[Features of inflammatory reactions in patients with juvenile depression with a clinically high risk of psychosis]. / Osobennosti vospalitel'nykh reaktsii u patsientov s yunosheskimi depressiyami s klinicheski vysokim riskom psikhoza.

OBJECTIVE: To determine the levels of pro-inflammatory and anti-inflammatory cytokines and inflammatory markers such as C-reactive protein, leukocyte elastase, α1-proteinase inhibitor, autoantibodies to neuroantigens in the blood of patients with adolescent depression with clinical high risk for psychosis (CHR-P) and to study the relation of these biological markers to the features of psychopathological symptomatology of the patients. MATERIAL AND METHODS: Eighty young adults, aged 16-24 years, with the first depressive episode (F32.1-2, F32.38, F32.8) were studied. Based on the presence of attenuated positive symptoms in the structure of depression, all patients were divided into two groups: with CHR-P (clinical group, n=58) and without CHR-P (comparative group, n=22). The HDRS-21, SOPS, and SANS were used for psychometric assessment of the patients. Serum levels of cytokines TNF-α, IL-6, IL-8, IL-10, and concentration of C-reactive protein (CRP) were determined. Leukocyte elastase (LE) activity, α1-proteinase inhibitor (α1-PI) activity, and plasma levels of autoantibodies to S100B protein and myelin basic protein (MBP) were assessed. RESULTS: Both groups of patients were characterized by the high levels of inflammation as assessed by LE (250.5 (226.2-280.8) nmol/min·ml vs 248.3 (226.8-284.5) nmol/min·ml) and α1-PI activity (44.4 (37.5-50.1) IE/ml vs 45.2 (36.4-49.9) IE/ml). Higher levels (p<0.05) of IL-6 (1.22 (0.64-2.2) pg/ml), CRP (0.93 (0.18-3.18) mg/l), and TNF-α/IL-10 (0.34 (0.2-0.47)) were detected in the group with CHR-P. This group was also characterized by higher levels of antibodies to the S100B protein 0.78 (0.69-0.84 units of opt.density) compared with the group without CRH-P (p<0.05). In each clinical group, different correlations between clinical, psychometric and biological parameters were revealed. CONCLUSIONS: The results confirm the involvement of inflammation in the development of depression in youth and indicate a different role of the inflammatory markers analyzed in the formation of CHR-P. The differences in the spectrum of inflammatory markers in depressed patients suggest a more pronounced pro-inflammatory potential in the group with CHR-P.

[A comparative analysis of two methods for assessing the proinflammatory activity of monocytes in patients with juvenile depression]. / Sravnitel'nyi analiz dvukh sposobov otsenki provospalitel'noi aktivnosti monotsitov pri depressii u bol'nykh yunosheskogo vozrasta.

OBJECTIVE: To show that the results of evaluation of monocyte pro-inflammatory activity (PA) in patients with juvenile depression and healthy donors, obtained using a new method developed by us for counting the relative number of large monocytes on a multifunctional counter and cell analyzer, are similar to the results obtained using a standard assessment of the level of proinflammatory CD14+/CD16+ - monocytes on a flow cytofluorimeter. MATERIAL AND METHODS: The PA of monocytes, isolated from the peripheral venous blood of 18 patients with juvenile depression and 12 mentally and somatically healthy age and gender-matched persons was evaluated in two ways: using the generally accepted method of determining the relative number of monocytes with the proinflammatory phenotype CD14+/CD16+ on a flow cytofluorometer FC-500 and by counting the relative number of large monocytes on a multifunctional counter and cell analyzer Multisizer MS-4. PA of monocytes in patients was studied by using both methods in different variants: in the general group and in the subgroups of patients with low and high levels of active monocytes. RESULTS: The levels of monocyte PA determined in patients using the two methods did not statistically differ from each other in all variants of the analysis (p=0.6). The equivalence of the obtained results was confirmed by the Chi-square test (r=0.77, p=0.05), as well as by the detection of a statistically significant positive correlation between the number of monocytes with the pro-inflammatory CD14+/CD16+ phenotype, on the one hand, and the relative number of large monocytes, on the other hand (Spearman r=0.75; p<0.05). At the same time, a comparative analysis of the level of monocyte PA in the general groups of patients and healthy controls revealed significantly higher values of this indicator in patients compared with healthy persons when evaluated by both methods (p<0.05). Definition of monocytes PA using the new method developed by us for counting the relative number of large monocytes on the analyzer and cell counter is more economical and easier to perform, since it does not require the use of expensive devices and reagents, as well as complex device settings and a high level of operator qualification, as in the common method, and is carried out only by two parameters: by counting the number of large monocytes with a diameter of 12.5 to 15 microns and the total number of monocytes with a diameter of 9 to 15 microns. CONCLUSION: The proposed method for assessing monocyte PA by counting the relative number of large monocytes on the cell counter and analyzer can be used to analyze the activity of monocytes for research purposes.

