IL-33/ST2 Pathway and Galectin-3 as a New Analytes in Pathogenesis and Cardiometabolic Risk Evaluation in Psychosis

Senescent endothelial cell-derived Galectin 3 promotes silicosis through endothelial-fibroblast and endothelial-macrophage crosstalk

Silicosis is an occupational and irreversible interstitial lung disease, which is caused by the inhalation of respirable crystalline silica. Recent studies suggested that the senescence of endothelial cells is implicated in the pathogenesis of lung diseases. However, the role of senescent endothelial cells in silicosis remains poorly understood. By establishing multiple endothelial cell senescence models, and a silica-induced pulmonary fibrosis mouse model, we found that silica-induced endothelial cell senescence was accompanied by the increased expression of Galectin 3 (Gal3, gene name LGALS3). Mechanistically, silica-induced senescent cells synthesized a substantial amount of Gal3, which was subsequently released into the cellular microenvironment. Then, Gal3 directly binds to TGFBR1 on the cell membrane of lung fibroblasts and TLR4 on the macrophages, respectively. This cell communication facilitates the progression of silicosis by promoting fibroblast-myofibroblast transition (FMT) and NLRP3 inflammasome activation. Furthermore, Gal3 is regulated by the transcriptional regulatory factor CEBPB (CCAAT/ enhancer-binding protein beta) in senescent endothelial cells. In vivo, the administration of Lgals3 siRNA-loaded liposomes significantly ameliorated silica-induced pulmonary fibrosis. Collectively, our study demonstrated the critical role of endothelial cell senescence through the secretion of Gal3, which contributes to pulmonary fibrosis by promoting endothelial-fibroblast and endothelial-macrophage crosstalk.

Relationships between schizophrenia and the alarmins interleukin-33 (IL-33), soluble receptor of interleukin-33 (sST2) and the ratio IL-33/sST2. A systematic review

Schizophrenia is a multi-aetiologic disease. Inflammation have recently been involved in its pathophysiology. Recent research suggests that inflammation may be a key factor in its pathophysiology. Alarmins, interleukin-33 (IL-33), its soluble receptor sST2 and the ratio IL-33/sST2, have been investigated as neuroinflammation biomarkers. However, data on alarmins in schizophrenia remain scarce and conflicting, with findings varying across studies. The aim of this systematic review consists of analysing the relationships between IL-33, its sST2 and the ratio IL-33/sST2 in schizophrenia. The authors follow the PRISMA recommendations. The keywords IL-33 OR interleukin-33 OR sST2 OR soluble ST2 OR IL-33/sST2 were intersected with the Boolean operator AND with the key words schizophrenia OR psychosis OR psychotic disorder. The search was carried out in PubMed/MEDLINE, EMBASE, PsycInfo, Scopus and Web of Science. Despite the initial search yielding 115 publications, only five studies met inclusion criteria, comprising 107 healthy controls (HC) and 267 patients, highlighting the limited data available. IL-33 and its sST2 were significantly increased in patients with an acute relapse compared to HC, while patients in clinical remission had levels comparable to those of HC. No consistent relationship was found between antipsychotic treatment and IL-33 or sST2 levels, raising questions about the influence of medication on these markers. The quality of evidence was low to moderate (10 ± 1, with an evidence level of 3 ± 0, according to the Oxford Centre for Evidence-Based Medicine criteria). This systematic review highlights the possibility that IL-33 and sST2 play a role in the pathophysiology of schizophrenia, particularly in relation to neuroinflammation and neuronal dysfunction. However, the controversial and inconsistent findings suggest the need for larger, well-controlled studies. Additionally, the lack of mechanistic insight into how these alarmins contribute to schizophrenia pathophysiology remains a critical gap. Understanding the impact of IL-33 and sST2 on neuroinflammatory pathways could provide new therapeutic targets. Future research should also explore whether these markers can aid in early diagnosis or monitoring treatment response.

IL-33/ST2 axis in diverse diseases: regulatory mechanisms and therapeutic potential

Interleukin-33 (IL-33) is a nuclear factor and member of the IL-1 cytokine family. IL-33 is mainly expressed by epithelial and endothelial cells and exerts its function through interaction with various immune cells, and binding to its receptor can form the IL-33/Suppression of tumorigenicity 2 (ST2) signaling pathway. While most cytokines are actively synthesized within cells, IL-33 is produced passively in response to tissue damage or cell necrosis, indicating its role as a signaling molecule following cellular infection, stress, or trauma. IL-33/ST2 signaling pathway has been proved to play diverse role in the pathological process of central nervous system disorders, cancer, fibrosis, autoimmune diseases, etc. Although research on the IL-33/ST2 signaling pathway has deepened recently, relevant treatment strategies have been proposed, and even targeted drugs are in the preclinical stage; further research on the effect of the IL-33/ST2 signaling pathway in different diseases is still necessary, to provide a clearer understanding of the different roles of IL-33/ST2 in disease progression and to develop new drugs and treatment strategies. Because IL-33/ST2 plays an important role in the occurrence and progression of diseases, the study of therapeutic drugs targeting this pathway is also necessary. This review focused on recent studies on the positive or negative role of IL-33/ST2 in different diseases, as well as the current related drugs targeting IL-33/ST2 in the preclinical and clinical stage. The mechanism of IL-33/ST2 in different diseases and its mediating effect on different immune cells have been summarized, as well as the antibody drugs targeting IL-33 or ST2, natural compounds with a mediating effect, and small molecule substances targeting relative pathway. We aim to provide new ideas and treatment strategies for IL-33/ST2-related drugs to treat different diseases.

