Immune processes are major factors for central nervous system health, as well as for risk or resilience to brain disorders. Exciting scientific insights indicate a highly sensitive and fine-tuned equilibrium of inflammation modulating our cognitive and social abilities. Recent discoveries in neurology and psychiatry are challenging our traditional classification of brain diseases. Among the pathophysiological mechanisms underlying the strong link between psychiatric and neurologic disorders, one of the most relevant refers to the pivotal position of inflammation. New biomarkers to identify homogenous subgroups are required to identify subgroups of patients to pave the way towards precision medicine and in particular to uncover mechanism-based immune treatments. Immune-modulatory therapies are effective options for a range of neurologic and psychiatric diseases. It is of fundamental importance to identify subgroups of psychiatric patients with signs of immune dysregulation to develop individualized therapeutic strategies.
For example, in psychiatric disorders with very early onset, such as Autism Spectrum Disorders, early insults such as maternal infections or maternal auto- antibodies against fetal brain have been repeatedly found to be associated with increased risk of Autism Spectrum Disorders leading to chronic inflammation in the offspring at peripheral, brain and digestive sites.
In psychiatric disorders starting in early adulthood, inflammation has also been documented to significantly reduce the effectiveness of classical psychiatric treatment leading to resistant schizophrenia or bipolar disorders. For instance, several clinical studies have found elevated pre-treatment inflammatory markers specifically in depressed patients showing unsuccessful response to classical antidepressants acting by blocking selectively serotonin reuptake. In this context, several anti-inflammatory compounds have already been tried and tested in those psychiatric patients with inflammatory profile showing favorable response.
Among neurological disorders, Multiple Sclerosis is the most frequent chronic autoimmune encephalomyelitis which leads to demyelination and progressive neurodegeneration and is associated with a higher lifetime prevalence of mood disturbances.
A compelling example for the overlap between psychiatric and neurologic pathologies is moreover the occurrence of psychosis with autoantibodies reactive against neuropil. Antibodies against neuronal structures may develop spontaneously, in the course of neoplastic diseases, or following viral infections. They may lead to severe encephalitis or to auto-immune psychosis.
Altogether, these data strengthen the need to build a large European group of collaborative centers in the area of immuno-psychiatry in order to share information on existing infrastructure (methods, data bases, clinical trials, training), to establish collaborative projects, to build training programs, to link private and public partnerships, thus strongly establishing this field in the heart of Europe towards better diagnosis and better treatment of our patients.
This ECNP Thematic Working Group (TWG) aims to share findings that are transforming our understanding of brain reserve and disease, setting the stage for new classifications and new treatment of neuropsychiatric disorders.
The TWG on “Immuno-NeuroPsychiatry” comprise internationally recognized clinical centers particularly helpful for the development of data bases, pathophysiological and therapeutic studies in humans. They will be completed by the implementation of research groups using laboratory animal models to perform high-level translational research projects, enabling to substantially improve mechanistic and functional knowledge about the exact nature of the relationships of inflammatory state with relevant clinical dimensions, treatment resistance and therefore promote appropriate pharmacological interventions.
Overall, the TWG will:
1. Identify methodological and technical skills and scientific expertise required for the development of relevant human and animal studies to set up collaborative projects.
2. Standardize comprehensive assessment of large cohorts of neurological and psychiatric patients allowing the exploration of immune-inflammatory component.
3. Examine the exact immuno-inflammatory mechanisms and related pathways involved in the occurrence of symptom dimensions in large cohorts of psychiatric and neurologic patients.
4. Study the effectiveness and tolerability of new drugs using the abnormal immune pathways, as targets for alleviating symptom dimensions in large cohorts of psychiatric and neurologic patients.
5. Determine the appropriate clinical and biological phenotypes of neurologic and psychiatric patients who could benefit from anti-inflammatory therapies.
6. Develop intensive translational research to better identify abnormal immune pathways and therefore contribute to the preclinical development of new drugs before applications and validation of their utility in large cohorts of neurologic and psychiatric patients.
7. Share collected data among the constitutive centers of the present TWG to carry out pilot or ancillary studies testing new hypotheses.
Therefore, because the important role of an impaired immune function has largely been demonstrated in the pathogenesis of psychiatric and neurologic affections, it is noteworthy to create a European group in the field of immune neuro-psychiatry to jointly perform basic science and clinical research designed to better characterize the major pathophysiological contributors that could further be considered in the perspective of the development of novel and encouraging anti-inflammatory therapeutic approaches for the management of psychiatric illnesses. This will thus offer great opportunity for the numerous psychiatric patients experiencing no improvement in response to standard psychiatric treatments.
Each constitutive center of the present TWG will be invited to:
1. answer the relevant European calls for scientific projects on the topic;
2. propose scientific studies on the topic ensuring the entire conception, integrity of the design, statistical analysis plan, and article writing in close collaboration with other investigator sites;
3. participate in the recruitment of neurologic and psychiatric patients for the ongoing scientific studies on the topic;
4. provide specific skills and competence useful for clinical and methodological support to the ongoing scientific studies on the topic performed under optimized experimental conditions;
5. made available database containing the wide range of variables completed during the ongoing scientific studies on the topic for further statistical analyses and publications;
6. vote the composition of the executive committee delineating general organization with policy, scientific program and budget orientation; and,
7. accept the fundamental principles of policy for future publications in international scientific journals and common charts drawn by the executive committee for this purpose.