Infectious mononucleosis as a risk factor for depression: A nationwide cohort study

Nonlinear physics perspective and essential disease dynamics of EBV infections and the dynamics of EBV-associated diseases

The Epstein-Barr virus affects more than 90% of the world population and, consequently, is a virus whose infection dynamics should not be overlooked. It can cause the disease infectious mononucleosis and comes with other virus-associated diseases and conditions ranging from certain cancers to episodes of fatigue and depression. While previous epidemiological and virological modeling studies have worked out the details of possible infection dynamics scenarios, the current study takes a different approach. Using a nonlinear physics perspective and a fairly general epidemiological model, we identify the essential EBV infection dynamics along its so-called infection order parameter. We demonstrate that the essential dynamics describes the initial path that EBV infections take in the multi-dimensional model space. In particular, we show that the essential dynamics predicts the initial dynamics of the relevant subpopulations and describes how the subpopulations involved in an EBV infection outbreak organize themselves during the outbreak. Intervention and prevention measures are discussed in the context of the nonlinear physics perspective. An adverse synergy effect between two infection rate parameters is identified. An early warning system based on the so-called critical slowing down phenomenon is proposed for EBV infection waves in college and university student populations, which are populations particularly vulnerable to EBV infections.

Knowledge mapping of childhood infectious mononucleosis: a bibliometric analysis for the twenty-first century

BACKGROUND

The incidence of infectious mononucleosis (IM) has increased in recent years, particularly in the pediatric population, and there are currently no specific drugs available, posing a threat to the lives and health of children worldwide. Although some results have been published, there is a lack of systematic review and summarization of current research.

METHODS

Based on screening criteria, literature on IM in children from 2000 to 2023 was retrieved from the Web of Science Core Collection. The included literature's indicators (country, institution, journal, author, keywords, and references) were analyzed and visualized using Citespace, VOSviewer software, and the Bibliometrix program package.

RESULTS

A total of 538 eligible publications were included in this study. The number of publications has been on an upward trend during this century, with great potential for future growth. The countries with the most publications are the USA and China, and Capital Medical University is the most contributing institution. Hjalgrim, Henrik and Cohen, Jeffrey, I are among the field's most influential authors and co-cited authors. Among the major journals, the JOURNAL OF MEDICAL VIROLOGY had the highest output and the JOURNAL OF INFECTIOUS DISEASES was the most frequently cited. The reference with the highest outbreak intensity was Ramagopalan, SV, LANCET NEUROLOGY, 2010. Through in-depth analysis of the keywords, we conclude that the characteristics of diagnosis and assessment of IM, the association of IM with other diseases, and interventions for IM are the current hot topics of research in the field and that the pathogenesis of IM due to EBV is a cutting-edge topic in the field. This study also analyzes the reasons for geographical research differences and proposes a new "increasing quantity-improving quality-integrating" cooperation model.

CONCLUSION

This study's hotspots and frontiers reflect the current status and trends in pediatric IM, and these findings provide important insights to guide future research and optimize therapeutic strategies. In the future, there is a need to strengthen international collaboration and cooperation, conduct RCTs with large sample sizes, and promote the development of new drugs in mechanism research.

Factors associated with depressive mood at the onset of multiple sclerosis - an analysis of 781 patients of the German NationMS cohort

Background

Depression has a major impact on the disease burden of multiple sclerosis (MS). Analyses of overlapping MS and depression risk factors [smoking, vitamin D (25-OH-VD) and Epstein-Barr virus (EBV) infection] and sex, age, disease characteristics and neuroimaging features associated with depressive symptoms in early MS are scarce.

Objectives

To assess an association of MS risk factors with depressive symptoms within the German NationMS cohort.

Design

Cross-sectional analysis within a multicenter observational study.