Aerobic Exercise Improves the Overall Outcome of Type 2 Diabetes Mellitus Among People With Mental Disorders

The escalating global prevalence of type 2 diabetes mellitus (T2DM) and mental disorder (MD) including schizophrenia, bipolar disorder, major depressive disorder, and anxiety highlights the urgency for comprehensive therapeutic strategies. Aerobic exercise (AE) is a viable adjunct therapy, providing significant benefits for individuals dealing with both T2DM and MD. This review consolidates evidence on AE's role in alleviating the physiological and psychological effects of these comorbid conditions. It delves into the pathophysiological connections between T2DM and various MD, including depression, schizophrenia, anxiety, and bipolar disorder-emphasizing their reciprocal exacerbation. Key neurophysiological mechanisms through which AE confers benefits are explored, including neuroinflammation modulation, brain structure and neuroplasticity enhancement, growth factor expression regulation, and hypothalamic-pituitary-adrenal (HPA)/microbiota-gut-brain (MGB) axis normalization. Clinical results indicate that AE significantly improves both metabolic and psychological parameters in patients with T2DM and MD, providing a substantial argument for integrating AE into comprehensive treatment plans. Future research should aim to establish detailed, personalized exercise prescriptions and explore the long-term benefits of AE in this population. This review underscores the potential of AE to complement existing therapeutic modalities and enhance the management of patients with T2DM and MD.

Circulating inflammatory cytokines influencing schizophrenia: a Mendelian randomization study

Introduction

Schizophrenia (SCZ) is a severe psychiatric disorder whose pathophysiology remains elusive. Recent investigations have underscored the significance of systemic inflammation, particularly the impact of circulating inflammatory proteins, in SCZ.

Methods

This study explores the potential causal association between certain inflammatory proteins and SCZ. Bidirectional Mendelian randomization (MR) analyses were conducted utilizing data from expansive genome-wide association studies (GWAS). Data regarding circulating inflammatory proteins were sourced from the GWAS Catalog database, encompassing 91 inflammatory cytokines. SCZ-related data were derived from the Finngen database, incorporating 47,696 cases and 359,290 controls. Analytical methods such as inverse variance weighted, MR-Egger, weighted median, simple mode, and weighted mode were employed to evaluate the association between inflammatory cytokines and SCZ. Sensitivity analyses were also performed to affirm the robustness of the results.

Results

Following FDR adjustment, significant associations were observed between levels of inflammatory cytokines, including Fibroblast Growth Factor 5 (OR = 1.140, 95%CI = 1.045, 1.243, p = 0.003, FDR=0.015), C-C Motif Chemokine 4 (OR = 0.888, 95%CI = 0.816, 0.967, p = 0.006, FDR = 0.015), C-X-C Motif Chemokine 1 (OR = 0.833, 95%CI = 0.721, 0.962, p = 0.013, FDR = 0.064), and C-X-C Motif Chemokine 5 (OR = 0.870, 95%CI = 0.778, 0.973, p = 0.015, FDR = 0.074), and the risk of SCZ.

Conclusion

Our results from MR analysis suggest a potential causal link between circulating inflammatory cytokines and SCZ, thereby enriching our understanding of the interactions between inflammation and SCZ. Furthermore, these insights provide a valuable foundation for devising therapeutic strategies targeting inflammation.

Evaluation of galectin-1 and galectin-3 levels in patients with bipolar disorder: is galectin-3 associated with treatment response?

OBJECTIVE

Galectins (Gal), which have been linked with inflammatory response in the central nervous system, may play an important role in the pathogenesis of bipolar disorder. In this study, we investigated whether serum Gal-1 and Gal-3 levels are related to bipolar disorder.

METHODS

Thirty-six patients diagnosed with bipolar disorder were included. C-reactive protein, Gal-1, Gal-3 serum concentrations were evaluated on the first day of hospitalization and the third week of treatment and were compared with 41 healthy controls. Illness severity was evaluated with the Young Mania Rating Scale.

RESULTS

Upon hospitalization, the C-reactive protein levels of bipolar disorder patients were significantly higher than in the third week of treatment or in healthy controls. Gal-1 levels on the first day of hospitalization and the third week of treatment were higher than those of healthy controls.There was no significant difference between patient Gal-3 levels upon hospitalization and those of healthy controls; at the end of the third week of treatment, Gal-3 levels were significantly higher than on the first day of hospitalization.

