, Joyce E, Barnes TRE, Lawrie SM, Husain N, Dazzan P, Deakin B, Shannon Weickert C, Upthegrove R. Inflammatory subgroups of schizophrenia and their association with brain structure: A semi-supervised machine learning examination of heterogeneity. Brain Behav Immun 2023; 113:166-175. [PMID: 37423513 DOI: 10.1016/j.bbi.2023.06.023] [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: 10/06/2022] [Revised: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE Immune system dysfunction is hypothesised to contribute to structural brain changes through aberrant synaptic pruning in schizophrenia. However, evidence is mixed and there is a lack of evidence of inflammation and its effect on grey matter volume (GMV) in patients. We hypothesised that inflammatory subgroups can be identified and that the subgroups will show distinct neuroanatomical and neurocognitive profiles. METHODS The total sample consisted of 1067 participants (chronic patients with schizophrenia n = 467 and healthy controls (HCs) n = 600) from the Australia Schizophrenia Research Bank (ASRB) dataset, together with 218 recent-onset patients with schizophrenia from the external Benefit of Minocycline on Negative Symptoms of Psychosis: Extent and Mechanism (BeneMin) dataset. HYDRA (HeterogeneitY through DiscRiminant Analysis) was used to separate schizophrenia from HC and define disease-related subgroups based on inflammatory markers. Voxel-based morphometry and inferential statistics were used to explore GMV alterations and neurocognitive deficits in these subgroups. RESULTS An optimal clustering solution revealed five main schizophrenia groups separable from HC: Low Inflammation, Elevated CRP, Elevated IL-6/IL-8, Elevated IFN-γ, and Elevated IL-10 with an adjusted Rand index of 0.573. When compared with the healthy controls, the IL-6/IL-8 cluster showed the most widespread, including the anterior cingulate, GMV reduction. The IFN-γ inflammation cluster showed the least GMV reduction and impairment of cognitive performance. The CRP and the Low Inflammation clusters dominated in the younger external dataset. CONCLUSIONS Inflammation in schizophrenia may not be merely a case of low vs high, but rather there are pluripotent, heterogeneous mechanisms at play which could be reliably identified based on accessible, peripheral measures. This could inform the successful development of targeted interventions.
Collapse
Affiliation(s)
- Paris Alexandros Lalousis
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Lianne Schmaal
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Renate L E P Reniers
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Institute of Clinical Sciences, University of Birmingham, United Kingdom
| | - Vanessa L Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Andrew Watson
- The Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia; NorthWestern Mental Health, Western Hospital Sunshine, St. Albans, Vicroria, Australia
| | - John Suckling
- Brain Mapping Unit, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, United Kingdom; Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Nicholas M Barnes
- Institute for Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Carmine Pariante
- Stress, Psychiatry and Immunology Lab & Perinatal Psychiatry, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Peter B Jones
- Brain Mapping Unit, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, United Kingdom; Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Eileen Joyce
- The Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas R E Barnes
- Division of Psychiatry, Imperial College London, London United Kingdom
| | - Stephen M Lawrie
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester & Mersey Care NHS Foundation Trust
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Cynthia Shannon Weickert
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA; Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Birmingham Early Interventions Service, Birmingham Women's and Children's NHS Foundation Trust, United Kingdom
| |
Collapse
|
18
|
Wang Y, Fang X, Wang G, Tang W, Liu S, Yang Y, Chen J, Ling Y, Zhou C, Zhang X, Zhang C, Su KP. The association between inflammation and kynurenine pathway metabolites in electroconvulsive therapy for schizophrenia: Implications for clinical efficacy. Brain Behav Immun 2023; 113:1-11. [PMID: 37353059 DOI: 10.1016/j.bbi.2023.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023] Open
Abstract
The kynurenine pathway (KP) of tryptophan has been implicated in the pathogenesis of schizophrenia and its interaction with the immune system has been suggested to play a role. In this study, 28 schizophrenia patients and 25 healthy controls were recruited and divided into different inflammatory subgroups using a two-step recursive clustering analysis. Cytokine gene expression and plasma KP metabolites were measured before, during and after treatment. Our findings indicated that schizophrenia patients had lower levels of Tryptophan (TRP), N-formylkynurenine (NFK), xanthinic acid (XA), quinolinic acid (QA), kynurenic acid (KYNA), KYNA/KYN and QA/KYNA, but higher levels of IL-18 mRNA, KYN/TRP compared to healthy controls (all p < 0.05). After electroconvulsive therapy (ECT), patients with low inflammation achieved better clinical improvement (PANSS scores) compared to those with high inflammation (F = 5.672, P = 0.025), especially in negative symptoms (F = 6.382, P = 0.018, η2 = 0.197). While IL-18 mRNA (F = 32.910, P < 0.0001) was significantly decreased following ECT, the KYN/TRP (F = 3.455, p = 0.047) and KYNA/TRP (F = 4.264, P = 0.026) only significantly decreased in patients with low inflammation. Correlation analyses revealed that baseline IL-18 gene expression significantly correlated with pre- (r = 0.537, p = 0.008) and post-KYNA/TRP (r = 0.443, p = 0.034), post-KYN/TRP (r = 0.510, p = 0.013), and post-negative symptoms (r = 0.525, p = 0.010). Moreover, baseline TRP (r = -0.438, p = 0.037) and XA (r = -0.516, p = 0.012) were negatively correlated with baseline PANSS, while post-KYN (r = -0.475, p = 0.022), 2-AA (r = -0.447, p = 0.032) and KYN/TRP (r = -0.566, p = 0.005) were negatively correlated with Montreal Cognitive Assessment (MoCA) following ECT. Overall, these findings suggested that the association between inflammation and kynurenine pathway plays an essential role in mechanism of ECT for schizophrenia and that the regulation of ECT on KP is influenced by inflammatory characteristics, which may relate to clinical efficacy in schizophrenia.
Collapse
Affiliation(s)
- Yu Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Guangfa Wang
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Wei Tang
- The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, China
| | - Shasha Liu
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Yujing Yang
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Jin Chen
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Yuru Ling
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chao Zhou
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China.
| | - Caiyi Zhang
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China.
| | - Kuan-Pin Su
- College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
| |
Collapse
|
19
|
Zhu Y, Webster MJ, Walker AK, Massa P, Middleton FA, Weickert CS. Increased prefrontal cortical cells positive for macrophage/microglial marker CD163 along blood vessels characterizes a neuropathology of neuroinflammatory schizophrenia. Brain Behav Immun 2023; 111:46-60. [PMID: 36972743 DOI: 10.1016/j.bbi.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Transcript levels of cytokines and SERPINA3 have been used to define a substantial subset (40%) of individuals with schizophrenia with elevated inflammation and worse neuropathology in the dorsolateral prefrontal cortex (DLPFC). In this study, we tested if inflammatory proteins are likewise related to high and low inflammatory states in the human DLFPC in people with schizophrenia and controls. Levels of inflammatory cytokines (IL6, IL1β, IL18, IL8) and a macrophage marker (CD163 protein) were measured in brains obtained from the National Institute of Mental Health (NIMH) (N = 92). First, we tested for diagnostic differences in protein levels overall, then we determined the percentage of individuals that could be defined as "high" inflammation using protein levels. IL-18 was the only cytokine to show increased expression in schizophrenia compared to controls overall. Interestingly, two-step recursive clustering analysis showed that IL6, IL18, and CD163 protein levels could be used as predictors of "high and low" inflammatory subgroups. By this model, a significantly greater proportion of schizophrenia cases (18/32; 56.25%; SCZ) were identified as belonging to the high inflammatory (HI) subgroup compared to control cases (18/60; 30%; CTRL) [χ2(1) = 6.038, p = 0.014]. When comparing across inflammatory subgroups, IL6, IL1β, IL18, IL8, and CD163 protein levels were elevated in both SCZ-HI and CTRL-HI compared to both low inflammatory subgroups (all p < 0.05). Surprisingly, TNFα levels were significantly decreased (-32.2%) in schizophrenia compared to controls (p < 0.001), and were most diminished in the SCZ-HI subgroup compared to both CTRL-LI and CTRL-HI subgroups (p < 0.05). Next, we asked if the anatomical distribution and density of CD163+ macrophages differed in those with schizophrenia and high inflammation status. Macrophages were localized to perivascular sites and found surrounding small, medium and large blood vessels in both gray matter and white matter, with macrophage density highest at the pial surface in all schizophrenia cases examined. A higher density of CD163+ macrophages, that were also larger and more darkly stained, was found in the SCZ-HI subgroup (+154% p < 0.05). We also confirmed the rare existence of parenchymal CD163+ macrophages in both high inflammation subgroups (schizophrenia and controls). Brain CD163+ cell density around blood vessels positively correlated with CD163 protein levels. In conclusion, we find a link between elevated interleukin cytokine protein levels, decreased TNFα protein levels, and elevated CD163+ macrophage densities especially along small blood vessels in those with neuroinflammatory schizophrenia.
Collapse
Affiliation(s)
- Yunting Zhu
- Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Adam K Walker
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Laboratory of Immunopsychiatry, Neuroscience Research Australia, Sydney, NSW, Australia; Monash Institute of Pharmaceutical Science, Monash University, Parkville, Vic, Australia
| | - Paul Massa
- Department of Neurology, Upstate Medical University, Syracuse, NY 13210, USA; Department of Microbiology and Immunology, Upstate Medical University, Syracuse, NY 13210, USA
| | - Frank A Middleton
- Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, NY 13210, USA
| | - Cynthia Shannon Weickert
- Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, NY 13210, USA; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, NSW 2031, Australia.
| |
Collapse
|
20
|
Patlola SR, Donohoe G, McKernan DP. The relationship between inflammatory biomarkers and cognitive dysfunction in patients with schizophrenia: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 121:110668. [PMID: 36283512 DOI: 10.1016/j.pnpbp.2022.110668] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Schizophrenia is a complex psychiatric disorder that includes positive and negative symptoms but also debilitating cognitive deficits. Current pharmacological interventions do not target these deficits. Recent evidence suggests a connection between some inflammatory markers (including C-reactive protein) and cognitive impairment, but did not address other inflammatory markers. In the current study, we try to fill the gap by focusing on the association of Interleukin-6 (IL-6), IL-1β, Tumor Necrosis Factor-α and CRP with cognitive dysfunction. METHODS PUBMED and Web of Science databases were searched for all studies published until July 2022. A total of 25 studies were included in an analysis of the association between cognitive performance and variation in IL-6, IL-1β, TNF-α and CRP. RESULTS A total of 2398 patients were included in this study. Meta-analyses results showed a significant inverse relationship between performance in five cognitive domains (attention-processing speed, executive function, working memory, verbal and visual learning and memory) and systemic IL-6, IL-1β, TNF-α and CRP plasma levels in patients with schizophrenia. The meta-analyses results showed a significant decline in the cognitive performances with the evaluated inflammatory markers with effect sizes ranging from -0.136 to -0.181 for IL-6, -0.188 to -0.38 for TNF-α -0.372 to -0.476 for IL-1β and - 0.168 to -0.311 for CRP. CONCLUSION Findings from the current study shows that cognitive deficits are reflective of elevated proinflammatory biomarkers (IL-6, IL-1β, TNF-α and CRP) levels. The results obtained indicate relatedness between inflammation and cognitive decline in patients with schizophrenia. Understanding the underlying pathways between them could have a significant impact on the disease progression and quality of life in schizophrenia patients.
