Address: Loyola University Stritch School of Medicine, Loyola University Chicago 2160,
Address: Clinic for Psychiatry and Psychotherapy II, Ulm University, Bezirkskrankenhaus Günzburg,
Address: Erasmus MC, Department of Psychiatry, Room DP 1436, 's Gravendijkwal 230,
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Introduction to the field
The expanding field of psycho-neuro-immunology (PNI) has markedly increased the knowledge about the interference between the central nervous system and the immune system. PNI has shown that the activity of the immune system is influenced by the CNS and vice versa. There are recent developments in this area during last decade.
In schizophrenia one third of schizophrenic patients show immunological abnormalities such as high antibody titres against several antigens (Schwarz et al., 1999), or a distinct cytokine profile in serum and cerebrospinal fluid (CSF) (Müller et al., 1999a). Molecular genetic data suggest a possible role of endogenous retroviruses in the ethiopathology of schizophrenia (Yolken et al., 2000). Some studies show distinct changes in the cytokine patterns after administration of atypical antipsychotics, indicating the immunological potency of antipsychotics (Pollmacher et al., 1996; Müller et al., 1997; Müller et al., 1999b, Kim et al, 2009). The role cyclooxygenase-2 inhibitor as add-on therapy in schizophrenia showed promising outcome (Müller et al., 2010).
In depression some studies indicate a Th1-like immune response in depressed patients (Maes, 1995) as well as in psychological stress (Leonard and Song, 1996). Antidepressants induce a shift from Th1-like to Th2-like cytokine production was demonstrated both in vitro and in vivo (Maes et al., 1999, Myint et al., 2005). The beneficial role of cyclooxygenase-2 inhibitor as add-on therapy was demonstrated also in depression (Müller et al, 2006). The link between immune system activation and disturbed serotonergic neurotransmission through tryptophan break-down “kynurenine” pathway, such as, imbalanced neuroprotective and neurotoxic kynurenines in depression was demonstrated (Myint et al, 2007a). The possible role of kynurenines as immune system related biomarkers in mood disorders was proposed (Myint et al., 2007a, b). Recently, the role of monocyte mRNA signatures as biomarker in mood disorders also became of interest (Drexhage et al., 2010). A European Collaborative Research Project MOODINFLAME is being carried out European-wide for early diagnosis and new therapeutic strategies based on the role of immune activation in mood disorders.
What is new in the field
Schizophrenia One third of schizophrenic patients show immunological abnormalities such as high antibody titers against several antigens (e.g.: Schwarz et al., 1999), or a distinct cytokine profile in serum and cerebrospinal fluid (CSF) (Müller et al., 1999a). This cytokine pattern seems to be 'Th2-like' ('Th2' describes one of two balanced arms of the specific immune system, responsible for either cell-mediated (Th1) or antibody-mediated (Th2) immune response). The immunological abnormalities seem to be associated with a younger age at onset, a preponderance of negative symptoms and therapy resistance to classical antipsychotic drugs. Molecular genetic data suggest a possible role of endogenous retroviruses in the ethiopathology of schizophrenia (Yolken et al., 2000). Some studies show distinct changes in the cytokine patterns and an activation of the cellular arm of the immune system after administration of atypical antipsychotics, indicating not only the neurochemical, but also a immunological potency of antipsychotics (Pollmacher et al., 1996; Müller et al., 1997; Müller et al., 1999b).
Depression Some studies indicate a Th1-like immune response in depressed patients (Maes, 1995). This is in contrast to the immunological findings in schizophrenia. Moreover, this kind of immune activation is similar to that seen under psychological stress (Leonard and Song, 1996), indicating a possible causative role of the stress, patients are suffering from. Antidepressants induce a shift from Th1-like to Th2-like cytokine production of the treated immune cells in vitro (Maes et al., 1999).
Alzheimer's disease (AD) An activation of the microglia cells - the resident monocytes/macrophages in the brain parenchyma - in the surrounding of amyloid plaques was already described by Alois Alzheimer. The activated microglia cells are producing neurotoxic agents that worsen the neuronal degeneration induced by the amyloid plaques (Akiyama et al., 2000). On the other hand, it has been demonstrated that microglia is able to reduce the plaques after vaccination with amyloid beta (Schenk et al., 1999). Altogether, the immune response seems to play a crucial role in both, the pathophysiology and the treatment strategies of AD.
Obsessive-compulsive disorder and tics Autoimmune mechanisms seem to be associated with tics and obsessive-compulsive disorder (OCD). The 'pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections' (PANDAS) is a group of disorders of this category (Swedo et al., 1998). Elevated antibody titers against streptococci indicating an autoimmune reaction against bacteria are also reported in Gilles de la Tourette's syndrome (GTS) (Muller et al., 2000a; Muller et al., 2000b). Immunomodulatory therapies such as immunoglobulins and antibiotics are now in clinical trial as therapeutic aproaches of these disorders.
The expanding field of psycho-neuro-immunology has markedly increased the knowledge about the interference of the central nervous system and the immune system. Immunological abnormalities in psychiatric patients have been repeatedly described during the last decades. Modern concepts of immunology and the growing knowledge of psychoneuroimmunology (PNI) may help to understand the immunological mechanisms and to identify subgroups with distinct etiopathology in the heterogeneous psychiatric disorders.
Section activities (2008 - 2010)
- 2008 Seeon, Munich, Germany 11th-13th July – Psychoneuroimmunology Training Workshop
- 2009 17th European Congress, Lisbon, Portugal, 24th-28th January - European Psychiatric Association Symposium - Role of inflammation in pathophysiology and management of psychiatric disorders
- 2009 PNI Expert Meeting Günzburg 13th-14th November (co-organize the meeting)
- 2010 Munich, Germany 27th February – Round Table Discussion on Immunology and Psychiatry (mainly organized by WPA, Immunology and Psychiatry Section in collaboration with Psychoneuroimmunology Section of DGBP)
- 2010 18th European Congress, Munich, Germany 27th February to 2nd March - European Psychiatric Association Symposiums – (1) Role of Inflammation in Pathophysiology of Depression; (2) Immune System and Inflammation in Schizophrenia
- 2010 GEBIN meeting Essen 28th-30th April – Symposium on Immunology and Psychiatry
Section activities 2011
- 2011 WFSBP (World Federation of Societies of Biological Psychiatry) Congress, Prague, Czech Republic, 29th May to 2nd June - Symposium on "What bearing does immunology have on mental illness"
- 2011 WPA Thematic Conference, Istanbul, Turkey, 9th to 12th June – Section Symposium on "Immune changes in Psychiatric Disorders: From Research to Diagnosis and Treatment"
- 2011 June: First Section Newsletter on-line
- Section has recruited 5 young psychiatrists engaged in the research area of immunology and psychiatry
- Vol. 1, No. 1, June, 2011
- Vol. 1, No. 2, December, 2011
- Vol. 2, No. 1, June, 2012
- Vol. 2, No. 2, December, 2012
- Vol. 3, No. 1, June, 2013
- Vol. 3, No. 2, December, 2013
- Vol. 4, No. 1, June, 2014
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