CONCLUSION

Our study is the first to show a change in Gal levels after treatment and to evaluate the role of Gal in bipolar disorder. Gal-1 may play a role in the pathophysiology of bipolar disorder. Gal-3 could be a biomarker candidate for assessing treatment response.

Impact of Helicobacter pylori and metabolic syndrome on mast cell activation-related pathophysiology and neurodegeneration

Both Helicobacter pylori (H. pylori) infection and metabolic syndrome (MetS) are highly prevalent worldwide. The emergence of relevant research suggesting a pathogenic linkage between H. pylori infection and MetS-related cardio-cerebrovascular diseases and neurodegenerative disorders, particularly through mechanisms involving brain pericyte deficiency, hyperhomocysteinemia, hyperfibrinogenemia, elevated lipoprotein-a, galectin-3 overexpression, atrial fibrillation, and gut dysbiosis, has raised stimulating questions regarding their pathophysiology and its translational implications for clinicians. An additional stimulating aspect refers to H. pylori and MetS-related activation of innate immune cells, mast cells (MC), which is an important, often early, event in systemic inflammatory pathologies and related brain disorders. Synoptically, MC degranulation may play a role in the pathogenesis of H. pylori and MetS-related obesity, adipokine effects, dyslipidemia, diabetes mellitus, insulin resistance, arterial hypertension, vascular dysfunction and arterial stiffness, an early indicator of atherosclerosis associated with cardio-cerebrovascular and neurodegenerative disorders. Meningeal MC can be activated by triggers including stress and toxins resulting in vascular changes and neurodegeneration. Likewise, H.pylori and MetS-related MC activation is linked with: (a) vasculitis and thromboembolic events that increase the risk of cardio-cerebrovascular and neurodegenerative disorders, and (b) gut dysbiosis-associated neurodegeneration, whereas modulation of gut microbiota and MC activation may promote neuroprotection. This narrative review investigates the intricate relationship between H. pylori infection, MetS, MC activation, and their collective impact on pathophysiological processes linked to neurodegeneration. Through a comprehensive search of current literature, we elucidate the mechanisms through which H. pylori and MetS contribute to MC activation, subsequently triggering cascades of inflammatory responses. This highlights the role of MC as key mediators in the pathogenesis of cardio-cerebrovascular and neurodegenerative disorders, emphasizing their involvement in neuroinflammation, vascular dysfunction and, ultimately, neuronal damage. Although further research is warranted, we provide a novel perspective on the pathophysiology and management of brain disorders by exploring potential therapeutic strategies targeting H. pylori eradication, MetS management, and modulation of MC to mitigate neurodegeneration risk while promoting neuroprotection.

Higher Levels of Galectin-1 and Galectin-3 in Young Subjects with Autism Spectrum Disorder Compared to Unaffected Siblings and Healthy Controls

Objective

: Despite being highly genetic, the etiology of autism spectrum disorder (ASD), has not yet been clarified. Recent research has focused on the role of neuroinflammation and immune system dysfunction in the pathophysiology of neurodevelopmental disorders including ASD. Galectin-1 and galactin-3 are considered among the biomarkers of neuroinflammation and there has been recent reports on the potential role of galectins in the etiology of neurodevelopmental disorders. However, there has been no study examining the relationship between ASD and galectin levels.

Methods

: Current study aimed to investigate galectin-1 and galectin-3 serum levels in young subjects with ASD comparing with their unaffected siblings and healthy controls.

Results

: We found significantly higher levels of galectin-1 in case group compared to both unaffected siblings and healthy controls, and higher levels of galectin-3 in case group compared to healthy controls. However, there was no significant association between galectin-1 and galectin-3 levels with the severity of ASD.

Conclusion

: Findings of our study may support neuroinflammation hypothesis in the etiology of ASD and the potential role of galectin-1 and galectin-3 as biomarkers.

An exploration of the correlations between seven psychiatric disorders and the risks of breast cancer, breast benign tumors and breast inflammatory diseases: Mendelian randomization analyses

Background

Previous observational studies have showed that certain psychiatric disorders may be linked to breast cancer risk, there is, however, little understanding of relationships between mental disorders and a variety of breast diseases. This study aims to investigate if mental disorders influence the risks of overall breast cancer, the two subtypes of breast cancer (ER+ and ER-), breast benign tumors and breast inflammatory diseases.

Methods

During our research, genome-wide association study (GWAS) data for seven psychiatric disorders (schizophrenia, major depressive disorder, bipolar disorder, post-traumatic stress disorder, panic disorder, obsessive-compulsive disorder and anorexia nervosa) from the Psychiatric Genomics Consortium (PGC) and the UK Biobank were selected, and single-nucleotide polymorphisms (SNPs) significantly linked to these mental disorders were identified as instrumental variables. GWAS data for breast diseases came from the Breast Cancer Association Consortium (BCAC) as well as the FinnGen consortium. We performed two-sample Mendelian randomization (MR) analyses and multivariable MR analyses to assess these SNPs' effects on various breast diseases. Both heterogeneity and pleiotropy were evaluated by sensitivity analyses.