Collapse
Affiliation(s)
- Saahithh Redddi Patlola
- Pharmacology & Therapeutics, School of Medicine, National University of Ireland Galway, Ireland
| | - Gary Donohoe
- School of Psychology, National University of Ireland Galway, Ireland
| | - Declan P McKernan
- Pharmacology & Therapeutics, School of Medicine, National University of Ireland Galway, Ireland.
| |
Collapse
|
21
|
Šagud M, Madžarac Z, Nedic Erjavec G, Šimunović Filipčić I, Mikulić FL, Rogić D, Bradaš Z, Bajs Janović M, Pivac N. The Associations of Neutrophil-Lymphocyte, Platelet-Lymphocyte, Monocyte-Lymphocyte Ratios and Immune-Inflammation Index with Negative Symptoms in Patients with Schizophrenia. Biomolecules 2023; 13:biom13020297. [PMID: 36830666 PMCID: PMC9952992 DOI: 10.3390/biom13020297] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) and systemic immune-inflammation index (SII index) are increasingly used as indicators of inflammation in different conditions, including schizophrenia. However, their relationship with negative symptoms, including anhedonia, is largely unknown. Included were 200 patients with schizophrenia and 134 healthy controls (HC), assessed for physical anhedonia (PA), using the Revised Physical Anhedonia Scale (RPAS), and social anhedonia (SA) by the Revised Social Anhedonia Scale (RSAS). Patients were rated by the Positive and Negative Syndrome Scale (PANSS), the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Brief Negative Symptom Scale (BNSS). Most of the negative symptoms were in a weak to moderate positive correlations with blood cell inflammatory ratios, namely, between NLR and MLR with PANSS negative scale, CAINS, and BNSS, and in male patients, between PLR and PANSS negative scale and CAINS. Fewer correlations were detected in females, but also in a positive direction. An exception was SA, given the negative correlation between its severity and the SII index in females, and its presence and higher PLR in males. While different negative symptoms were associated with subclinical inflammation, the relationship between SA and lower inflammatory markers deserves further exploration.
Collapse
Affiliation(s)
- Marina Šagud
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zoran Madžarac
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | | | - Ivona Šimunović Filipčić
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | | | - Dunja Rogić
- Department for Laboratory Diagnostics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zoran Bradaš
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Maja Bajs Janović
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Nela Pivac
- Rudjer Boskovic Institute, 10000 Zagreb, Croatia
- Correspondence:
| |
Collapse
|
22
|
Chemokine Dysregulation and Neuroinflammation in Schizophrenia: A Systematic Review. Int J Mol Sci 2023; 24:ijms24032215. [PMID: 36768537 PMCID: PMC9917146 DOI: 10.3390/ijms24032215] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
Chemokines are known to be immunoregulatory proteins involved not only in lymphocyte chemotaxis to the site of inflammation, but also in neuromodulation, neurogenesis, and neurotransmission. Multiple lines of evidence suggest a peripheral proinflammatory state and neuroinflammation in at least a third of patients with schizophrenia. Therefore, chemokines can be active players in these processes. In this systematic review, we analyzed the available data on chemokine dysregulation in schizophrenia and the association of chemokines with neuroinflammation. It has been shown that there is a genetic association of chemokine and chemokine receptor gene polymorphisms in schizophrenia. Besides, the most reliable data confirmed by the results of meta-analyses showed an increase in CXCL8/IL-8, CCL2/MCP-1, CCL4/MIP-1β, CCL11/eotaxin-1 in the blood of patients with schizophrenia. An increase in CXCL8 has been found in cerebrospinal fluid, but other chemokines have been less well studied. Increased/decreased expression of genes of chemokine and their receptors have been found in different areas of the brain and peripheral immune cells. The peripheral proinflammatory state may influence the expression of chemokines since their expression is regulated by pro- and anti-inflammatory cytokines. Mouse models have shown an association of schizophrenia with dysregulation of the CX3CL1-CX3CR1 and CXCL12-CXCR4 axes. Altogether, dysregulation in chemokine expression may contribute to neuroinflammation in schizophrenia. In conclusion, this evidence indicates the involvement of chemokines in the neurobiological processes associated with schizophrenia.
Collapse
|
23
|
Orsolini L, Pompili S, Volpe U. C-Reactive Protein (CRP): A Potent Inflammation Biomarker in Psychiatric Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1411:135-160. [PMID: 36949309 DOI: 10.1007/978-981-19-7376-5_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
An increasing number of studies have investigated the role of inflammation in psychiatric disorders, by demonstrating how an altered/dysfunctional immunological and inflammatory system may underpin a psychiatric condition. Particularly, several studies specifically investigated the role of a neuroinflammatory biomarker, named C-reactive protein (CRP), in psychiatric disorders. Overall, even though scientific literature so far published still does not appear definitive, CRP is more likely reported to be elevated in several psychiatric disorders, including schizophrenia, mood disorders, anxiety disorders and post-traumatic stress disorder. Moreover, a low-grade inflammation (CRP >3 mg/L) has been more likely observed in a subgroup of patients affected with a more severe psychopathological symptomatology, more treatment resistance and worst clinical mental illness course, strengthening the hypothesis of the need for a different clinical and prognostic characterization based on this concomitant neuroinflammatory predisposition. However, even though further research studies are needed to confirm this preliminary evidence, CRP may represent a potential clinical routine biomarker which could be integrated in the clinical routine practice to better characterize clinical picture and course as well as address clinicians towards a personalized treatment.
Collapse
Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy.
| | - Simone Pompili
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
24
|
Ribavirin Treatment for Severe Schizophrenia with Anti-Borna Disease Virus 1 Antibodies 30 Years after Onset. Case Rep Psychiatry 2023; 2023:4899364. [PMID: 36891160 PMCID: PMC9988380 DOI: 10.1155/2023/4899364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/23/2022] [Accepted: 02/11/2023] [Indexed: 03/01/2023] Open
Abstract
Objective Borna disease virus 1 (BoDV-1) was proven to cause fatal encephalitis in humans in 2018. However, the effects of persistent infections remain unclear. Here, we present the case of a 50-year-old woman with a 30-year history of severe schizophrenia, who was exposed to fleas from stray cats prior to disease onset, suggesting the possibility of zoonosis including BoDV-1 infection. The patient had experienced significant social impairment, thought deterioration, delusions, and hallucinations for more than 20 years. Method A radioligand assay was used to test the patient for IgG and IgM antibodies against BoDV-1 nucleoprotein (N) and phosphoprotein (P). Based on the protocol for hepatitis C, we treated the patient with 400 mg/day ribavirin, which was later increased to 600 mg/day. Results The serological examination revealed anti-BoDV-1 N IgG. Although only subtle changes were observed over the 24 weeks of treatment, the family noticed that the patient's Cotard delusions had disappeared 7 months after completing the treatment, accompanied by some improvements in the relationship with the family. Conclusion Though definite proof was not obtained, this presumed suppression of BoDV-1 by ribavirin leading to improvements in Cotard syndrome-like symptoms suggests that intractable schizophrenia might be one of the BoDV-1 infection phenotypes. Further studies are needed to clarify the effect of persistent BoDV-1 infections in humans.
Collapse
|
25
|
Kulacaoglu F, Yıldırım YE, Aslan M, İzci F. Neutrophil to lymphocyte and monocyte to high-density lipoprotein ratios are promising inflammatory indicators of bipolar disorder. Nord J Psychiatry 2023; 77:77-82. [PMID: 36074909 DOI: 10.1080/08039488.2022.2116106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), and monocyte to high-density lipoprotein (MHR) are indicators of inflammation. In this study, we aimed to examine the possible association between NLR, PLR, MLR, and MHR in the same patients with bipolar disorder (BD) during their manic, depressive, and euthymic episodes. METHODS The participants of this study consisted of 61 patients with BD, aged between 18 and 65, who were hospitalized with a diagnosis of BD. Patients who were hospitalized during their manic and depressive episodes and medication free for at least 1 month before hospitalization were included. White blood cell, neutrophil, lymphocyte, platelet, and monocyte counts, high-density lipoprotein (HDL) cholesterol, and C reactive protein (CRP) levels were recorded. RESULTS Leukocytes (p = 0.000), neutrophil (p = 0.009), monocyte counts (p = 0.012), CRP levels (p = 0.026), NLR (p = 0.025), and MHR (p = 0.011) values were significantly higher in their manic episode and depressive episode compared with the values in their remission period. There was no significant difference between manic and depressive episodes in terms of inflammation parameters. Significant positive correlations were found between the number of depressive episodes and patients' CRP levels (p = 0.031). CONCLUSIONS This study was the first study to examine the inflammatory markers such as NLR, MLR, PLR, and MHR levels in same patients with BD during their three episodes of disorder. Both NLR and MHR values in manic and depressive episodes were higher than euthymic episodes. NLR and MHR were useful inflammatory markers to evaluate inflammation in bipolar patients.
