Innate Immune Cells and C-Reactive Protein in Acute First-Episode Psychosis and Schizophrenia: Relationship to Psychopathology and Treatment. (29th August 2019)

• Record Type: Journal Article
• Authors: Steiner, Johann; Frodl, Thomas; Schiltz, Kolja; Dobrowolny, Henrik; Jacobs, Roland; Fernandes, Brisa S; Guest, Paul C; Meyer-Lotz, Gabriela; Borucki, Katrin; Bahn, Sabine; Bogerts, Bernhard; Falkai, Peter; Bernstein, Hans-Gert
• Is Part Of: Schizophrenia bulletin. Volume 46:Number 2(2020)
• Page Start: 363
• Page End: 373
• Publication Date: 2019-08-29
• Subjects: neutrophils -- neutrophil-lymphocyte ratio (NLR) -- monocytes -- monocyte-lymphocyte ratio (MLR) -- eosinophils -- innate immunity; Schizophrenia -- Periodicals; Schizophrenia -- Research -- Periodicals; 616.898005
• DOI: 10.1093/schbul/sbz068
• Languages: English
• ISSNs: 0586-7614

Abstract

Abstract: Innate immunity has been linked to initiation of Alzheimer's disease and multiple sclerosis. Moreover, risk of first-episode psychosis (FEP) and schizophrenia (Sz) is increased after various infections in predisposed individuals. Thus, we hypothesized an analogous role of innate immunity with increased C-reactive protein (CRP) in non-affective psychosis. Differential blood count, CRP, neutrophil and monocyte–macrophage activation markers, cortisol and psychotic symptoms (Positive and Negative Syndrome Scale [PANSS]) were assessed in controls ( n = 294) and acutely ill unmedicated FEP ( n = 129) and Sz ( n = 124) patients at baseline and after 6 weeks treatment. Neutrophils, monocytes, and CRP were increased in patients vs controls at baseline ( P < .001), and neutrophil and monocyte counts correlated positively with activation markers. Eosinophils were lower at baseline in FEP ( P < .001) and Sz ( P = .021) vs controls. Differences in neutrophils ( P = .023), eosinophils ( P < .001), and CRP ( P < .001) were also present when controlling for smoking and cortisol, and partially remitted after antipsychotic treatment. FEP patients with high neutrophils ( P = .048) or monocytes ( P = .021) had higher PANSS-P scores at baseline but similar disease course. CRP correlated with PANSS-P at baseline (ρ = 0.204, P = .012). Improvement of positive symptoms after treatment correlated with declining neutrophils (ρ = 0.186, P = .015) or CRP (ρ = 0.237, P = .002) and rising eosinophils (ρ = −0.161, P = .036). In FEP, normalization of neutrophils (ρ = −0.231, P = .029) and eosinophils (ρ = 0.209, P = .048) correlated with drug dosage. In conclusion, innate immune system activation correlated with PANSS-P, supporting the immune hypothesis of psychosis. Neutrophil and monocyte counts and CRP levels may be useful markers of disease acuity, severity, and treatment response.