[Features of the immune profile of schizophrenic patients with catatonic syndrome]. / Osobennosti immunnogo profilya bol'nykh shizofreniei s katatonicheskim sindromom.

OBJECTIVE: An analysis of inflammatory and autoimmune markers in schizophrenic patients with- and without catatonic symptoms in comparison to healthy controls. MATERIAL AND METHODS: A sample of 170 patients with paranoid schizophrenia was stratified by the presence of catatonic symptoms in the structure of psychosis (66 patients with catatonia and 104 patients without catatonia), inclusion threshold was >10 points on the Bush-Francis catatonia scale. The examination was carried out in the early days of inpatient treatment using psychopathological, psychometric and immunological methods. RESULTS: Quantitative and qualitative differences in the spectrum of immune indicators in both groups of patients are revealed. A higher level of the immune system activation is found in the group with catatonic symptoms that indicates a worsening of the pathological process. A specific feature of the immunological profile of catatonic syndrome in schizophrenia is a decrease in ratio between leukocyte elastase and a1-proteinase inhibitor (leukocyte-inhibitory index) accompanied by the increase of other inflammatory markers that, presumably, indicates the deterioration of the phagocyte component of the inflammatory response. CONCLUSION: The results suggest that the decrease in leukocyte-inhibitory index is a potential biomarker of catatonic syndrome in schizophrenia.

[Clinical and immunological correlations in endogenous depression].

OBJECTIVE: To study the possibility of using immunological parameters for the evaluation of the activity of endogenous process in depression and quality of response to psychopharmacotherapy. MATERIAL AND METHODS: Authors examined 42 patients, aged 20-55 years, with the prevalence of anxiety (n = 22) or apathy (n = 20) in the clinical picture of depression. The following immunological parameters were measured in the blood of the patients: degranulation activity of leukocyte elastase (LE), functional activity of alpha-1-proteinase inhibitor (alpha-1-PI); the level of autoantibodies to neuroantigen S-100B and myelin basic protein. RESULTS AND CONCLUSION: The involvement of inflammatory and autoimmune responses in the pathophysiology of endogenous depression was confirmed. Depression associated with increased levels of autoantibodies to brain neuroantigens (an autoimmune component) had a more complicated structure and showed the tendency to prolonged course and resistance to the therapy. The results suggest that some immunological parameters may be used as markers of patient's clinical status and quality and completeness of psychopathological symptom reduction.

[Inflammatory and autoimmune reactions in different forms of nervous system functioning disorders].

Parameters of innate (the leukocyte elastase (LE) and alpha1-proteinase inhibitor (α-1-PI) activity) and adaptive immunity (the level of autoantibodies to neuroantigens nerve growth factor (NGF) and myelin basic protein (MPB)) were studied over time in the blood serum of 107 children with perinatal hypoxic-ischemic encephalopathy; 188 children with autism spectrum disorder; 108 patients with schizophrenia. The correlations between immunological parameters and clinical status assessment in all groups of patients using psychometric scales were analyzed. The involvement of innate immunity, i.e. inflammatory reactions, in pathogenesis of all analyzed forms of nervous system functioning disorders was confirmed. The activation of adaptive immunity, i.e. autoimmune reactions, was found only in the group of patients with the most severe forms of nervous system functioning endogenous disorders. The results indicate that the inflammatory and autoimmune reactions are pathogenic mechanism of all studied forms of nervous system functioning disorders.

[Immunological monitoring of endogenous attack-like psychoses].