Collapse
Affiliation(s)
- Filiz Kulacaoglu
- Department of Psychiatry, Health Sciences University Prof. Dr. Mazhar Osman Bakirkoy Research and Training Hospital for Psychiatry and Neurological Diseases, Istanbul, Turkey
| | | | - Metin Aslan
- Department of Psychiatry, Health Sciences University Erenkoy Research and Training Hospital for Psychiatry and Neurological Diseases, Istanbul, Turkey
| | - Filiz İzci
- Department of Psychiatry, Health Sciences University Erenkoy Research and Training Hospital for Psychiatry and Neurological Diseases, Istanbul, Turkey
| |
Collapse
|
26
|
Jiang C, Dobrowolny H, Gescher DM, Meyer-Lotz G, Steiner J, Hoeschen C, Frodl T. Volatile organic compounds from exhaled breath in schizophrenia. World J Biol Psychiatry 2022; 23:773-784. [PMID: 35171077 DOI: 10.1080/15622975.2022.2040052] [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] [Indexed: 01/25/2023]
Abstract
OBJECTIVES This study aims to find out whether volatile organic compounds (VOCs) from exhaled breath differ significantly between patients with schizophrenia and healthy controls and whether it might be possible to create an algorithm that can predict the likelihood of suffering from schizophrenia. METHODS To test this theory, a group of patients with clinically diagnosed acute schizophrenia as well as a healthy comparison group has been investigated, which have given breath samples during awakening response right after awakening, after 30 min and after 60 min. The VOCs were measured using Proton-Transfer-Reaction Mass Spectrometry. RESULTS By applying bootstrap with mixed model analysis (n = 1000), we detected 10 signatures (m/z 39, 40, 59, 60, 69, 70, 74, 85, 88 and 90) showing reduced concentration in patients with schizophrenia compared to healthy controls. These could safely discriminate patients and controls and were not influenced by smoking. Logistic regression forward method achieved an area under the receiver operating characteristic curve (AUC) of 0.91 and an accuracy of 82% and a machine learning approach with bartMachine an AUC of 0.96 and an accuracy of 91%. CONCLUSION Breath gas analysis is easy to apply, well tolerated and seems to be a promising candidate for further studies on diagnostic and predictive clinical utility.
Collapse
Affiliation(s)
- Carina Jiang
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg (OVGU), Magdeburg, Germany
| | - Henrik Dobrowolny
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg (OVGU), Magdeburg, Germany
| | - Dorothee Maria Gescher
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg (OVGU), Magdeburg, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen, Aachen, Germany
| | - Gabriela Meyer-Lotz
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg (OVGU), Magdeburg, Germany
| | - Johann Steiner
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg (OVGU), Magdeburg, Germany
| | - Christoph Hoeschen
- Institute of Medical Engineering, Otto von Guericke University Magdeburg (OVGU), Magdeburg, Germany
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg (OVGU), Magdeburg, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen, Aachen, Germany
| |
Collapse
|
27
|
Gracias J, Orhan F, Hörbeck E, Holmén-Larsson J, Khanlarkani N, Malwade S, Goparaju SK, Schwieler L, Demirel İŞ, Fu T, Fatourus-Bergman H, Pelanis A, Goold CP, Goulding A, Annerbrink K, Isgren A, Sparding T, Schalling M, Yañez VAC, Göpfert JC, Nilsson J, Brinkmalm A, Blennow K, Zetterberg H, Engberg G, Piehl F, Sheridan SD, Perlis RH, Cervenka S, Erhardt S, Landen M, Sellgren CM. Cerebrospinal fluid concentration of complement component 4A is increased in first episode schizophrenia. Nat Commun 2022; 13:6427. [PMID: 36329007 PMCID: PMC9633609 DOI: 10.1038/s41467-022-33797-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Postsynaptic density is reduced in schizophrenia, and risk variants increasing complement component 4A (C4A) gene expression are linked to excessive synapse elimination. In two independent cohorts, we show that cerebrospinal fluid (CSF) C4A concentration is elevated in patients with first-episode psychosis (FEP) who develop schizophrenia (FEP-SCZ: median 0.41 fmol/ul [CI = 0.34-0.45], FEP-non-SCZ: median 0.29 fmol/ul [CI = 0.22-0.35], healthy controls: median 0.28 [CI = 0.24-0.33]). We show that the CSF elevation of C4A in FEP-SCZ exceeds what can be expected from genetic risk variance in the C4 locus, and in patient-derived cellular models we identify a mechanism dependent on the disease-associated cytokines interleukin (IL)-1beta and IL-6 to selectively increase neuronal C4A mRNA expression. In patient-derived CSF, we confirm that IL-1beta correlates with C4A controlled for genetically predicted C4A RNA expression (r = 0.39; CI: 0.01-0.68). These results suggest a role of C4A in early schizophrenia pathophysiology.
Collapse
Affiliation(s)
- Jessica Gracias
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Funda Orhan
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Elin Hörbeck
- The Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Psychosis Clinic, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jessica Holmén-Larsson
- The Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Neda Khanlarkani
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Susmita Malwade
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Sravan K Goparaju
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lilly Schwieler
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - İlknur Ş Demirel
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ting Fu
- Center for Quantitative Health, Center for Genomic Medicine and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Helena Fatourus-Bergman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Aurimantas Pelanis
- Department of Anesthesiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Anneli Goulding
- Psychosis Clinic, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | | | - Anniella Isgren
- The Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Psychosis Clinic, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Timea Sparding
- The Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Viviana A Carcamo Yañez
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Jens C Göpfert
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Johanna Nilsson
- The Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ann Brinkmalm
- The Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- The Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- The Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Göran Engberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Steven D Sheridan
- Center for Quantitative Health, Center for Genomic Medicine and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Roy H Perlis
- Center for Quantitative Health, Center for Genomic Medicine and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Simon Cervenka
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Sophie Erhardt
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landen
- The Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Carl M Sellgren
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| |
Collapse
|
28
|
O’Donnell M, Teasdale SB, Chua XY, Hardman J, Wu N, Curtis J, Samaras K, Bolton P, Morris MJ, Shannon Weickert C, Purves-Tyson T, El-Assaad F, Jiang XT, Hold GL, El-Omar E. The Role of the Microbiome in the Metabolic Health of People with Schizophrenia and Related Psychoses: Cross-Sectional and Pre-Post Lifestyle Intervention Analyses. Pathogens 2022; 11:1279. [PMID: 36365032 PMCID: PMC9695516 DOI: 10.3390/pathogens11111279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 03/20/2024] Open
Abstract
The microbiome has been implicated in the development of metabolic conditions which occur at high rates in people with schizophrenia and related psychoses. This exploratory proof-of-concept study aimed to: (i) characterize the gut microbiota in antipsychotic naïve or quasi-naïve people with first-episode psychosis, and people with established schizophrenia receiving clozapine therapy; (ii) test for microbiome changes following a lifestyle intervention which included diet and exercise education and physical activity. Participants were recruited from the Eastern Suburbs Mental Health Service, Sydney, Australia. Anthropometric, lifestyle and gut microbiota data were collected at baseline and following a 12-week lifestyle intervention. Stool samples underwent 16S rRNA sequencing to analyse microbiota diversity and composition. Seventeen people with established schizophrenia and five people with first-episode psychosis were recruited and matched with 22 age-sex, BMI and ethnicity matched controls from a concurrent study for baseline comparisons. There was no difference in α-diversity between groups at baseline, but microbial composition differed by 21 taxa between the established schizophrenia group and controls. In people with established illness pre-post comparison of α-diversity showed significant increases after the 12-week lifestyle intervention. This pilot study adds to the current literature that detail compositional differences in the gut microbiota of people with schizophrenia compared to those without mental illness and suggests that lifestyle interventions may increase gut microbial diversity in patients with established illness. These results show that microbiome studies are feasible in patients with established schizophrenia and larger studies are warranted to validate microbial signatures and understand the relevance of lifestyle change in the development of metabolic conditions in this population.
Collapse
Affiliation(s)
- Maryanne O’Donnell
- Discipline of Psychiatry and Mental Health, School of Medicine and Health, University of New South Wales, Kensington 2033, Australia
- Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Randwick 2031, Australia
| | - Scott B. Teasdale
- Discipline of Psychiatry and Mental Health, School of Medicine and Health, University of New South Wales, Kensington 2033, Australia
- Mindgardens Neuroscience Network, Sydney 2033, Australia
| | - Xin-Yi Chua
- Microbiome Research Centre, St George and Sutherland Clinical Campuses, University of New South Wales, Kogarah 2217, Australia
| | - Jamie Hardman
- Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Randwick 2031, Australia
| | - Nan Wu
- Microbiome Research Centre, St George and Sutherland Clinical Campuses, University of New South Wales, Kogarah 2217, Australia
- Department of Gastroenterology, The Sutherland Hospital, Caringbah 2229, Australia
| | - Jackie Curtis
- Discipline of Psychiatry and Mental Health, School of Medicine and Health, University of New South Wales, Kensington 2033, Australia
- Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Randwick 2031, Australia
- Mindgardens Neuroscience Network, Sydney 2033, Australia
| | - Katherine Samaras
- Department of Endocrinology, St Vincent’s Hospital Sydney, Victoria St, Darlinghurst 2010, Australia
- Clinical Obesity, Nutrition and Adipose Biology Lab, 384 Garvan Institute of Medical Research, Victoria St, Darlinghurst 2010, Australia
- School of Clinical Medicine, St Vincent’s Healthcare Clinical Campus, University of New South Wales, Darlinghurst 2010, Australia
| | - Patrick Bolton
- Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Randwick 2031, Australia
- School of Public Health, University of New South Wales, Kensington 2033, Australia
| | - Margaret J. Morris
- School of Medical Sciences, University of New South Wales, Kensington 2033, Australia
| | - Cyndi Shannon Weickert
- Discipline of Psychiatry and Mental Health, School of Medicine and Health, University of New South Wales, Kensington 2033, Australia
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney 2033, Australia
- Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY 13210, USA
| | - Tertia Purves-Tyson
- Discipline of Psychiatry and Mental Health, School of Medicine and Health, University of New South Wales, Kensington 2033, Australia
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney 2033, Australia
| | - Fatima El-Assaad
- Microbiome Research Centre, St George and Sutherland Clinical Campuses, University of New South Wales, Kogarah 2217, Australia
| | - Xiao-Tao Jiang
- Microbiome Research Centre, St George and Sutherland Clinical Campuses, University of New South Wales, Kogarah 2217, Australia
| | - Georgina L. Hold
- Microbiome Research Centre, St George and Sutherland Clinical Campuses, University of New South Wales, Kogarah 2217, Australia
| | - Emad El-Omar
- Microbiome Research Centre, St George and Sutherland Clinical Campuses, University of New South Wales, Kogarah 2217, Australia
| |
Collapse
|
29
|
The influence of modifiable cardiovascular risk factors on cognition, functioning, and inflammatory markers in first-episode psychosis: Results from a 2-year follow-up study. Psychiatry Res 2022; 316:114760. [PMID: 35977447 DOI: 10.1016/j.psychres.2022.114760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/24/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022]
Abstract
To explore the influence of cardiovascular risk factors (CVRFs) on cognitive symptoms, functional impairment, and systemic inflammatory markers in first-episode psychosis (FEP) patients at baseline and 2-year follow-up. Method: In a sample of 70 FEP patients and 85 age- and sex-matched healthy controls, we assessed nine modifiable CVRFs. All participants were classified into two subgroups according to their CVRF profile: lower (0-1 CVRFs) or higher (≥2 CVRFs). The following outcomes were measured at baseline and 2-year follow-up: cognition; functional outcomes; and white blood cell (WBC) subtype. Adjusted general linear models were conducted to study the effect of diagnosis and CVRF profile on cognition, functioning, WBC, and longitudinal changes in these variables. At baseline, FEP patients with a higher CVRF profile showed a significantly slower performance on the TMT-A test for psychomotor speed and higher lymphocyte levels than patients with a lower CVRF profile. No longitudinal changes were observed in primary outcomes at 2-year follow-up. Among FEP patients with a higher CVRF profile, slower psychomotor speed performance did not correlate with increased lymphocyte levels. Our findings suggest that the cognitive effects of CVRFs manifest early in the course of psychosis, thus highlighting the importance of targeting both CVRFs and cognitive deficits in FEP.