Results

When the GWAS data of psychiatric disorders were derived from the PGC, our research found that schizophrenia significantly increased the risks of overall breast cancer (two-sample MR: OR 1.05, 95%CI [1.03-1.07], p = 3.84 × 10^-6; multivariable MR: OR 1.06, 95%CI [1.04-1.09], p = 2.34 × 10^-6), ER+ (OR 1.05, 95%CI [1.02-1.07], p = 5.94 × 10^-5) and ER- (two-sample MR: OR 1.04, 95%CI [1.01-1.07], p = 0.006; multivariable MR: OR 1.06, 95%CI [1.02-1.10], p = 0.001) breast cancer. Nevertheless, major depressive disorder only showed significant positive association with overall breast cancer (OR 1.12, 95%CI [1.04-1.20], p = 0.003) according to the two-sample MR analysis, but not in the multivariable MR analysis. In regards to the remainder of the mental illnesses and breast diseases, there were no significant correlations. While as for the data from the UK Biobank, schizophrenia did not significantly increase the risk of breast cancer.

Conclusions

The correlation between schizophrenia and breast cancer found in this study may be false positive results caused by underlying horizontal pleiotropy, rather than a true cause-and-effect relationship. More prospective studies are still needed to be carried out to determine the definitive links between mental illnesses and breast diseases.

Galectin-3 levels in school aged children with autism spectrum disorder

Objective: Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders with underlying pathogenesis and etiological factors not fully understood. We assumed that galectin-3, which is also linked with inflammatory responses, may be central to the ethiopathogenesis of ASD. Method: The current study consisted of 33 psychotropic medication-naive children with ASD and 32 control subjects. The Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime Version-DSM-5 (K-SADS-PL-DSM-5) was used to screen healthy controls for psychiatric disorders by a psychiatrist after a physical examination by a pediatrician. The clinical severity of the ASD symptoms has been assessed by the Childhood Autism Rating Scale (CARS). Venous blood samples were collected and serum galectin-3 levels were measured. Results: When the ASD and control groups are compared, the mean galectin-3 level is 417.77 (SD = 200.20) in the ASD group and 243.08 (SD = 64.65) in the control group, and there is a statistically significant difference between the groups (p < 0.001). When examining whether there is a correlation between galectin-3 levels and CARS total scores, no statistically significant correlation was found between them (r = 0.015, p = 0.933). Discussion: In this study, we examined whether serum galectin-3 levels have a relation with ASD in childhood or not. Our findings have indicated that the children with ASD have higher serum galectin-3 levels compared to the controls. However, no significant relationship has been found between serum galectin-3 levels and ASD symptom severity.

Galectin-3 in Microglia-Mediated Neuroinflammation: Implications for Central Nervous System Diseases

Microglial activation is one of the common hallmarks shared by various central nervous system (CNS) diseases. Based on surrounding circumstances, activated microglia play either detrimental or neuroprotective effects. Galectin-3 (Gal-3), a group of β-galactoside-binding proteins, has been cumulatively revealed to be a crucial biomarker for microglial activation after injuries or diseases. In consideration of the important role of Gal-3 in the regulation of microglial activation, it might be a potential target for the treatment of CNS diseases. Recently, Gal-3 expression has been extensively investigated in numerous pathological processes as a mediator of neuroinflammation, as well as in cell proliferation. However, the underlying mechanisms of Gal-3 involved in microgliamediated neuroinflammation in various CNS diseases remain to be further investigated. Moreover, several clinical studies support that the levels of Gal-3 are increased in the serum or cerebrospinal fluid of patients with CNS diseases. Thus, we summarized the roles and underlying mechanisms of Gal-3 in activated microglia, thus providing a better insight into its complexity expression pattern, and contrasting functions in CNS diseases.

Galectin-3 mediated risk of inflammation in stable schizophrenia, with only possible secondary consequences for cognition

BACKGROUND

Evidence suggests that cytokines cause immune disturbances, shape immunological sequelae later in life, and modulate the risk of schizophrenia (SC). Galectin-3 (Gal-3), a multifaceted molecule of the glycan family, is involved in the formation of the immunological synapse and modulates the signalling pathway and effector functions of T lymphocytes, which are major producers of cytokines. We have previously reported elevated serum Gal-3 levels in stable SC patients. However, Gal-3 as a link between cognitive functioning and inflammation has not yet been investigated in SC.

AIM

To investigate the relationship between serum Gal-3 levels and cognitive performance, serum cytokines, and white blood cell count in three-month stably treated SC patients.