To analyze the possibility of using immunological parameters for the assessment of the activity of the process and prediction of the quality and completion of remission, we compared the dynamics of clinical and immunological parameters in 76 patients with endogenous attack-like psychoses during pharmacotherapy of a psychotic episode. Authors confirmed evidence for the activation of innate and adaptive immunity in the acute stage of psychosis as well as the correlation between immunological parameters (leukocyte elastase (LE) activity, alpha(1)-proteinase inhibitor (alpha(1)-PI), the level of autoantibodies to nerve growth factor (Aab-NGF)) and clinical symptoms assessed with the PANSS. The improvement of the clinical state assessed by the reduction in PANSS total score was noted in all patients though there were variations in the dynamics of immunological parameters. The increase of immunological parameters, along with the absence of changes at the discharge from the hospital, suggests that the remission was of low quality and the pathological process did not attenuate. Outpatient examination revealed the different dynamics of psychopathological disorders: stable state in 50% patients, moderate worsening of psychological state in 50% patients. Worsening of clinical symptoms after the discharge and in the outpatient stage was correlated with the elevation of the activity/level of immunological parameters. The changes in LE activity and Aab-NGF level precede the changes in mental state of patients in the following 1-2 months. These parameters may be used for monitoring of patients and prediction of quality and completion of remission.

[Possibilities of the use of immunological indicators for the assessment of the risk of manifestation of endogenous psychoses in patients with nonpsychotic disorders of the juvenile age].

OBJECTIVE: To study parameters of innate and adaptive immunity in the blood serum of patients with nonpsychotic mental disorders and to classify them by risk of psychosis manifestation. MATERIAL AND METHODS: Authors studied 49 male patients, aged from 16 to 25 years, with nonpsychotic mental disorders corresponded to the premanifest stage of endogenous psychosis. The activity of leukocyte elastase (LE), functional activity of alpha-1-proteinase inhibitor (α1-PI) and the level of autoantibodies (aAB) to S-100 and basic myelin protein were measured. RESULTS: A significant increase in LE and α1-PI was found in patients compared to controls (p<0.001). The level of aAB to neuroantigens was similar in patients and controls. The increase in LE activity was positively correlated with HAM-D depressive symptoms and SOPS total scores (r=0.47, p=0.02). Correlations between α1-PI activity and scores on SOPS positive subscale (r= -0.61, p=0.002) and SOPS total scores (r= -0.43, p=0.04) were identified. After treatment, the improvement of patient's state assessed by SOPS and HAM-D was correlated with the decrease in LE activity in 80% (p<0.01). The further increase of LE activity in 20% may be considered as an indicator of low quality remission and risk of psychosis manifestation. CONCLUSION: Patients with nonpsychotic mental disorders with higher levels of inflammation markers may be attributed to high risk group.

[Dynamics of immunological and clinical parameters in the treatment of childhood schizophrenia].

A state of innate and adaptive immunity (leukocyte elastase (LE) activity, alpha(1)-proteinase inhibitor (alpha(1)-PI), the level of autoantibodies to nerve growth factor (Aab-NGF) and to basic myelin protein), have been studied in the blood serum of children with schizophrenia and compared to the changes of their clinical-psychopathological state. It has been shown that the exacerbation of schizophrenic process with early onset is accompanied by the activation of some parameters of innate immunity. But the higher activity of LE and alpha(1)-PI before the treatment cannot be considered as a predictive marker of therapeutic efficacy. At the same time, the decrease of LE activity during the treatment is a significant predictor of favorable therapeutic response. The unchanged level of Aab-NGF comparing to controls is also a favorable factor associated with therapeutic efficacy.

[Immunological reactions in different forms of mental disorders].

State of innate and adaptive immunity has been assessed by the indices of activity of leukocyte elastase, alpha1-proteinase inhibitor (alpha(1)-PI), level of C-reactive protein and autoantibodies to neuroantigens (nerve growth factor and basic myelin protein) in different forms of mentalopathology: schizophrenia-spectrum disorders, mental retardation with behavioral abnormalities, organic mental disorders, affective disorders, psychogenias (adaptation disorders), early alcoholism. The increase of activity or levels of all immunological parameters was characteristic of these diseases. However within each group were patients with different levels of immunity activation. A number of patients with significant immunity activation was higher in the groups of schizophrenia-spectrum disorders, early alcoholism, organic mental disorders, mental retardation with behavioral abnormalities and affective disorders. The lowest frequency of such cases was observed for psychogenias (adaptation disorders). These results give grounds to suggest that the extent of immunity activation depends as on severity of psychopathogy as well on individual peculiarities of immunological reactivity in response to a brain pathological process.

[Correlations between clinical and immunological parameters in endogenous psychoses with a first episode at the juvenile age].