Collapse
|
30
|
Bhikram T, Sandor P. Neutrophil-lymphocyte ratios as inflammatory biomarkers in psychiatric patients. Brain Behav Immun 2022; 105:237-246. [PMID: 35839998 DOI: 10.1016/j.bbi.2022.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE There is a growing amount of evidence to suggest that inflammation may have a role in the onset and prognosis of psychiatric disorders. We reviewed the literature of studies investigating neutrophil-lymphocyte ratios (NLR), a biomarker of inflammation, in both adult and youth psychiatric populations. The limitations of NLR, in addition to the potential mechanisms underlying its relationship with psychiatric disorders, are also discussed. RECENT FINDINGS Unlike in the general population, NLR is elevated in a proportion of adult patients with schizophrenia, major depressive disorder and bipolar disorder, though associations with symptom severity and other clinical parameters are less clear. When compared to baseline, reductions in NLR are sometimes reported after treatment and remission. Results in youth populations largely resemble findings obtained from adult samples, even though youth studies are far fewer in number. SUMMARY The consistent findings of elevated NLR across the reviewed psychiatric disorders suggest that abnormal NLR is not specific to any one disorder but may reflect a pathological brain process that leads to brain dysfunction. These findings support hypotheses of neuroinflammation being important to the etiology of psychiatric disorders. More research is needed to further elucidate the relationship between specific diagnostic and behavioural constructs and NLR. Future work is also needed to determine the specific neuroinflammatory mechanisms that give rise to specific disorders.
Collapse
Affiliation(s)
- Tracy Bhikram
- Tourette Syndrome Neurodevelopmental Clinic, University Health Network, Toronto, Ontario, Canada.
| | - Paul Sandor
- Tourette Syndrome Neurodevelopmental Clinic, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Child Psychiatry, Department of Psychiatry, Youthdale Treatment Centers, Toronto, Ontario, Canada; Youthdale Treatment Centers, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Evidence of genetic overlap and causal relationships between blood-based biochemical traits and human cortical anatomy. Transl Psychiatry 2022; 12:373. [PMID: 36075890 PMCID: PMC9458732 DOI: 10.1038/s41398-022-02141-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 01/08/2023] Open
Abstract
Psychiatric disorders such as schizophrenia are commonly associated with structural brain alterations affecting the cortex. Recent genetic evidence suggests circulating metabolites and other biochemical traits play a causal role in many psychiatric disorders which could be mediated by changes in the cerebral cortex. Here, we leveraged publicly available genome-wide association study data to explore shared genetic architecture and evidence for causal relationships between a panel of 50 biochemical traits and measures of cortical thickness and surface area. Linkage disequilibrium score regression identified 191 genetically correlated biochemical-cortical trait pairings, with consistent representation of blood cell counts and other biomarkers such as C-reactive protein (CRP), haemoglobin and calcium. Spatially organised patterns of genetic correlation were additionally uncovered upon clustering of region-specific correlation profiles. Interestingly, by employing latent causal variable models, we found strong evidence suggesting CRP and vitamin D exert causal effects on region-specific cortical thickness, with univariable and multivariable Mendelian randomization further supporting a negative causal relationship between serum CRP levels and thickness of the lingual region. Our findings suggest a subset of biochemical traits exhibit shared genetic architecture and potentially causal relationships with cortical structure in functionally distinct regions, which may contribute to alteration of cortical structure in psychiatric disorders.
Collapse
|
32
|
Klaus F, Nguyen TT, Thomas ML, Liou SC, Soontornniyomkij B, Mitchell K, Daly R, Sutherland AN, Jeste DV, Eyler LT. Peripheral inflammation levels associated with degree of advanced brain aging in schizophrenia. Front Psychiatry 2022; 13:966439. [PMID: 36032250 PMCID: PMC9412908 DOI: 10.3389/fpsyt.2022.966439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Brain structural abnormalities have been demonstrated in schizophrenia (SZ); these resemble those seen in typical aging, but are seen at younger ages. Furthermore, SZ is associated with accelerated global brain aging, as measured by brain structure-based brain predicted age difference (Brain-PAD). High heterogeneity exists in the degree of brain abnormalities in SZ, and individual differences may be related to levels of peripheral inflammation and may relate to cognitive deficits and negative symptoms. The goal of our study was to investigate the relationship between brain aging, peripheral inflammation, and symptoms of SZ. We hypothesized older brain-PAD in SZ vs. healthy comparison (HC) participants, as well as positive relationships of brain-PAD with peripheral inflammation markers and symptoms in SZ. We analyzed data from two cross-sectional studies in SZ (n = 26; M/F: 21/5) and HC (n = 28; 20/8) (22-64 years). Brain-PAD was calculated using a previously validated Gaussian process regression model applied to raw T1-weighted MRI data. Plasma levels of inflammatory biomarkers (CRP, Eotaxin, Fractalkine, IP10, IL6, IL10, ICAM1, IFNγ, MCP1, MIP1β, SAA, TNFα, VEGF, VCAM1) and cognitive and negative symptoms were assessed. We observed a higher brain-PAD in SZ vs. HC, and advanced brain age relative to chronological age was related to higher peripheral levels of TNFα in the overall group and in the SZ group; other inflammatory markers were not related to brain-PAD. Within the SZ group, we observed no association between cognitive or negative symptoms and brain-PAD. These results support our hypothesis of advanced brain aging in SZ. Furthermore, our findings on the relationship of the pro-inflammatory cytokine TNFα with higher brain-PAD of SZ are relevant to explain heterogeneity of brain ages in SZ, but we did not find strong evidence for cognitive or negative symptom relationships with brain-PAD.
Collapse
Affiliation(s)
- Federica Klaus
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, La Jolla, CA, United States
| | - Tanya T. Nguyen
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, La Jolla, CA, United States
| | - Michael L. Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, United States
| | - Sharon C. Liou
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | | | - Kyle Mitchell
- VA San Diego Healthcare System, La Jolla, CA, United States
| | - Rebecca Daly
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Ashley N. Sutherland
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, La Jolla, CA, United States
| | - Dilip V. Jeste
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Lisa T. Eyler
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, La Jolla, CA, United States
| |
Collapse
|
33
|
Lestra V, Romeo B, Martelli C, Benyamina A, Hamdani N. Could CRP be a differential biomarker of illness stages in schizophrenia? A systematic review and meta-analysis. Schizophr Res 2022; 246:175-186. [PMID: 35785580 DOI: 10.1016/j.schres.2022.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 05/13/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with schizophrenia display peripheral inflammation but the impact of illness phase is not clear. Our meta-analysis investigated the difference in CRP levels between patients with schizophrenia and controls according to their illness phase. METHODS After a systematic search, all studies measuring CRP in patients with schizophrenia and controls were included. Standardized mean differences were calculated between patients and controls according to illness phase. The influence of sociodemographic and clinical variables on our results was investigated using a meta-regression analysis. RESULTS Fifty studies were included in this meta-analysis. Patients with schizophrenia had higher CRP levels than controls in the acute (p < 0.00001) and stable (p < 0.00001) stage of their disease. Patients with acute exacerbation of schizophrenia had higher CRP levels than stable patients (p = 0.02) but this difference did not persist when considering antipsychotic-medicated patients in both phases. Meta-regressions found that the increase of CRP in acutely ill patients as compared to controls was influenced by age (p < 0.01), BMI (p = 0.01) and first episode (p = 0.02), whereas the increase in CRP levels of stable patients as compared to controls was moderated by BMI (p = 0.004). CONCLUSIONS In conclusion, this meta-analysis provides strong evidence that patients with schizophrenia have higher CRP levels than controls, but also show an increase in inflammatory response in the acute stage of the disease as compared to the stable stage. CRP could thus be considered as a state marker and a trait marker of the disease.
Collapse
Affiliation(s)
- V Lestra
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France
| | - B Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France.
| | - C Martelli
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France; Institut National de la Santé et de la Recherche Médicale U1299, Research unit, NeuroImaging and Psychiatry, Paris Sud University, Paris Saclay University, Paris Descartes University, Digiteo Labs, Bâtiment 660, Gif-sur-Yvette, France
| | - A Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France
| | - N Hamdani
- Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France; Cédiapsy, 87 rue d'Assas, 75006 Paris, France
| |
Collapse
|
34
|
Mostafa M, Fathy AA, Elwasify M, Abdelsalam M. Analysis of selected polymorphisms in FOXP3 gene in a cohort of Egyptian patients with schizophrenia. J Genet Eng Biotechnol 2022; 20:83. [PMID: 35641708 PMCID: PMC9156649 DOI: 10.1186/s43141-022-00371-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Schizophrenia is a chronic mental disorder with different symptoms. The environmental and genetic factors are suggested to be the etiology of schizophrenia. However, the exact cause and pathogenesis of schizophrenia are still unclear. Different studies suggested that the immune system may have a role in schizophrenia. A genetic study found a relation between the disease and the HLA region on the sixth chromosome. Regulatory T cells (Treg) have a role in the regulation of immune response, especially the balance between TH1 and TH2 cells. The FOXP3 protein is a key regulator for Treg cell's functions. FOXP3 is a transcriptional factor, and its gene is present on the short arm of the X chromosome. The selected SNPs present in the promoter region which act as binding sites for transcriptional factors. This study investigated FOXP3 gene polymorphisms (rs3761548, rs3761549, and rs2232365) in Egyptian patients with schizophrenia. There are no previous studies about the association of FOXP3 gene polymorphisms with schizophrenia. The three selected single-nucleotide polymorphisms (SNPs) were investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for 125 schizophrenia patients and 160 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate patients with schizophrenia. RESULTS No significant associations were found between schizophrenia patients and healthy controls for the alleles and genotypes of the selected SNPs (P-value > 0.05). However, a significant association with ACC and ATC haplotypes was detected (P-value 0.001). No significant association was detected between the PANSS score and any of the studied SNPs. CONCLUSION The ATC haplotype of rs2232365, rs3761549, and rs3761548 could be considered a risk factor for schizophrenia in Egyptian patients.