METHODS

Twenty-seven patients with SC in remission and 18 healthy volunteers participated in this case-control and correlational study. Clinical assessment was performed using the Positive and Negative Syndrome Scale and the Montreal-Cognitive Assessment. The results of previously measured serum levels of Gal-3, interleukin (IL)-33, soluble suppression of tumorigenicity 2 (sST2), tumor necrosis factor-alpha (TNF-α), IL-6 and IL-17 were used for further statistical analyses, and IL-4, IL-23, IL-1β and transforming growth factor-beta (TGF-β) were now additionally measured with a sensitive enzyme-linked immunosorbent assay. The number of leukocytes in the blood and the percentage of neutrophils, lymphocytes, and monocytes were determined with a standardized routine measurement procedure (Sysmex Technology). Statistical analyses were performed using SPSS 20.0 software.

RESULTS

We found no correlation between serum Gal-3 levels and cognitive functioning in SC patients. A positive correlation was found between the levels of Gal-3 and TNF-α (r = 0.476; P = 0.012), Gal-3 and IL-23 (r = 0.417; P = 0.031), and Gal-3 and sST2 (r = 0.402; P = 0.038). The binary logistic model, which included all nine cytokines measured in this patient sample, indicated the particular role of Gal-3 and TGF-β in the duration of SC. In the stabilization phase of SC, we observed a moderate and negative correlation between serum Gal-3 levels and leukocytes (r = -0.449; P < 0.019). Additional linear regression analysis showed a positive correlation between Gal-3 expression and risperidone dose (F: 4.467; P < 0.045; r² = 0.396).

CONCLUSION

The combined activity of Gal-3 and proinflammatory cytokines, TGF-β downregulation and lower counts of leukocytes influence the SC duration. Gal-3 likely manifests indirect immunometabolic regulation of cognition in SC.

Galectin-3 Involvement in Cognitive Processes for New Therapeutic Considerations

Cognitive impairment may be a consequence of the normal aging process, but it may also be the hallmark of various neurodegenerative and psychiatric diseases. Early identification of individuals at particular risk for cognitive decline is critical, as it is imperative to maintain a cognitive reserve in these neuropsychiatric entities. In recent years, galectin-3 (Gal-3), a member of the galectin family, has received considerable attention with respect to aspects of neuroinflammation and neurodegeneration. The mechanisms behind the putative relationship between Gal-3 and cognitive impairment are not yet clear. Intrigued by this versatile molecule and its unique modular architecture, the latest data on this relationship are presented here. This mini-review summarizes recent findings on the mechanisms by which Gal-3 affects cognitive functioning in both animal and human models. Particular emphasis is placed on the role of Gal-3 in modulating the inflammatory response as a fine-tuner of microglia morphology and phenotype. A review of recent literature on the utility of Gal-3 as a biomarker is provided, and approaches to strategically exploit Gal-3 activities with therapeutic intentions in neuropsychiatric diseases are outlined.

Inflammation in first-episode psychosis: The contribution of inflammatory biomarkers to the emergence of negative symptoms, a systematic review and meta-analysis

OBJECTIVE

To provide a comprehensive analysis of cytokine perturbations in antipsychotic-naïve first-episode psychosis (FEP) populations and assess the relationship between inflammatory biomarkers and negative symptom severity.

METHODS

A systematic review and meta-analysis following PRISMA guidelines were conducted. A total of 1042 records were identified via systematic search of EMBASE, MEDLINE and APA PsycInfo databases. Sixteen studies met the inclusion criteria and were eligible for inclusion in the review. Ten of these studies had sufficient data for inclusion in a random effects, pooled-effect meta-analysis.

RESULTS

A significant and large effect size was reported for IFN-γ, IL-6 and IL-12, and a moderate effect size reported for IL-17 (p = <0.05) in people with antipsychotic naive first episode psychosis, compared to healthy controls, suggesting a significant elevation in proinflammatory cytokine concentration. Non-significant effect sizes were reported for TNF-α, IL-1β, IL-2, IL-4, IL-8 and IL-10 (p = >0.05). Regarding proinflammatory cytokines and relationships to negative symptomology, moderate positive relationships were reported for negative symptoms and IL-1β, IL-2, IL-6 and TNF-α, across four studies. For anti-inflammatory cytokines, one strong and one weak-to-moderate negative relationship was described for IL-10 and negative symptoms. Contrastingly, a strong positive relationship was reported for IL-4 and negative symptoms.

CONCLUSION

There is evidence of significantly elevated proinflammatory cytokines in antipsychotic-naïve FEP populations, alongside promising findings from cohort data suggesting an interaction between inflammation and primary negative symptomology. Future studies should seek to come to a consensus on a panel of cytokines that relate most specifically to negative symptoms, and consider longitudinal studies to investigate how cytokine fluctuations may relate to exacerbation of symptoms.

