Immune system aberrations in postpartum psychosis: An immunophenotyping study from a tertiary care neuropsychiatric hospital in India

Kumar, Manoj; Venkataswamy, Manjunatha M.; Sathyanarayanan, Gopinath; Thippeswamy, Harish; Chandra, Prabha S.; Mani, Reeta Subramaniam

doi:10.1016/j.jneuroim.2017.06.002

Cited by 28 publications

(31 citation statements)

References 30 publications

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“…Pro-inflammatory alterations included increased monocytes, failure to reduce NK, and B cells, along with a reduction in T cells, particularly T h 1 cells, which are normally increased in healthy postpartum controls [177]. Additional studies have replicated the overall decrease in T cells in mothers with postpartum psychosis and discovered that within Tcell populations, activated CD8 + and T regs were increased [176].…”

Section: Sex Differences In the Peripheral Immune System Across Hormomentioning

confidence: 98%

“…In general, there is a higher incidence of firsttime postpartum psychiatric issues in women who experience autoimmune attacks during or after pregnancy, including preeclampsia [174] and thyroid dysfunction [175]. When defining postpartum psychosis as any postpartum psychiatric diagnosis that includes psychotic features (depressive, manic, or mixed), researchers found an inflammatory shifted profile of cytokines and immune cells in blood even in the absence of autoimmune disease [176,177]. Pro-inflammatory alterations included increased monocytes, failure to reduce NK, and B cells, along with a reduction in T cells, particularly T h 1 cells, which are normally increased in healthy postpartum controls [177].…”

Section: Sex Differences In the Peripheral Immune System Across Hormomentioning

confidence: 99%

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Inflaming sex differences in mood disorders

Rainville

Hodes

2018

Neuropsychopharmacol

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Men and women often experience different symptoms or rates of occurrence for a variety of mood disorders. Many of the symptoms of mood disorders overlap with autoimmune disorders, which also have a higher prevalence in women. There is a growing interest in exploring the immune system to provide biomarkers for diagnosis of mood disorders, along with new targets for developing treatments. This review examines known sex differences in the immune system and their relationship to mood disorders. We focus on immune alterations associated with unipolar depression, bipolar depression, and anxiety disorders. We describe work from both basic and clinical research examining potential immune mechanisms thought to contribute to stress susceptibility and associated mood disorders. We propose that sex and age are important, intertwined factors that need to be included in future experimental designs if we are going to harness the power of the immune system to develop a new wave of treatments for mood disorders.

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Section: Sex Differences In the Peripheral Immune System Across Hormomentioning

confidence: 98%

Section: Sex Differences In the Peripheral Immune System Across Hormomentioning

confidence: 99%

Inflaming sex differences in mood disorders

Rainville

Hodes

2018

Neuropsychopharmacol

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“…Finally, monocyte and macrophage levels have also been found to be significantly higher in women with PP than in those without PP. Although Kumar and colleagues [22] found no difference in total monocyte numbers between women with PP and healthy postpartum women, their study did find lower levels of the non-classical monocyte subtype, which display inflammatory characteristics upon activation, in the former group. The parallel findings of higher blood levels of chemokine CCL2 (produced by monocytes during tissue infiltration) in women with PP, and of a robustly upregulated immune system-related gene expression profile in this clinical group, strongly support the relevance of monocyte alterations in this disorder [21] .…”

Section: Immune System Dysfunction and Ppmentioning

confidence: 71%

“…Two recent studies have reported that women with PP have lower levels of Th1, Th17, and Tregs [21] and a lower proportion of naïve Tregs (but a higher proportion of memory Tregs) [22] than healthy postpartum women. These findings may reflect the disrupted function of one or more subpopulations of Tregs in this clinical group, although the mechanisms underlying group differences in T cell proportions, and their precise functional relevance, are currently unclear.…”

Section: Immune System Dysfunction and Ppmentioning

confidence: 98%

“…These findings may reflect the disrupted function of one or more subpopulations of Tregs in this clinical group, although the mechanisms underlying group differences in T cell proportions, and their precise functional relevance, are currently unclear. In addition, women with PP have been reported to exhibit lower numbers of NK cells [21] but increased regulatory NK cells [22] that counterbalance the cytotoxic NK response and are suggestive of a possible defect in the immune restoration normally present in the postpartum period. Furthermore, women with PP show a reduction in numbers of dendritic cells [22] ; these cells are known to secrete higher levels of IL-12 and IL-6 in MS by inducing proinflammatory Th1 and Th17 cells, and their reduced numbers in women with PP could theoretically result in the persistence of immunosuppressive cells in the postpartum period.…”

Section: Immune System Dysfunction and Ppmentioning

confidence: 99%

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Do Defective Immune System-Mediated Myelination Processes Increase Postpartum Psychosis Risk?

Dazzan

Fusté

Davies

2018

Trends in Molecular Medicine

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Postpartum (or puerperal) psychosis (PP) is a rare, severe psychiatric disorder that affects women shortly after childbirth; risk is particularly high in individuals with a history of bipolar disorder or PP, but the underlying pathophysiology remains poorly understood. Emerging evidence suggests that immune system (dys)function plays an important role in disorder onset. On the basis of new findings from clinical and animal model studies, we hypothesise that the abundance and/or activity of regulatory T cells, and the efficacy of consequent (re)myelination processes in the brain mediated by CCN proteins, is perturbed in PP; this pathway may be modulated by risk and protective/treatment factors for the disorder, and identifying abnormalities within it could signpost novel predictive biomarkers and therapeutic targets.

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Toward a framework for best practices and research guidelines for perinatal depression research

Kimmel

Bauer

Meltzer‐Brody

2019

J of Neuroscience Research

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This review article highlights the current state of perinatal depression (PND) research including established standards of care and innovative research in progress. PND can have a significant adverse impact on mother, child, and family; however, to date, wide‐scale identification, prevention, and treatment have been limited. PND is heterogenous in presentation with likely multifactorial etiologies for each woman. Challenges in PND research are discussed including a need for universal tools, standardized measures, benchmarks, and best practices. Current examples are reviewed that highlight approaches to novel treatment paradigms and interventions. This includes reviewing epidemiologic studies in PND research, examining the biological underpinnings of PND, and discussing examples from this field and other fields currently developing translational research that spans from bench to bedside. Current and future challenges and opportunities in developing best practices for the treatment of PND are outlined. We also discuss the use of the NIMH Research Domain Criteria approach for PND research and provide recommendations for future directions in PND research collaboration. In conclusion, greater precision in perinatal psychiatry can be possible in the future with the development of guidelines and best practices that build on current work and apply innovative and collaborative approaches of scientists, providers, patients, community members, and government officials.

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Immune system aberrations in postpartum psychosis: An immunophenotyping study from a tertiary care neuropsychiatric hospital in India

Cited by 28 publications

References 30 publications

Inflaming sex differences in mood disorders

Inflaming sex differences in mood disorders

Do Defective Immune System-Mediated Myelination Processes Increase Postpartum Psychosis Risk?

Toward a framework for best practices and research guidelines for perinatal depression research

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