Collapse
Affiliation(s)
- Maged Mostafa
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Aya Ahmed Fathy
- Public Health and Community Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elwasify
- Psychiatry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Maha Abdelsalam
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt. .,Immunology Department, Egypt Center for Research and Regenerative Medicine (ECRRM), Cairo, Egypt.
| |
Collapse
|
35
|
Ermakov EA, Melamud MM, Buneva VN, Ivanova SA. Immune System Abnormalities in Schizophrenia: An Integrative View and Translational Perspectives. Front Psychiatry 2022; 13:880568. [PMID: 35546942 PMCID: PMC9082498 DOI: 10.3389/fpsyt.2022.880568] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
The immune system is generally known to be the primary defense mechanism against pathogens. Any pathological conditions are reflected in anomalies in the immune system parameters. Increasing evidence suggests the involvement of immune dysregulation and neuroinflammation in the pathogenesis of schizophrenia. In this systematic review, we summarized the available evidence of abnormalities in the immune system in schizophrenia. We analyzed impairments in all immune system components and assessed the level of bias in the available evidence. It has been shown that schizophrenia is associated with abnormalities in all immune system components: from innate to adaptive immunity and from humoral to cellular immunity. Abnormalities in the immune organs have also been observed in schizophrenia. Evidence of increased C-reactive protein, dysregulation of cytokines and chemokines, elevated levels of neutrophils and autoantibodies, and microbiota dysregulation in schizophrenia have the lowest risk of bias. Peripheral immune abnormalities contribute to neuroinflammation, which is associated with cognitive and neuroanatomical alterations and contributes to the pathogenesis of schizophrenia. However, signs of severe inflammation are observed in only about 1/3 of patients with schizophrenia. Immunological parameters may help identify subgroups of individuals with signs of inflammation who well respond to anti-inflammatory therapy. Our integrative approach also identified gaps in knowledge about immune abnormalities in schizophrenia, and new horizons for the research are proposed.
Collapse
Affiliation(s)
- Evgeny A. Ermakov
- Laboratory of Repair Enzymes, Institute of Chemical Biology and Fundamental Medicine, Novosibirsk, Russia
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
| | - Mark M. Melamud
- Laboratory of Repair Enzymes, Institute of Chemical Biology and Fundamental Medicine, Novosibirsk, Russia
| | - Valentina N. Buneva
- Laboratory of Repair Enzymes, Institute of Chemical Biology and Fundamental Medicine, Novosibirsk, Russia
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
| | - Svetlana A. Ivanova
- Laboratory of Molecular Genetics and Biochemistry, Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russia
| |
Collapse
|
36
|
Reay WR, Kiltschewskij DJ, Geaghan MP, Atkins JR, Carr VJ, Green MJ, Cairns MJ. Genetic estimates of correlation and causality between blood-based biomarkers and psychiatric disorders. SCIENCE ADVANCES 2022; 8:eabj8969. [PMID: 35385317 PMCID: PMC8986101 DOI: 10.1126/sciadv.abj8969] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
There is a long-standing interest in exploring the relationship between blood-based biomarkers and psychiatric disorders, despite their causal role being difficult to resolve in observational studies. In this study, we leverage genome-wide association study data for a large panel of heritable serum biochemical traits to refine our understanding of causal effect in biochemical-psychiatric trait pairings. We observed widespread positive and negative genetic correlation between psychiatric disorders and biochemical traits. Causal inference was then implemented to distinguish causation from correlation, with strong evidence that C-reactive protein (CRP) exerts a causal effect on psychiatric disorders. Notably, CRP demonstrated both protective and risk-increasing effects on different disorders. Multivariable models that conditioned CRP effects on interleukin-6 signaling and body mass index supported that the CRP-schizophrenia relationship was not driven by these factors. Collectively, these data suggest that there are shared pathways that influence both biochemical traits and psychiatric illness.
Collapse
Affiliation(s)
- William R. Reay
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
- Centre for Brain and Mental Health Research, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dylan J. Kiltschewskij
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
- Centre for Brain and Mental Health Research, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Michael P. Geaghan
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
- Centre for Brain and Mental Health Research, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Joshua R. Atkins
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Vaughan J. Carr
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Melissa J. Green
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Murray J. Cairns
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
- Centre for Brain and Mental Health Research, Hunter Medical Research Institute, Newcastle, NSW, Australia
- Corresponding author.
| |
Collapse
|
37
|
Ji E, Boerrigter D, Cai HQ, Lloyd D, Bruggemann J, O'Donnell M, Galletly C, Lloyd A, Liu D, Lenroot R, Weickert TW, Shannon Weickert C. Peripheral complement is increased in schizophrenia and inversely related to cortical thickness. Brain Behav Immun 2022; 101:423-434. [PMID: 34808287 DOI: 10.1016/j.bbi.2021.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/23/2021] [Accepted: 11/15/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There is growing evidence for complement system involvement in the pathophysiology of schizophrenia, although the extent and magnitude of complement factor disturbances has not been fully reported. It also remains unclear whether complement abnormalities are characteristic of all patients with schizophrenia or whether they are representative of a subgroup of patients who show signs of heightened inflammation. The aim of the present study was to quantify and compare the levels of a range of complement factors, receptors and regulators in healthy controls and people with schizophrenia and to determine the extent to which the levels of these peripheral molecules relate to measures of brain structure, particularly cortical thickness. METHOD Seventy-five healthy controls and 90 patients with schizophrenia or schizoaffective disorder were included in the study. Peripheral blood samples were collected from all participants and mRNA expression was quantified in 20 complement related genes, four complement proteins, as well as for four cytokines. T1-weighted structural MRI scans were acquired and analysed to determine cortical thickness measures. RESULTS There were significant increases in peripheral mRNA encoding receptors (C5ar1, CR1, CR3a), regulators (CD55, C59) and protein concentrations (C3, C3b, C4) in people with schizophrenia relative to healthy controls. C4a expression was significantly increased in a subgroup of patients displaying elevated peripheral cytokine levels. A higher inflammation index score derived from mRNA expression patterns predicted reductions in cortical thickness in the temporal lobe (superior temporal gyrus, transverse temporal gyrus, fusiform gyrus, insula) in patients with schizophrenia and healthy controls. CONCLUSIONS Analysis of all three major complement pathways supports increased complement activity in schizophrenia and also shows that peripheral C4a up-regulation is related to increased peripheral pro-inflammatory cytokines in healthy controls. Our region-specific, neuroimaging findings linked to an increased peripheral complement mRNA expression pattern suggests a role for complement in cortical thinning. Further studies are required to further clarify clinical and neurobiological consequences of aberrant complement levels in schizophrenia and related psychoses.
Collapse
Affiliation(s)
- Ellen Ji
- Psychiatric University Hospital Zurich, Zurich, Switzerland; Neuroscience Research Australia, Sydney, NSW, Australia
| | | | - Helen Q Cai
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David Lloyd
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jason Bruggemann
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Edith Collins Centre (Translational Research in Alcohol Drugs & Toxicology), Sydney Local Health District, Australia; Speciality of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Maryanne O'Donnell
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, Adelaide, South Australia, Australia; Ramsay Health Care (SA) Mental Health Services, Adelaide, South Australia, Australia
| | - Andrew Lloyd
- Inflammation and Infection Research Centre, University of New South Wales, Sydney, Australia
| | - Dennis Liu
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Rhoshel Lenroot
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Thomas W Weickert
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA
| | - Cynthia Shannon Weickert
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, USA.
| |
Collapse
|
38
|
Fathian F, Gjestad R, Kroken RA, Løberg EM, Reitan SK, Fleichhacker WW, Rettenbacher M, Larsen TK, Joa I, Stabell LA, Kjelby E, Sinkevicute I, Alisauskiene R, Steen VM, Johnsen E. Association between C-reactive protein levels and antipsychotic treatment during 12 months follow-up period after acute psychosis. Schizophr Res 2022; 241:174-183. [PMID: 35131596 DOI: 10.1016/j.schres.2022.01.049] [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: 04/05/2021] [Revised: 01/04/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND A potential role of inflammatory pathways in the pathology of schizophrenia has been suggested for at least a subgroup of patients. Elevated levels of the inflammatory marker C-reactive protein (CRP) have been observed, with associations to pathogenesis and symptoms. The current evidence regarding effects of antipsychotics on CRP levels is ambiguous. OBJECTIVES To examine and compare the influence on CRP levels of three pharmacologically diverse new generation antipsychotics during a one-year follow-up in schizophrenia spectrum disorder. METHODS In a multicenter, pragmatic and rater-blinded randomized trial, the effects of amisulpride, aripiprazole and olanzapine were compared in 128 patients with schizophrenia spectrum disorder. All had positive symptoms of psychosis at study entry. Clinical and laboratory assessments including the measurement of CRP levels were conducted at baseline, and 1, 3, 6, 12, 26, 39, and 52 weeks thereafter. RESULTS For all antipsychotic drugs analysed together, there was an increase in CRP levels during the one-year follow-up. Aripiprazole, as opposed to amisulpride and olanzapine, was associated with a reduced CRP level after one week, after which the CRP level caught up with the other drugs. Compared to those previously exposed to antipsychotic drugs, antipsychotic-naïve patients had lower CRP levels at all follow-up time points, but with the same temporal patterns of change. CONCLUSION Treatment with amisulpride, aripiprazole and olanzapine showed different effects on CRP levels in patients with schizophrenia spectrum disorders, modified by previous antipsychotics exposure status. This finding suggests that antipsychotic drugs may vary with respect to their influence on pro-inflammatory pathways. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT01446328; URL: http://www. CLINICALTRIALS gov/.