Schizophrenia and Alarmins

Schizophrenia, consisting of a group of severe psychiatric disorders with a complex etiology, is a leading cause of disability globally. Due to the lack of objective indicators, accurate diagnosis and selection of effective treatments for schizophrenia remain challenging. The association between schizophrenia and alarmins levels has been proposed for many years, but without solid evidence. Alarmins are prestored molecules that do not require processing and can be released upon cell death or damage, making them an ideal candidate for an early initiator of inflammation. Immunological biomarkers seem to be related to disease progression and treatment effectiveness. Several studies suggest strong associations among the high-mobility group box 1 protein (HMGB1), interleukin-1α, interleukin-33, S100B, heat-shock proteins, and uric acid with schizophrenic disorders. The purpose of this review is to discuss the evidence of central and peripheral immune findings in schizophrenia, their potential causes, and the effects of immunomodulatory therapies on symptoms and outline potential applications of these markers in managing the illness. Although there are currently no effective markers for diagnosing or predicting treatment effects in patients with schizophrenia, we believe that screening immune-inflammatory biomarkers that are closely related to the pathological mechanism of schizophrenia can be used for early clinical identification, diagnosis, and treatment of schizophrenia, which may lead to more effective treatment options for people with schizophrenia.

Influence of antipsychotics on metabolic syndrome risk in patients with schizophrenia

OBJECTIVE

Many studies so far have shown that antipsychotic therapy may have an effect on the development of metabolic syndrome in patients diagnosed with schizophrenia. Our goal was to determine whether our respondents are at risk for developing metabolic syndrome and who is more predisposed to it.

METHODS

In a stable phase, 60 patients diagnosed with schizophrenia were equally divided into three groups according to the drug (risperidone, clozapine, and aripiprazole monotherapy). Control group had 20 healthy examinees. Patients were evaluated first using The Positive and Negative Syndrome Scale (PANSS). Prolactin, lipid status, glycemia, insulin, cytokine values (IL-33, TGF-β, and TNF-α) and C-reactive protein (CRP) were measured. Also, Body mass index (BMI), Homeostatic Model Assesment for Insulin Resistance (HOMA index), waist and hip circumference (WHR) and blood pressure (TA) measurement were performed in the study.

RESULTS

Patients treated with risperidone compared to healthy control subjects and aripiprazol group of patients had statistically significant difference in prolactin levels. In clozapine group compared to healthy control group values of HDL cholesterol and glucose level were statistically significant different. In aripiprazole group compared to healthy control group value of BMI was statistically significant different. Statistically significant correlations were found in TNF-α with glucose and HOMA index in risperidone treated patients and with BMI in clozapine group of patients; IL-33 with glucose in risperidone and with BMI in clozapine group of patients and TGF-β with glucose in risperidone group, with insulin and HOMA index in clozapine group and statistically significant negative correlation with LDL cholesterol in aripiprazole group of patients.

CONCLUSION

Patients on risperidone and clozapine therapy may be at greater risk of developing metabolic syndrome than patients treated with aripiprazole. Statistically significant difference in concentration of TNF-α and TGF-β was in the group of patients treated with risperidone compared to healthy control group.

Breast cancer in schizophrenia could be interleukin-33-mediated

Recent epidemiological and genetic studies have revealed an interconnection between schizophrenia and breast cancer. The mutual underlying pathophysiological mechanisms may be immunologically driven. A new cluster of molecules called alarmins may be involved in sterile brain inflammation, and we have already reported the potential impact of interleukin-33 (IL-33) on positive symptoms onset and the role of its soluble trans-membranes full length receptor (sST2) on amelioration of negative symptoms in schizophrenia genesis. Furthermore, these molecules have already been shown to be involved in breast cancer etiopathogenesis. In this review article, we aim to describe the IL-33/suppressor of tumorigenicity 2 (ST2) axis as a crossroad in schizophrenia-breast cancer comorbidity. Considering that raloxifene could be tissue-specific and improve cognition and that tamoxifen resistance in breast carcinoma could be improved by strategies targeting IL-33, these selective estrogen receptor modulators could be useful in complementary treatment. These observations could guide further somatic, as well as psychiatric therapeutical protocols by incorporating what is known about immunity in schizophrenia.

Galectin-3 possible involvement in antipsychotic-induced metabolic changes of schizophrenia: A minireview

Recently, specific immunometabolic profiles have been postulated in patients with schizophrenia, even before full-blown disease and independent of antipsychotic treatment. Proteomic profiling studies offer a promising potential for elucidating the cellular and molecular pathways that may be involved in the onset and progression of schizophrenia symptoms, and co-occurrent metabolic changes. In view of all this, we were intrigued to explore galectin-3 (Gal-3) as a glycan, and in our previous study, we measured its elevated levels in remission of schizophrenia. The finding may be a consequence of antipsychotic treatment and may have an impact on the onset of inflammation, the development of obesity, and the presumed cognitive changes in schizophrenia. In the animal study, it was shown that downregulation of Gal-3 was beneficial in insulin regulation of obesity and cognitive preservation. Strategies involving plasma exchange are discussed in this review, particularly in the context of Gal-3 elimination.