Methods

Baseline data of n = 781 adults with newly diagnosed clinically isolated syndrome or relapsing-remitting MS qualified for analysis. Global and region-specific magnetic resonance imaging (MRI)-volumetry parameters were available for n = 327 patients. Association of demographic factors, MS characteristics and risk factors [sex, age, smoking, disease course, presence of current relapse, expanded disability status scale (EDSS) score, fatigue (fatigue scale motor cognition), 25-OH-VD serum concentration, EBV nuclear antigen-1 IgG (EBNA1-IgG) serum levels] and depressive symptoms (Beck Depression Inventory-II, BDI-II) was tested as a primary outcome by multivariable linear regression. Non-parametric correlation and group comparison were performed for associations of MRI parameters and depressive symptoms.

Results

Mean age was 34.3 years (95% confidence interval: 33.6-35.0). The female-to-male ratio was 2.3:1. At least minimal depressive symptoms (BDI-II > 8) were present in n = 256 (32.8%), 25-OH-VD deficiency (<20 ng/ml) in n = 398 (51.0%), n = 246 (31.5%) participants were smokers. Presence of current relapse [coefficient (c) = 1.48, p = 0.016], more severe fatigue (c = 0.26, p < 0.0001), lower 25-OH-VD (c = -0.03, p = 0.034) and smoking (c = 0.35, p = 0.008) were associated with higher BDI-II scores. Sex, age, disease course, EDSS, month of visit, EBNA1-IgG levels and brain volumes at baseline were not.

Conclusion

Depressive symptoms need to be assessed in early MS. Patients during relapse seem especially vulnerable to depressive symptoms. Contributing factors such as fatigue, vitamin D deficiency and smoking, could specifically be targeted in future interventions and should be investigated in prospective studies.

Examining the Relationships between the Incidence of Infectious Diseases and Mood Disorders: An Analysis of Data from the Global Burden of Disease Studies, 1990-2019

Mood disorders are among the commonest mental disorders worldwide. Epidemiological and clinical evidence suggests that there are close links between infectious diseases and mood disorders, but the strength and direction of these association remain largely unknown. Theoretical models have attempted to explain this link based on evolutionary or immune-related factors, but these have not been empirically verified. The current study examined cross-sectional and longitudinal associations between the incidence of infectious diseases and mood disorders, while correcting for climate and economic factors, based on data from the Global Burden of Disease Studies, 1990-2019. It was found that major depressive disorder was positively associated with lower respiratory infections, while bipolar disorder was positively associated with upper respiratory infections and negatively associated with enteric and tropical infections, both cross-sectionally and over a period of 30 years. These results suggest that a complex, bidirectional relationship exists between these disorders. This relationship may be mediated through the immune system as well as through the gut-brain and lung-brain axes. Understanding the mechanisms that link these groups of disorders could lead to advances in the prevention and treatment of both.

Mitochondrial and metabolic features of salugenesis and the healing cycle

Pathogenesis and salugenesis are the first and second stages of the two-stage problem of disease production and health recovery. Salugenesis is the automatic, evolutionarily conserved, ontogenetic sequence of molecular, cellular, organ system, and behavioral changes that is used by living systems to heal. It is a whole-body process that begins with mitochondria and the cell. The stages of salugenesis define a circle that is energy- and resource-consuming, genetically programmed, and environmentally responsive. Energy and metabolic resources are provided by mitochondrial and metabolic transformations that drive the cell danger response (CDR) and create the three phases of the healing cycle: Phase 1-Inflammation, Phase 2-Proliferation, and Phase 3-Differentiation. Each phase requires a different mitochondrial phenotype. Without different mitochondria there can be no healing. The rise and fall of extracellular ATP (eATP) signaling is a key driver of the mitochondrial and metabolic reprogramming required to progress through the healing cycle. Sphingolipid and cholesterol-enriched membrane lipid rafts act as rheostats for tuning cellular sensitivity to purinergic signaling. Abnormal persistence of any phase of the CDR inhibits the healing cycle, creates dysfunctional cellular mosaics, causes the symptoms of chronic disease, and accelerates the process of aging. New research reframes the rising tide of chronic disease around the world as a systems problem caused by the combined action of pathogenic triggers and anthropogenic factors that interfere with the mitochondrial functions needed for healing. Once chronic pain, disability, or disease is established, salugenesis-based therapies will start where pathogenesis-based therapies end.