Collapse
Affiliation(s)
- Farivar Fathian
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A Kroken
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway; Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Solveig Klæbo Reitan
- Department of Mental Health, St. Olav University Hospital, 7006 Trondheim, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - W Wolfgang Fleichhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain 52, Innsbruck, Austria
| | - Maria Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain 52, Innsbruck, Austria
| | - Tor K Larsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; TIPS, Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- TIPS, Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Lena Antonsen Stabell
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eirik Kjelby
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Igne Sinkevicute
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Renata Alisauskiene
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Vidar M Steen
- NORMENT Centre of Excellence, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
39
|
Beck D, de Lange AG, Pedersen ML, Alnæs D, Maximov II, Voldsbekk I, Richard G, Sanders A, Ulrichsen KM, Dørum ES, Kolskår KK, Høgestøl EA, Steen NE, Djurovic S, Andreassen OA, Nordvik JE, Kaufmann T, Westlye LT. Cardiometabolic risk factors associated with brain age and accelerate brain ageing. Hum Brain Mapp 2022; 43:700-720. [PMID: 34626047 PMCID: PMC8720200 DOI: 10.1002/hbm.25680] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 09/02/2021] [Accepted: 09/25/2021] [Indexed: 11/17/2022] Open
Abstract
The structure and integrity of the ageing brain is interchangeably linked to physical health, and cardiometabolic risk factors (CMRs) are associated with dementia and other brain disorders. In this mixed cross-sectional and longitudinal study (interval mean = 19.7 months), including 790 healthy individuals (mean age = 46.7 years, 53% women), we investigated CMRs and health indicators including anthropometric measures, lifestyle factors, and blood biomarkers in relation to brain structure using MRI-based morphometry and diffusion tensor imaging (DTI). We performed tissue specific brain age prediction using machine learning and performed Bayesian multilevel modeling to assess changes in each CMR over time, their respective association with brain age gap (BAG), and their interaction effects with time and age on the tissue-specific BAGs. The results showed credible associations between DTI-based BAG and blood levels of phosphate and mean cell volume (MCV), and between T1-based BAG and systolic blood pressure, smoking, pulse, and C-reactive protein (CRP), indicating older-appearing brains in people with higher cardiometabolic risk (smoking, higher blood pressure and pulse, low-grade inflammation). Longitudinal evidence supported interactions between both BAGs and waist-to-hip ratio (WHR), and between DTI-based BAG and systolic blood pressure and smoking, indicating accelerated ageing in people with higher cardiometabolic risk (smoking, higher blood pressure, and WHR). The results demonstrate that cardiometabolic risk factors are associated with brain ageing. While randomized controlled trials are needed to establish causality, our results indicate that public health initiatives and treatment strategies targeting modifiable cardiometabolic risk factors may also improve risk trajectories and delay brain ageing.
Collapse
Affiliation(s)
- Dani Beck
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
- Sunnaas Rehabilitation Hospital HTNesodden
| | - Ann‐Marie G. de Lange
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- LREN, Centre for Research in Neurosciences‐Department of Clinical NeurosciencesCHUV and University of LausanneLausanneSwitzerland
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Mads L. Pedersen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
| | - Dag Alnæs
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Bjørknes CollegeOsloNorway
| | - Ivan I. Maximov
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
| | - Irene Voldsbekk
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
| | - Geneviève Richard
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
| | - Anne‐Marthe Sanders
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
- Sunnaas Rehabilitation Hospital HTNesodden
| | - Kristine M. Ulrichsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
- Sunnaas Rehabilitation Hospital HTNesodden
| | - Erlend S. Dørum
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
- Sunnaas Rehabilitation Hospital HTNesodden
| | - Knut K. Kolskår
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
- Sunnaas Rehabilitation Hospital HTNesodden
| | - Einar A. Høgestøl
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
| | - Nils Eiel Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
| | - Srdjan Djurovic
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
| | - Ole A. Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- KG Jebsen Centre for Neurodevelopmental DisordersUniversity of OsloOsloNorway
| | | | - Tobias Kaufmann
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of Psychiatry and PsychotherapyUniversity of TübingenTubingenGermany
| | - Lars T. Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical MedicineUniversity of OsloOslo
- Department of PsychologyUniversity of OsloOslo
- KG Jebsen Centre for Neurodevelopmental DisordersUniversity of OsloOsloNorway
| |
Collapse
|
40
|
Rahman T, Purves-Tyson T, Geddes AE, Huang XF, Newell KA, Weickert CS. N-Methyl-d-Aspartate receptor and inflammation in dorsolateral prefrontal cortex in schizophrenia. Schizophr Res 2022; 240:61-70. [PMID: 34952289 DOI: 10.1016/j.schres.2021.11.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/02/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
Lower N-methyl-d-aspartate receptor (NMDAR) GluN1 subunit levels and heightened neuroinflammation are found in the cortex in schizophrenia. Since neuroinflammation can lead to changes in NMDAR function, it is possible that these observations are linked in schizophrenia. We aimed to extend our previous studies by measuring molecular indices of NMDARs that define key functional properties of this receptor - particularly the ratio of GluN2A and GluN2B subunits - in dorsolateral prefrontal cortex (DLPFC) from schizophrenia and control cases (37/37). We sought to test whether changes in these measures are specific to the subset of schizophrenia cases with high levels of inflammation-related mRNAs, defined as a high inflammatory subgroup. Quantitative autoradiography was used to detect 'functional' NMDARs ([3H]MK-801), GluN1-coupled-GluN2A subunits ([3H]CGP-39653), and GluN1-coupled-GluN2B subunits ([3H]Ifenprodil). Quantitative RT-PCR was used to measure NMDAR subunit transcripts (GRIN1, GRIN2A and GRIN2B). The ratios of GluN2A:GluN2B binding and GRIN2A:GRIN2B mRNAs were calculated as an index of putative NMDAR composition. We found: 1) GluN2A binding, and 2) the ratios of GluN2A:GluN2B binding and GRIN2A:GRIN2B mRNAs were lower in schizophrenia cases versus controls (p < 0.05), and 3) lower GluN2A:GluN2B binding and GRIN2A:GRIN2B mRNA ratios were exaggerated in the high inflammation/schizophrenia subgroup compared to the low inflammation/control subgroup (p < 0.05). No other NMDAR-related indices were significantly changed in the high inflammation/schizophrenia subgroup. This suggests that neuroinflammation may alter NMDAR stoichiometry rather than targeting total NMDAR levels overall, and future studies could aim to determine if anti-inflammatory treatment can alleviate this aspect of NMDAR-related pathology.
Collapse
Affiliation(s)
- Tasnim Rahman
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Tertia Purves-Tyson
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Amy E Geddes
- School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Xu-Feng Huang
- School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Kelly A Newell
- School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, Australia.
| | - Cynthia Shannon Weickert
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, NY, USA.
| |
Collapse
|
41
|
Murphy CE, Walker AK, O'Donnell M, Galletly C, Lloyd AR, Liu D, Weickert CS, Weickert TW. Peripheral NF-κB dysregulation in people with schizophrenia drives inflammation: putative anti-inflammatory functions of NF-κB kinases. Transl Psychiatry 2022; 12:21. [PMID: 35027554 PMCID: PMC8758779 DOI: 10.1038/s41398-021-01764-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 12/18/2022] Open
Abstract
Elevations in plasma levels of pro-inflammatory cytokines and C-reactive protein (CRP) in patient blood have been associated with impairments in cognitive abilities and more severe psychiatric symptoms in people with schizophrenia. The transcription factor nuclear factor kappa B (NF-κB) regulates the gene expression of pro-inflammatory factors whose protein products trigger CRP release. NF-κB activation pathway mRNAs are increased in the brain in schizophrenia and are strongly related to neuroinflammation. Thus, it is likely that this central immune regulator is also dysregulated in the blood and associated with cytokine and CRP levels. We measured levels of six pro-inflammatory cytokine mRNAs and 18 mRNAs encoding NF-κB pathway members in peripheral blood leukocytes from 87 people with schizophrenia and 83 healthy control subjects. We then assessed the relationships between the alterations in NF-κB pathway genes, pro-inflammatory cytokine and CRP levels, psychiatric symptoms and cognition in people with schizophrenia. IL-1β and IFN-γ mRNAs were increased in patients compared to controls (both p < 0.001), while IL-6, IL-8, IL-18, and TNF-α mRNAs did not differ. Recursive two-step cluster analysis revealed that high levels of IL-1β mRNA and high levels of plasma CRP defined 'high inflammation' individuals in our cohort, and a higher proportion of people with schizophrenia were identified as displaying 'high inflammation' compared to controls using this method (p = 0.03). Overall, leukocyte expression of the NF-κB-activating receptors, TLR4 and TNFR2, and the NF-κB subunit, RelB, was increased in people with schizophrenia compared to healthy control subjects (all p < 0.01), while NF-κB-inducing kinase mRNAs IKKβ and NIK were downregulated in patients (all p < 0.05). We found that elevations in TLR4 and RelB appear more related to inflammatory status than to a diagnosis of schizophrenia, but changes in TNFR2 occur in both the high and low inflammation patients (but were exaggerated in high inflammation patients). Further, decreased leukocyte expression of IKKβ and NIK mRNAs was unique to high inflammation patients, which may represent schizophrenia-specific dysregulation of NF-κB that gives rise to peripheral inflammation in a subset of patients.
Collapse
Affiliation(s)
- Caitlin E Murphy
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Adam K Walker
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Drug Discovery Biology Theme, Monash University, Parkville, Australia
| | | | - Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Ramsay Health Care (SA) Mental Health, Adelaide, South Australia, Australia
| | - Andrew R Lloyd
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Dennis Liu
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Cynthia Shannon Weickert
- Neuroscience Research Australia, Sydney, New South Wales, Australia.
- School of Psychiatry, University of New South Wales, Sydney, Australia.
- Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, New York, NY, USA.
| | - Thomas W Weickert
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, New York, NY, USA
| |
Collapse
|
42
|
Chen PS, Tang LY, Chang HH. Roles of C-reactive protein polymorphisms and life event changes on cognitive function in bipolar patients receiving valproate. Int J Immunopathol Pharmacol 2022; 36:3946320221084835. [PMID: 35377256 PMCID: PMC8984865 DOI: 10.1177/03946320221084835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients with bipolar disorder (BD) exhibit an inflamed condition that is
associated with metabolic disturbance and cognitive impairment. Whether
inflammation, represented by C-reactive protein (CRP), is causally
associated with BD and influences treatment outcome has not been
established. Methods We examined whether CRP is a causal factor for the risk of BD in drug-naïve,
depressed BD patients and investigated whether polymorphisms in
CRP and life event changes influence cognitive function
in BD patients receiving valproate (VPA) treatment. Results Our results showed that BD patients had significantly higher CRP levels and
worse cognitive function than the controls, while the frequencies of
CRP single nucleotide polymorphisms in BD patients and
in controls were not different. In addition, the life event scale score was
higher for BD patients than for controls. Furthermore, the genotypes of
CRP polymorphisms and the interactions between
polymorphisms of CRP and life event scale score had a
significant influence on cognitive performance in BD patients after 12 weeks
of VPA treatment. Conclusion Our study demonstrated the clinical utility of the application of functional
genetics in clarifying the interactions among CRP, life event stress, and BD
and suggested the important roles of CRP gene–environment
interactions in developing treatment strategies for BD.