Galectins - Important players of the immune response to CNS parasitic infection

Galectins are a family of proteins that bind β-galactosides and play key roles in a variety of cellular processes including host defense and entry of parasites into the host cells. They have been well studied in hosts but less so in parasites. As both host and parasite galectins are highly upregulated proteins following infection, galectins are an area of increasing interest and their role in immune modulation has only recently become clear. Correlation of CNS parasitic diseases with mental disorders as a result of direct or indirect interaction has been observed. Therefore, galectins produced by the parasite should be taken into consideration as potential therapeutic agents.

Alarmins (IL-33, sST2, HMGB1, and S100B) as potential biomarkers for schizophrenia

There is growing evidence that immune/inflammatory processes are related to the etiology of schizophrenia. Danger-/damage-associated molecular patterns (DAMPs), also called alarmins, are recognized as inflammatory mediators that play an important role in the development of many infection-induced or sterile inflammatory diseases. The importance of DAMPs particles in various mental disorders is still not clear. Therefore, this study aimed to evaluate serum levels of the most promising alarmins (IL-33, sST2, HMGB1, and S100B), as potent schizophrenia biomarkers. Sixty-eight adult patients with chronic schizophrenia and twenty-nine healthy volunteers were included in this prospective study. Enzyme-linked immunosorbent assay (ELISA) was used to assess the serum concentration of IL-33, sST2, HMGB1, and S100B. We documented that the serum levels of IL-33 (p = 0.006), sST2 (p = 0.02), HMGB1 (p = 0.01), and S100B (p = 0.04) are significantly higher in patients with schizophrenia than in healthy subjects. In male, but not in female, patients with schizophrenia, we found a significant difference in the serum IL-33, sST2, and HMGB1 concentrations as compared to the healthy men. In both male and female patients with schizophrenia, there was no significant difference in the serum concentrations of S100B in comparison to control subjects. In patients with schizophrenia, no significant correlations were noticed neither between any studied alarmins and PANSS scores nor between CDSS scores. Given that all investigated alarmins participate in the course of the neuroinflammatory process, they might be considered as biomarkers of neuroinflammatory process underlying schizophrenia. Based on our observations, it seems that the most useful biological indicator of schizophrenia would be IL-33.

IL-33 as a Novel Serum Prognostic Marker of Intracerebral Hemorrhage

Objective

Interleukin 33 (IL-33) is a key cytokine involved in inflammation and oxidative stress. The significance of serum IL-33 levels on the prognosis of patients with intracerebral hemorrhage (ICH) has not been well studied. The purpose of this study is to determine whether there is a relationship between the serum IL-33 level and the prognosis of patients with ICH upon admission.

Methods

A total of 402 patients with confirmed ICH were included in this study. Their demographic data, medical history, laboratory data, imaging data, and clinical scores on admission were collected. At the same time, enzyme-linked immunoassay (ELISA) was used to detect the serum IL-33 levels of patients. The prognosis of patients was evaluated by mRS scale after 3 months, and mRS > 2 was defined as poor prognosis.

Results

Among 402 patients with ICH, the number of patients with good prognosis and poor prognosis after 3 months was 148 and 254, respectively. Compared with the ICH group with poor prognosis, the ICH group with good prognosis had lower baseline NHISS scores (p = 0.039) and hematoma volume (p = 0.025) and higher GCS scores (p < 0.001) and serum IL-33 levels (p < 0.001). The results of linear correlation analysis showed that serum IL-33 levels were significantly negatively correlated with baseline NHISS scores (r = −0.224, p = 0.033) and hematoma volume (r = −0.253, p = 0.046) but were significantly positively correlated with baseline GCS scores (r = 0.296, p = 0.020). The receiver operating characteristic curve (ROC) analysis showed that the sensitivity and specificity of serum IL-33 level in evaluating the prognosis of ICH were 72.1% and 74.3%, respectively. A cut-off value of serum IL-33 level < 109.3 pg/mL may indicate a poor prognosis for ICH.

Conclusions

Serum IL-33 level on admission may be a prognostic indicator of ICH, and its underlying mechanism needs further study.

IL-33 in Mental Disorders

Mental disorders are common in the general population; every year about 25% of the total European population is affected by a mental condition. The prevalence of psychiatric disorders might be underestimated. Emerging evidence highlights the role of immune response as a key factor in MDs. Immunological biomarkers seem to be related to illness progression and to treatment effectiveness; several studies suggest strong associations among IL-6, TNFa, S100b, IL 1b, and PCR with affective or schizophrenic disorders. The purpose of this review is to examine and to understand the possible link between mental disorders and interleukin 33 to clarify the role of this axis in the immune system. We found 13 research papers that evaluated interleukin 33 or interleukin 31 levels in subjects affected by mental disorders. Eight studies investigated cytokines in affective disorders. Three studies measured levels of IL-33 in schizophrenia and two studies focused on patients affected by autism spectrum disorders. Alterations in brain structure and neurodevelopmental outcome are affected by multiple levels of organization. Disorders of the autoimmune response, and of the IL-33/31 axis, may therefore be one of the factors involved in this process. These results support the evidence that alarmins, particularly the IL-33/31 axis, need more consideration among researchers and practitioners.

