We discuss the rationale for a trial of a novel biologic immunotherapy in
schizophrenia (SZ). Available antipsychotic treatments for SZ are often limited
by partial effectiveness and significant side effects. Thus, the search for
novel medications is of high priority. All current antipsychotics function
primarily by blocking D2-type dopamine receptors. An emerging theory of SZ
postulates disturbances of cytokines and inflammatory mediators (i.e., the
cytokine model), possibly originating in part from infectious exposures.
Cytokines are one of the most important components of the immune system that
orchestrate the response to infectious and other exogenous insults. Preclinical
models of SZ support a convergence between a role for certain cytokines in the
pathophysiology of SZ and major neurochemical postulates of the disorder,
including the dopamine and glutamate hypotheses. Furthermore, several cytokines
are elevated in plasma in SZ, and Positron Emission Tomography (PET) studies
have shown active inflammation in the brains of individuals with psychosis.
Treatment studies of certain anti-inflammatory agents, such as celecoxib and
aspirin, in patients with SZ have provided further support for neuroinflammation
in this disorder. The recent development of approved biological therapies for
autoimmune diseases provides us with new opportunities to directly target
cytokine signaling as a novel treatment strategy in SZ. In addition, advances in
imaging, immunology, and psychopharmacology have paved the way for utilizing
measures of target engagement of neuroimmune components that would facilitate
the identification of patient subgroups who are most likely to benefit from
cytokine modulation.