Collapse
Affiliation(s)
- Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
| | - Li-Yi Tang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
| | - Hui Hua Chang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| |
Collapse
|
43
|
Chumakov E, Dorofeikova M, Tsyrenova K, Petrova N. A Cross-Sectional Study on Associations Between BDNF, CRP, IL-6 and Clinical Symptoms, Cognitive and Personal Performance in Patients With Paranoid Schizophrenia. Front Psychiatry 2022; 13:943869. [PMID: 35873262 PMCID: PMC9298757 DOI: 10.3389/fpsyt.2022.943869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cognitive impairment is among the core dimensions in schizophrenia and is a significant predictor of everyday functioning in people with schizophrenia. Given the enormous burden of schizophrenia, the search for its clinically relevant biomarkers is essential. Researchers have been trying to elucidate factors of cognitive impairment as well as personal performance, but the search is still ongoing. The aim of the study was to search for associations between BDNF, CRP, IL-6 and clinical symptoms, cognitive and personal performance in patients with paranoid schizophrenia. METHODS A total of 86 patients (53.5% women, mean age 31.1 ± 6.5) with paranoid schizophrenia (F20.0; ICD-10) in remission were examined. Clinical and neuropsychological examination included the Positive and Negative Syndrome Scale, Personal and Social Performance Scale, Calgary Depression Scale for Schizophrenia and the Brief Assessment of Cognitive Function in Schizophrenia. IL-6, BDNF, CRP levels were determined in the patients' blood serum. RESULTS Cognitive impairment was revealed in 79.1% of patients and was more profound in patients with higher number of hospitalizations (p = 0.006). The average BDNF levels were 13.38 ± 15.84 ng/ml, CRP concentration was 2.09 ± 2.54 mg/l, and IL-6 levels were 12.14 ± 5.88 pg/ml. There were no differences in biomarker levels or BACS results in patients that had different antipsychotic therapy or differed in the presence of anticholinergic therapy. CRP levels were higher in patients with longer disease duration, lower age of onset, more impaired personal social performance and processing speed. IL-6 was higher in individuals with lower working memory scores. PANSS negative subscale score negatively correlated and PSP score positively correlated with most cognitive domains. A linear regression established that the first episode vs. multiple episodes of schizophrenia could statistically significantly predict personal and social performance and cognition, including speech fluency and planning, as well as CRP levels. CONCLUSIONS This study continues the search for biomarkers of schizophrenia and cognitive impairment in schizophrenia to improve the reliability of diagnosing the disorder and find new treatment approaches. The role of the number of psychoses experienced (first episode vs. multiple episodes of schizophrenia) in cognition, personal and social performance and inflammation is shown.
Collapse
Affiliation(s)
- Egor Chumakov
- Department of Psychiatry and Addiction, Saint-Petersburg State University, Saint Petersburg, Russia.,Saint Petersburg Psychiatric Hospital No̱ 1 Named After P. P. Kashchenko, Saint Petersburg, Russia
| | - Mariia Dorofeikova
- Laboratory of Neurophysiology and Pathology of Behavior, Sechenov Institute of Evolutionary Physiology and Biochemistry, Saint Petersburg, Russia.,Center for Molecular Neurobiology, Institute of Developmental Neurophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristina Tsyrenova
- Department of Psychiatry and Addiction, Saint-Petersburg State University, Saint Petersburg, Russia
| | - Nataliia Petrova
- Department of Psychiatry and Addiction, Saint-Petersburg State University, Saint Petersburg, Russia
| |
Collapse
|
44
|
Abstract
ABSTRACT Inflammatory phenomena are found in many psychiatric disorders-notably, depression, schizophrenia, and posttraumatic stress disorder. Inflammation has been linked to severity and treatment resistance, and may both contribute to, and result from, the pathophysiology of some psychiatric illnesses. Emerging research suggests that inflammation may contribute to symptom domains of reward, motor processing, and threat reactivity across different psychiatric diagnoses. Reward-processing deficits contribute to motivational impairments in depression and schizophrenia, and motor-processing deficits contribute to psychomotor slowing in both depression and schizophrenia. A number of experimental models and clinical trials suggest that inflammation produces deficits in reward and motor processing through common pathways connecting the cortex and the striatum, which includes the nucleus accumbens, caudate nucleus, and putamen.The observed effects of inflammation on psychiatric disorders may cut across traditional conceptualizations of psychiatric diagnoses. Further study may lead to targeted immunomodulating treatments that address difficult-to-treat symptoms in a number of psychiatric disorders. In this review, we use a Research Domain Criteria framework to discuss proposed mechanisms for inflammation and its effects on the domains of reward processing, psychomotor slowing, and threat reactivity. We also discuss data that support contributing roles of metabolic dysregulation and sex differences on the behavioral outcomes of inflammation. Finally, we discuss ways that future studies can help disentangle this complex topic to yield fruitful results that will help advance the field of psychoneuroimmunology.
Collapse
Affiliation(s)
- David S Thylur
- From the Department of Psychiatry and Behavioral Sciences, Emory University
| | | |
Collapse
|
45
|
Efthymiou D, Zekakos DX, Papatriantafyllou E, Ziagkas E, Petrelis AN, Vassilopoulou E. Gait Alterations in the Prediction of Metabolic Syndrome in Patients With Schizophrenia: A Pilot Study With PODOSmart ® Insoles. Front Psychiatry 2022; 13:756600. [PMID: 35153872 PMCID: PMC8829465 DOI: 10.3389/fpsyt.2022.756600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Second-generation antipsychotics (APs) are associated with metabolic syndrome (MetS), characterized by abnormal pro-inflammatory cytokine production and oxidative stress due to the reduced antioxidant systems, and neurological effects, including mobility impairment. This pilot study investigated relationships between inflammatory-metabolic biomarkers, MetS and gait alterations in patients with psychosis treated with APs. METHODS Patients with psychosis treated with APs, 20 with MetS (MPS group) and 20 without MetS (PS group) were studied, usinganthropometric data, blood measurements and gait analysis performed with the PODOSmart ® gait analysis device. RESULTS AND DISCUSSION The MPS group had significantly higher mean body mass index (BMI) and arterial blood pressure (BP) than the PS group. PODOSmart ® gait analysis recorded significant differences between groups in pronation-supination at Heel Off (HO), gaitline HO and gaitline Toe Off (TO). Multifactorial elastic net regression models demonstrated significant association with MetS of inflammatory markers, specific AP2 treatment, gender, age; BMI; BP and smoking (accuracy λ = 0.08), and in relation to gait parameters (accuracy λ = 0.750), the three pronation- supination variables, i.e., at HO, flat foot in (AP2 related) and TO, and propulsion speed. The gait parameters were at the edges of the model, thus indicating a more significant role of these parameters compared to the other clinical variables. Early diagnosis of MetS in patients with schizophrenia via identification of gait alterations can be a screening measure for serious cardiovascular complications related to psychosis and APs, to enable timely dietary intervention that can control the pro-inflammatory state and reduce oxidative stress.
Collapse
Affiliation(s)
- Dimitris Efthymiou
- Division of Neurosciences, Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Efthimis Ziagkas
- Laboratory of Motor Behaviour, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| |
Collapse
|
46
|
Bulut NS, Yorguner N, Çarkaxhiu Bulut G. The severity of inflammation in major neuropsychiatric disorders: comparison of neutrophil-lymphocyte and platelet-lymphocyte ratios between schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and obsessive compulsive disorder. Nord J Psychiatry 2021; 75:624-632. [PMID: 34319861 DOI: 10.1080/08039488.2021.1919201] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As non-specific markers of immune dysregulation, neutrophil-lymphocyte and platelet-lymphocyte ratios (NLR and PLR) have been consistently shown to be increased in major neuropsychiatric disorders. Although this increase seems to be trans-diagnostic, the extent to which its magnitude differs between disorders remains largely unclear. AIM The aim of this study was to directly compare the severity of inflammation (as reflected by NLR and PLR) between schizophrenia (Sch), bipolar mania (BD-M), bipolar depression (BD-D), major depressive disorder (MDD) and obsessive compulsive disorder (OCD). METHODS NLR and PLR were obtained for a total of 417 subjects (91 Sch, 70 BD-D, 37 BD-M, 93 MDD, 37 OCD, and 95 controls) and analyzed for group differences. RESULTS Sch, BD-M, BD-D and MDD presented with significantly higher NLR compared with both OCD and HC. NLR in BD-M was significantly higher than all the remaining groups, whereas Sch, BD-D and MDD presented with comparably elevated NLR. Moreover, BD-M, Sch and MDD had significantly higher PLR compared with HC. CONCLUSION These results suggest that the underlying inflammation may be most severe in BD-M, followed by Sch, BD-D and MDD. On the other hand, inflammation may be of negligible intensity in OCD, or at least undetectable by means of NLR or PLR.
Collapse
Affiliation(s)
- Necati Serkut Bulut
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Neşe Yorguner
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Gresa Çarkaxhiu Bulut
- Department of Child and Adolescent Psychiatry, Maltepe University Medical School, Istanbul, Turkey
| |
Collapse
|
47
|
Murphy CE, Walker AK, Weickert CS. Neuroinflammation in schizophrenia: the role of nuclear factor kappa B. Transl Psychiatry 2021; 11:528. [PMID: 34650030 PMCID: PMC8516884 DOI: 10.1038/s41398-021-01607-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/22/2021] [Accepted: 09/03/2021] [Indexed: 12/12/2022] Open
Abstract
Neuroinflammation, particularly in the dorsolateral prefrontal cortex, is well-established in a subset of people with schizophrenia, with significant increases in inflammatory markers including several cytokines. Yet the cause(s) of cortical inflammation in schizophrenia remains unknown. Clues as to potential microenvironmental triggers and/or intracellular deficits in immunoregulation may be gleaned from looking further upstream of effector immune molecules to transcription factors that control inflammatory gene expression. Here, we focus on the 'master immune regulator' nuclear factor kappa B (NF-κB) and review evidence in support of NF-κB dysregulation causing or contributing to neuroinflammation in patients. We discuss the utility of 'immune biotyping' as a tool to analyse immune-related transcripts and proteins in patient tissue, and the insights into cortical NF-κB in schizophrenia revealed by immune biotyping compared to studies treating patients as a single, homogenous group. Though the ubiquitous nature of NF-κB presents several hurdles for drug development, targeting this key immunoregulator with novel or repurposed therapeutics in schizophrenia is a relatively underexplored area that could aid in reducing symptoms of patients with active neuroinflammation.