Sixty-seven patients, aged 16-25 years, with the first episode of endogenous psychosis (ICD-10 items F20.03, F20.23, F25) have been examined. Positive, negative and general psychopathological symptoms were assessed with the PANSS. Activities of leukocyte elastase (LE) and alpha1-proteinase inhibitor were used for measuring of innate immunity and the level of autoantibodies to nerve growth factor (Aab-NGF) was used for measuring of adaptive immunity. The manifestation of endogenous psychosis was accompanied by the activation of innate immunity, the level of activation was not related with the syndrome structure of episode (the prevalence of catatonic, hallucinatory-delusional or affective-delusional symptoms). The LE activity and dynamics of Aab-NGF during the treatment may be considered as prognostic markers of treatment effectiveness: the higher LE activity during the episode and decrease of Aab-NGF in the treatment process may predict a favorable therapeutic response.

[Changes of the level of serum antibodies to neuroantigens in patients with schizophrenia during the treatment].

The level of antibodies (AT) to neuroantigens (nerve growth factor and basic myelin protein) has been studied in the serum of 80 patients with schizophrenia, attack-like type, (ICD-10 items F20.01-02) during the treatment with psychotropic drugs. Therapeutic effectiveness has been measured clinically and with the PANSS. It has been shown that the autoimmune component is present during the acute episode of schizophrenia in about 30% of cases. No statistically significant differences have been found in the mean values of AT before and after the treatment however the dynamics of their changes has been closely related with the results of therapy: the decrease of AT level during the therapy is a predictive factor for good therapeutical remission; on the contrary, the increase of this level may be considered as an unfavorable prognostic factor.

[Serum immunological markers as predictors of effectiveness of antipsychotic therapy in patients with schizophrenia].

Serum immunological parameters - activity of leukocyte elastase (LE) and a1-proteinase inhibitor (a1-PI), content of C-reactive protein, von Willebrand factor, interleukin 8 as well as a level of autoantibodies to neuroantigens (nerve growth factor and basic myelin protein) were studied in patients with schizophrenia during their treatment with psychotropic drugs. All parameters studied differed in the groups of patients and controls. However, the pronounced dynamics was found only for LE and a1-PI activity. After the therapeutic course, the reduction of LE activity accompanied by the increase of a1-PI activity was observed. The correlation study between the biological parameters during disease exacerbation and therapeutic effectiveness assessed by the PANSS scores revealed that activity of LE and a1-PI may be considered as a prognostic marker of therapeutic efficacy, i.e. the high enzyme activity at the moment of maximal activity of the process was predictive of good therapeutic response.

Influence of high level of antibodies to myelin basic protein in female mice on the postnatal development and behavioral reactions of the progeny.

Physical development, behavioral reactions, and training capacity were studied in the progeny of female BALB/c mice with high levels of antibodies to myelin basic protein. The proposed protocol of immunization ensures high levels of antibodies to myelin basic protein in this mouse strain. High level of antibodies to myelin basic protein in pregnant females causes an increase in the blood level of these antibodies in the progeny. Inhibitory effect of antibodies to myelin basic protein on physical development, training process, and memory in mouse pups was detected.

[Some indices of congenital and acquired immunity in patients with endogenous diseases of schizophrenic spectrum disorders].

Indices of congenital leukocyte elastase (LE) activity and adaptive immunity (a level of autoantiboies to nerve growth factor--AabNGF) in blood serum of patients with schizophrenia (attack-like, continuous and slow progressive types) and schizoaffective psychosis have been compared with clinical presentations of the disorders. A patient's state was assessed by clinico-psychopathological methods and with the Positive and Negative Syndromes Scale (PANSS). All schizophrenia types and schizoaffective psychosis were accompanied by LE activity elevation. An increase of AabNGF level was observed only in attack like and continuous schizophrenia. Correlations between AabNGF level and negative symptoms evaluated, using the PANSS, suggest a relation of autoimmune reactions against NGF to the progression of schizophrenic process. Differences in AabNGF level between schizoaffective psychosis and attack-like schizophrenia confirm nosologic independence of schizoaffective psychosis and demand for additional differential laboratory diagnosis of these disorders.

Effect of antibodies to nerve growth factor and serum albumin on the development and behavior of mice.

We studied physical development, behavioral characteristics, and learning capacity in the offspring of mice immunized with nerve growth factor and bovine serum albumin. High titer of antibodies to these factors in the blood of pregnant females determines high levels of these antibodies in the blood of their pups. These changes modulate physical development, behavior, and learning capacity of rat pups. The effects of these antibodies differed in the strength and directionality. Antibodies to nerve growth factor more markedly retarded physical development, reduced learning capacity, and considerably increased pain thresholds in animals.