The Immune System and Depression: From Epidemiological to Clinical Evidence

Depression is a frequent mental disorder with a substantial contribution to years lived with disability worldwide. In the search for new treatment targets, the immune system's contribution to the pathogenesis of depression has received increased attention as immune activation has been associated with depression in various epidemiological and case-control studies. Epidemiological studies have shown that immune exposures such as severe infections and autoimmune disorders increase the risk of depression. Furthermore, immune system activation has been indicated in case-control studies of depression revealing higher levels of key pro-inflammatory cytokines among patients with depression than healthy controls, particularly in blood and to some extent in the cerebrospinal fluid. Moreover, brain imaging studies indicate increased microglial activity during depression, and gut microbiota studies have documented alterations of gut microbiota composition to be associated with depression. Based on findings from animal and human studies, several immune-mediated molecular mechanisms have been suggested to underlie the association between increased immunological activity and depression. However, the research is challenged by the heterogeneity of the depression diagnosis and - to some extent - the precision of currently available technology for immune biomarker quantification, particularly regarding the assessment of low-grade neuroinflammation. Nonetheless, an enhanced understanding of the complex interactions between the immune system and the brain in the context of depression could pave the way for precision medicine approaches with immune-modulating treatment as a promising additional option in the treatment of depression.

Antidepressants with anti-inflammatory properties may be useful in long COVID depression

Long COVID, which is characterised by the presence of persistent symptoms following a COVID infection, may also cause long COVID depression (LCD). Although the risk factors for LCD are not directly characterised, prior mental health visits were associated with an increased risk for long COVID, whereas antidepressant use was not. Current evidence suggests that pro-inflammatory factors in the brain are linked to LCD, thus anti-inflammatory agents may be useful in mitigating LCD. Limited evidence suggests that selective serotonin reuptake inhibitors may also be effective in the treatment of LCD.

Possible role of the NLRP3 inflammasome and the gut-brain axis in multiple sclerosis-related depression

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system that results from complex interactions between genetic and environmental determinants. Patients with MS exhibit a high risk of depression, however, the exact pathomechanisms remain largely unknown. It is becoming widely accepted that the gut-brain axis (GBA) disorders may exert an influence on neuroinflammation and psychiatric symptoms, including so-called MS-related depression. The element suggested as a bridge between intestinal disorders, depression, and MS is an inflammatory response with the central role of the NLR family pyrin domain containing 3 (NLRP3) inflammasome. The pro-inflammatory activity of effector cytokines of the NLRP3 inflammasome forms the hypothesis that it is actively involved in the development of inflammatory and autoimmune diseases. Despite extensive reviews considering the possible origins of MS-related depression, its complex pathophysiology prevents any easy determination of its underlying mechanisms. This paper aims to discuss molecular mechanisms related to the GBA axis that can mediate dysbiosis, intestinal barrier dysfunction, disruption of blood-brain barrier integrity, neuroinflammation, and subsequent manifestation of MS-related major depressive disorder.

Potential diagnostic markers and therapeutic targets for rheumatoid arthritis with comorbid depression based on bioinformatics analysis

Background

Rheumatoid arthritis (RA) and depression are prevalent diseases that have a negative impact on the quality of life and place a significant economic burden on society. There is increasing evidence that the two diseases are closely related, which could make the disease outcomes worse. In this study, we aimed to identify diagnostic markers and analyzed the therapeutic potential of key genes.

Methods

We assessed the differentially expressed genes (DEGs) specific for RA and Major depressive disorder (MDD) and used weighted gene co-expression network analysis (WGCNA) to identify co-expressed gene modules by obtaining the Gene expression profile data from Gene Expression Omnibus (GEO) database. By using the STRING database, a protein-protein interaction (PPI) network constructed and identified key genes. We also employed two types of machine learning techniques to derive diagnostic markers, which were assessed for their association with immune cells and potential therapeutic effects. Molecular docking and in vitro experiments were used to validate these analytical results.