Collapse
Affiliation(s)
- Caitlin E. Murphy
- grid.250407.40000 0000 8900 8842Neuroscience Research Australia, Randwick, NSW 2031 Australia
| | - Adam K. Walker
- grid.250407.40000 0000 8900 8842Neuroscience Research Australia, Randwick, NSW 2031 Australia ,grid.1005.40000 0004 4902 0432School of Psychiatry, University of New South Wales, Randwick, NSW 2031 Australia ,grid.1002.30000 0004 1936 7857Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052 Australia
| | - Cynthia Shannon Weickert
- Neuroscience Research Australia, Randwick, NSW, 2031, Australia. .,School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia. .,Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, NY, 13210, USA.
| |
Collapse
|
48
|
Zhou Y, Huang J, Zhang P, Tong J, Fan F, Gou M, Cui Y, Luo X, Tan S, Wang Z, Feng W, Yang F, Tian B, Tian L, Savransky A, Hare S, Ryan MC, Goldwaser E, Chiappelli J, Chen S, Kochunov P, Kvarta M, Tan Y, Hong LE. Allostatic Load Effects on Cortical and Cognitive Deficits in Essentially Normotensive, Normoweight Patients with Schizophrenia. Schizophr Bull 2021; 47:1048-1057. [PMID: 33501486 PMCID: PMC8266595 DOI: 10.1093/schbul/sbaa196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Reduced cortical gray matter integrity and cognitive abilities are among core deficits in schizophrenia. We hypothesized that higher allostatic load (AL) that accounts for exposure to chronic stress is a contributor to structural and cognitive deficits in schizophrenia. One hundred and sixty-seven schizophrenia patients who were on average with normal weight, normal systolic, and diastolic blood pressure and 72 healthy controls were enrolled in the study. Group differences in subclinical cardiovascular, metabolic, immune, and neuroendocrine biological markers as indexed by AL and contribution of AL components to the structural and cognitive deficits in schizophrenia were explored. Compared with controls, schizophrenia patients who were normotensive, normoweight, and had low total cholesterol levels still had significantly higher AL mainly due to lower high-density lipoprotein cholesterol and higher heart rate, waist-hip ratio, hemoglobinA1c, hypersensitive C-reactive protein, and overnight-urine cortisol levels. Patients also had decreased whole-brain mean cortical thickness, and lower cognition assessed by the MATRICS consensus cognitive battery. AL was inversely correlated with mean cortical thickness and cognition in schizophrenia, while none of these relationships existed in controls. Mediation analyses showed the effect of AL on cognitive deficits in schizophrenia was significantly mediated by cortical thinning, and the most significant mediating cortical area was the left superior frontal gyrus. Cortical thickness may act as a mediator between AL and cognitive deficits in schizophrenia. Early intervention strategies to reduce cortical thinning and cognitive dysfunction in schizophrenia should target specific aspects of their high AL in addition to weight gain, hypertension and high cholesterol levels.
Collapse
Affiliation(s)
- Yanfang Zhou
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Ping Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Jinghui Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Mengzhuang Gou
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, P.R. China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Wei Feng
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Fude Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Li Tian
- Institute of Biomedicine and Translational Medicine, Department of Physiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Anya Savransky
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Stephanie Hare
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Meghann C Ryan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Eric Goldwaser
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Shuo Chen
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Mark Kvarta
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
49
|
Lizano P, Lutz O, Xu Y, Rubin LH, Paskowitz L, Lee AM, Eum S, Keedy SK, Hill SK, Reilly JL, Wu B, Tamminga CA, Clementz BA, Pearlson GD, Gershon ES, Keshavan MS, Sweeney JA, Bishop JR. Multivariate relationships between peripheral inflammatory marker subtypes and cognitive and brain structural measures in psychosis. Mol Psychiatry 2021; 26:3430-3443. [PMID: 33060818 PMCID: PMC8046847 DOI: 10.1038/s41380-020-00914-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022]
Abstract
Elevations in peripheral inflammatory markers have been reported in patients with psychosis. Whether this represents an inflammatory process defined by individual or subgroups of markers is unclear. Further, relationships between peripheral inflammatory marker elevations and brain structure, cognition, and clinical features of psychosis remain unclear. We hypothesized that a pattern of plasma inflammatory markers, and an inflammatory subtype established from this pattern, would be elevated across the psychosis spectrum and associated with cognition and brain structural alterations. Clinically stable psychosis probands (Schizophrenia spectrum, n = 79; Psychotic Bipolar disorder, n = 61) and matched healthy controls (HC, n = 60) were assessed for 15 peripheral inflammatory markers, cortical thickness, subcortical volume, cognition, and symptoms. A combination of unsupervised exploratory factor analysis and hierarchical clustering was used to identify inflammation subtypes. Levels of IL6, TNFα, VEGF, and CRP were significantly higher in psychosis probands compared to HCs, and there were marker-specific differences when comparing diagnostic groups. Individual and/or inflammatory marker patterns were associated with neuroimaging, cognition, and symptom measures. A higher inflammation subgroup was defined by elevations in a group of 7 markers in 36% of Probands and 20% of HCs. Probands in the elevated inflammatory marker group performed significantly worse on cognitive measures of visuo-spatial working memory and response inhibition, displayed elevated hippocampal, amygdala, putamen and thalamus volumes, and evidence of gray matter thickening compared to the proband group with low inflammatory marker levels. These findings specify the nature of peripheral inflammatory marker alterations in psychotic disorders and establish clinical, neurocognitive and neuroanatomic associations with increased inflammatory activation in psychosis. The identification of a specific subgroup of patients with inflammatory alteration provides a potential means for targeting treatment with anti-inflammatory medications.
Collapse
Affiliation(s)
- Paulo Lizano
- Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Olivia Lutz
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - Leah H Rubin
- Department of Neurology, Psychiatry, and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Lyle Paskowitz
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - Adam M Lee
- Department of Experimental and Clinical Pharmacology and Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Seenae Eum
- School of Pharmacy, Shenandoah University, Winchester, Virginia, USA
| | - Sarah K Keedy
- Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago, IL, USA
| | - S Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Baolin Wu
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Carol A Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brett A Clementz
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago, IL, USA
| | - Matcheri S Keshavan
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John A Sweeney
- Deptartment of Psychiatry, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology and Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
50
|
Laskaris L, Mancuso S, Shannon Weickert C, Zalesky A, Chana G, Wannan C, Bousman C, Baune BT, McGorry P, Pantelis C, Cropley VL. Brain morphology is differentially impacted by peripheral cytokines in schizophrenia-spectrum disorder. Brain Behav Immun 2021; 95:299-309. [PMID: 33838248 DOI: 10.1016/j.bbi.2021.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/13/2021] [Accepted: 04/03/2021] [Indexed: 01/28/2023] Open
Abstract
Deficits in brain morphology are one of the most widely replicated neuropathological features in schizophrenia-spectrum disorder (SSD), although their biological underpinnings remain unclear. Despite the existence of hypotheses by which peripheral inflammation may impact brain structure, few studies have examined this relationship in SSD. This study aimed to establish the relationship between peripheral markers of inflammation and brain morphology and determine whether such relationships differed across healthy controls and individuals with first episode psychosis (FEP) and chronic schizophrenia. A panel of 13 pro- and anti-inflammatory cytokines were quantified from serum in 175 participants [n = 84 Healthy Controls (HC), n = 40 FEP, n = 51 Chronic SCZ]. We first performed a series of permutation tests to identify the cytokines most consistently associated with brain structural regions. Using moderation analysis, we then determined the extent to which individual variation in select cytokines, and their interaction with diagnostic status, predicted variation in brain structure. We found significant interactions between cytokine level and diagnosis on brain structure. Diagnostic status significantly moderated the relationship of IFNγ, IL4, IL5 and IL13 with frontal thickness, and of IFNγ and IL5 and total cortical volume. Specifically, frontal thickness was positively associated with IFNγ, IL4, IL5 and IL13 cytokine levels in the healthy control group, whereas pro-inflammatory cytokines IFNγ and IL5 were associated with lower total cortical volume in the FEP group. Our findings suggest that while there were no relationships detected in chronic schizophrenia, the relationship between peripheral inflammatory markers and select brain regions are differentially impacted in FEP and healthy controls. Longitudinal investigations are required to determine whether the relationship between brain structure and peripheral inflammation changes over time.
Collapse
Affiliation(s)
- Liliana Laskaris
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Australia; Department of Psychiatry, The University of Melbourne, Australia.
| | - Sam Mancuso
- Department of Psychiatry, The University of Melbourne, Australia; Translational Clinical Psychology Research Unit, Institute for Social Neuroscience, Australia
| | - Cynthia Shannon Weickert
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick NSW 2031, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Department of Neuroscience & Physiology, Upstate Medical University, Syracuse, NY 13210, USA
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Australia; Department of Biomedical Engineering, Melbourne School of Engineering, The University of Melbourne
| | - Gursharan Chana
- Department of Medicine, Royal Melbourne Hospital, Royal Parade, Melbourne, Australia
| | - Cassandra Wannan
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Australia; Department of Psychiatry, The University of Melbourne, Australia
| | - Chad Bousman
- Departments of Medical Genetics, Psychiatry, Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Bernhard T Baune
- Department of Psychiatry, The University of Melbourne, Australia; Department of Psychiatry, University of Münster, Germany; Florey Institute for Neurosciences and Mental Health, Parkville, VIC Australia
| | - Patrick McGorry
- Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Australia; Department of Psychiatry, The University of Melbourne, Australia; North Western Mental Health, Melbourne Health, Parkville, VIC Australia; Florey Institute for Neurosciences and Mental Health, Parkville, VIC Australia
| | - Vanessa L Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Australia; Department of Psychiatry, The University of Melbourne, Australia; Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| |
Collapse
|