[Fwd: Microbes and Mental Illness: Insel]

[Guest guest]

*/

Microbes and Mental Illness/*

Posted by Insel

August 13, 2010

http://www.nimh.nih.gov/about/director/2010/microbes-and-mental-illness.shtml

Hints that some mental illness may be linked to infectious agents and/or

autoimmune processes date back to at least the early 20th Century. In

the 21st Century, the field of microbiomics, which is mapping the

microbial environment of the human organism, may transform the way we

think about human physical and mental development.1 It is already clear

that 90% of “our DNA” is microbial, not human. “We” are, in fact,

“super-organisms” made up of thousands of species, many of which are

being identified for the first time. And there are persistent individual

differences in our microbial ecology established early in life.

Insights from microbiomics have proven important for understanding

obesity2 and Type 1 diabetes,3 but microbiomics has not yet been a focus

for research on mental illness. Yet, there are many clues linking

microbiology and mental disorders, such as epidemiologic evidence of

increased risk for schizophrenia associated with prenatal exposure to

influenza. Probably the most compelling case for such involvement is

children who develop obsessive compulsive disorder (OCD) and/or tic

disorders “overnight,” following a strep infection. Despite continuing

debate over its parameters, evidence is mounting in support of Pediatric

Autoimmune Neuropsychiatric Disorders Associated with Streptococcal

Infections (PANDAS) — or at least a syndrome modeled on it.

Last month, the NIMH Pediatric Developmental Neuroscience Branch

convened dozens of experts from the field — including prominent PANDAS

critics — to update the science and attempt to achieve consensus on

criteria defining the syndrome. The mere fact that the conference took

place signals a change in the scientific climate. Until now, whether a

child presenting with sudden onset of OCD and/or tic symptoms gets

checked for possible involvement of strep has varied—often depending on

which medical journals a practitioner happens to read. I am hopeful that

will begin to change in light of the new evidence.

Interest in PANDAS has also been spurred by an increasingly vocal

network of affected families and the clinicians who are treating their

often severely-impaired children. Conference participants heard reports

from the front lines by some of these clinicians, who largely

corroborated key features of the syndrome, originally identified by

NIMH’s Dr. Swedo in the mid-l990s. These include sudden onset of

mood swings, impulsivity, anxiety, impaired attention and poor

handwriting in addition to obsessions, compulsions and tics. Dr. Swedo’s

studies have identified brain mechanisms through which strep antibodies

act. They have also demonstrated that cleansing the blood of the

antibodies, via plasma exchange or intravenous immunoglobulin,

significantly diminishes the symptoms.

Impetus for the July conference came, in part, from publication of two

independent studies within the past year that lend new credence to the

PANDAS concept.

In the first, Columbia University researchers demonstrated, for the

first time, that strep-triggered antibodies alone are necessary and

sufficient to trigger a PANDAS-like syndrome in mice.4 In an

autoimmune-disease susceptible strain of mice, exposure to strep

triggered OCD-like repetitive behaviors and antibodies that attacked

specific molecules in the brain. PANDAS-like behaviors also emerged in

naïve mice after they received antibodies from such PANDAS mice. These

included impaired learning and memory and social interaction. As in

humans with PANDAS, these impairments were more common in males than

females.

In the second study, a Yale University research team reported that OCD

and Tourette Syndrome (tic) symptoms worsened slightly following a strep

infection in some affected children. Moreover, the strep infection

triggered the worsened symptoms by increasing the impact of

psycho-social stress.5 The findings suggest that a subset of children

with these disorders may be at increased risk of strep infection, which

could interact with stress to exacerbate the course, as is seen in other

infectious and autoimmune diseases.

Granted, these new findings are still preliminary and need to be

replicated. However, the data relating to PANDAS is compelling enough to

warrant following up such leads. NIMH is preparing to launch a new trial

of intravenous immunoglobulin (IVIG) treatment for PANDAS this Fall,

with support from a NIH Clinical Center “Bench to Bedside” award. The

intramural NIMH will provide the clinical care, while data analysis will

be carried out by independent teams of investigators at Yale University

and the Oklahoma University Health Sciences Center. Dr. Swedo and her

team are hoping to recruit 50 children with clear-cut PANDAS. They are

predicting that IVIG treatment will produce striking benefits for OCD

and other neuropsychiatric symptoms, and will be most effective for

those children who start out with the highest levels of strep-triggered

antibodies that go astray and attack parts of the brain. Moreover,

monoclonal antibodies derived from these patients will be used to

develop animal models of OCD that could lead to improved treatments.

Do infectious agents influence the development of autism, anxiety, or

mood disorders? This remains a frontier area for NIMH research. The

increasing evidence linking strep infection to OCD in children suggests

that microbiomics may prove an important research area for understanding

and treating mental disorders.

References

1Bacterial community variation in human body habitats across space and time.

Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R.

Science. 2009 Dec 18;326(5960):1694-7. Epub 2009 Nov 5.PMID: 19892944

2A core gut microbiome in obese and lean twins.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE,

Sogin ML, WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath

AC, Knight R, Gordon JI.

Nature. 2009 Jan 22;457(7228):480-4. Epub 2008 Nov 30.PMID: 19043404

3Innate immunity and intestinal microbiota in the development of Type 1

diabetes.

Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu

C, Wong FS, Szot GL, Bluestone JA, Gordon JI, Chervonsky AV.

Nature. 2008 Oct 23;455(7216):1109-13. Epub 2008 Sep 21.PMID: 18806780

4Passive transfer of streptococcus-induced antibodies reproduces

behavioral disturbances in a mouse model of pediatric autoimmune

neuropsychiatric disorders associated with streptococcal infection.

Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G,

Lipkin WI.

Mol Psychiatry. 2010 Jul;15(7):712-26. Epub 2009 Aug 11.PMID: 19668249.

5Streptococcal upper respiratory tract infections and psychosocial

stress predict future tic and obsessive-compulsive symptom severity in

children and adolescents with Tourette syndrome and obsessive-compulsive

disorder.

Lin H, KA, Katsovich L, Findley DB, Grantz H, Lombroso PJ, King

RA, Bessen DE, D, Kaplan EL, Landeros-Weisenberger A, Zhang H,

Leckman JF.

Biol Psychiatry. 2010 Apr 1;67(7):684-91. Epub 2009 Oct 14.PMID: 19833320.

..