Results

In total, 48 DEGs were identified in RA with comorbid MDD. The PPI network was combined with WGCNA to identify 26 key genes of RA with comorbid MDD. Machine learning-based methods indicated that RA combined with MDD is likely related to six diagnostic markers: AURKA, BTN3A2, CXCL10, ERAP2, MARCO, and PLA2G7. CXCL10 and MARCO are closely associated with diverse immune cells in RA. However, apart from PLA2G7, the expression levels of the other five genes were associated with the composition of the majority of immune cells in MDD. Molecular docking and in vitro studies have revealed that Aucubin (AU) exerts the therapeutic effect through the downregulation of CXCL10 and BTN3A2 gene expression in PC12 cells.

Conclusion

Our study indicates that six diagnostic markers were the basis of the comorbidity mechanism of RA and MDD and may also be potential therapeutic targets. Further mechanistic studies of the pathogenesis and treatment of RA and MDD may be able to identify new targets using these shared pathways.

COVID-19-induced psychosis: two case reports and narrative literature review

Introduction: SARS-CoV-2 infection might be presented in many various specific and non-specific manifest and symptoms from different systems. Also, the psychotic symptoms are documented but the explanation for their pathophysiology remains debatable and a complex matter. The main objective of this paper is to present cases of patients without a history of psychiatric disorders who developed the first episode of psychosis during the SARS-CoV-2 infection.

Material and methods: Two cases of not-related patients with no previous psychiatric history developed psychotic episodes during COVID-19 infection. In both cases chronologically first they experienced symptoms of infection, secondly, delusions and psychomotor agitation that required psychiatric hospitalization. Full remission was observed after antipsychotic treatment in both cases.

Results: Even though the pathophysiology of the post-COVID-19 psychiatric symptoms remains unclear, some reports that indicate associations between the infection and the onset of such symptoms. The infection itself, by the induction of cytokine storm followed by the excessive release of pro-inflammatory cytokines, is considered to stimulate the potential onset of the psychosis, however, other factors such as medications used during treatment (with a particular emphasis on glucocorticosteroids) or psychological factors should be considered as well.

Conclusions: Patients infected with SARS-CoV-2 might develop serious psychotic episodes even without a prior psychiatric history. Besides, psychiatric symptoms might be the first the even the only manifestations associated with the active SARSCoV-2 infection which seems to be very challenging especially in cases of rapid psychotic episodes without any clear respiratory symptoms.

HLA-DR Expression Level in CD8+ T Cells Correlates With the Severity of Children With Acute Infectious Mononucleosis

Background

This study aimed to assess the host immune signatures associated with EBV infection and its clinical value in indicating the severity of children with acute infectious mononucleosis (IM).

Methods

Twenty-eight pediatric patients with IM aged 3–8 years were enrolled. The immune phenotypes and cytokine secretion capability of T cells were detected.

Results

The percentages and absolute numbers of CD3⁺ and CD8⁺ T cells were significantly increased in IM patients compared with HCs. The percentages of Naïve CD4⁺ and CD8⁺ T cells were decreased but with increased percentages of memory CD4⁺ and CD8⁺ T subsets. Our results showed the upregulation of active marker HLA-DR, TCR-αβ, and inhibitory receptors PD-1, TIGIT in CD8⁺ T cells from IM patients, which suggested that effective cytotoxic T cells were highly against EBV infection. However, EBV exposure impaired the cytokine (IFN-γ, IL-2, and TNF-α) secretion capability of CD4⁺ and CD8⁺ T cells after stimulation with PMA/ionomycin in vitro. Multivariate analysis revealed that the percentage of HLA-DR⁺ CD8⁺ T cells was an independent prognostic marker for IM. The percentage of HLA-DR⁺ CD8⁺ T cells was significantly correlated with high viral load and abnormal liver function results.

Conclusion

Robust expansion and upregulation of HLA-DR in CD8⁺ T cells, accompanied with impaired cytokine secretion, were typical characteristics of children with acute IM. The percentage of HLA-DR⁺ CD8⁺ T cells might be used as a prominent marker not only for the early diagnosis but also for indicating the severity of IM.