Galectin-3 in T cell-mediated immunopathology and autoimmunity

Galectin-3 (Gal-3) is the only member of galectin family able to form pentamers and heterodimers with chemokines. Its presence in various cells and tissues suggests variety of regulatory functions in physiological conditions, but increasing body of evidence indicates involvement of Gal-3 in pathological cascades of many diseases. Gal-3 exerts different, sometimes opposite, effects in various disorders or in different phases of the same disease. These differences in action of Gal-3 are related to the localization of Gal-3 in the cell, types of receptors through which it acts, or the types of cells that secrete it. As a regulator of immune response and T-cell activity, Gal-3 appears to have important role in development of autoimmunity mediated by T cells. Absence of Gal-3 in C57Bl6 mice favors Th2 mediated inflammatory myocarditis but attenuate fibrosis. Recent data also indicate Gal-3 involvement in development atherosclerosis. In pathogenesis of diabetes type 1 and autoimmune components of diabetes type 2 Gal-3 may have detrimental or protective role depending on its intracellular or extracellular localization. Gal-3 mediates autoimmune hepatic damage through activation of T-cells or natural killer T cells. Gal-3 is an important mediator in neurodevelopment, neuropathology and behavior due to its expression both in neurons and glial cells. All together, assessing the role of Gal-3 in immunopathology and autoimmunity it could be concluded that it is an important participant in pathogenesis, as well as promising monitoring marker and therapeutic target.

Oxidative Stress Impact on the Transcriptome of Differentiating Neuroblastoma Cells: Implication for Psychiatric Disorders

Prenatal environmental exposures that have been shown to induce oxidative stress (OS) during pregnancy, such as smoking and alcohol consumption, are risk factors for the onset of schizophrenia and other neurodevelopmental disorders (NDDs). While the OS role in the etiology of neurodegenerative diseases is well known, its contribution to the genomic dysregulation associated with psychiatric disorders is less well defined. In this study we used the SH-SY5Y cell line and applied RNA-sequencing to explore transcriptomic changes in response to OS before or during neural differentiation. We observed differential expression of many genes, most of which localised to the synapse and were involved in neuronal differentiation. These genes were enriched in schizophrenia-associated signalling pathways, including PI3K/Akt, axon guidance, and signalling by retinoic acid. Interestingly, circulatory system development was affected by both treatments, which is concordant with observations of increased prevalence of cardiovascular disease in patients with NDDs. We also observed a very significant increase in the expression of immunity-related genes, supporting current hypotheses of immune system involvement in psychiatric disorders. While further investigation of this influence in other cell and animal models is warranted, our data suggest that early life exposure to OS has a disruptive influence on neuronal gene expression that may perturb normal differentiation and neurodevelopment, thereby contributing towards overall risk for developing psychiatric diseases.

Type 17 Immune Response Facilitates Progression of Inflammation and Correlates with Cognition in Stable Schizophrenia

Dysregulation of the type 17 immune pathway has already been considered in schizophrenia and we previously measured decreased sera values of interleukin (IL)-17 in early stages. We further explored the possible correlation of IL-17 systemic levels with proinflammatory cytokines and cognitive scores and additionally analyzed the percentage of IL-17 producing lymphocytes in peripheral blood of patients with stable schizophrenia. We included 27 patients diagnosed with schizophrenia (F20), after a three-month stable depot antipsychotic therapy (risperidone or paliperidone) and 18 healthy control subjects. Positive and Negative Syndrome Scale of Schizophrenia and the Montreal-Cognitive Assessment (MoCA) were conducted. Sera concentrations of IL-17, IL-6, tumor necrosis factor alpha (TNF-α) and soluble ST2 receptor (sST2) were measured. Flow cytometry and Natural Killer (NK) and T cell analyses were done in 10 patients and 10 healthy controls. Moderate positive correlation was established between IL-17 and TNF-α (r = 0.640; p = 0.001), IL-17 and IL-6 (r = 0.514; p = 0.006), IL-17 and sST2 (r = 0.394; p = 0.042). Furthermore, a positive correlation between the serum levels of IL-17 and MoCA scores was observed, especially with visuospatial and executive functioning, as well as language functioning and delayed recall (p < 0.05). Significantly higher percentage of IL-17 producing CD56⁺ NK cells was measured in peripheral blood of patients with schizophrenia in remission vs. healthy individuals (p = 0.001). The percentage of CD4⁺ T cells and CD4⁺ T cells that produce IL-17 was significantly increased in patients (p = 0.001). This study revealed the involvement of innate type 17 immune response in the progression of inflammation and this could be related to cognitive functioning in stable schizophrenia.

Galectin-3: Roles in Neurodevelopment, Neuroinflammation, and Behavior

There is a plethora of evidence to suggest that Galectin-3 plays an important role in normal functions of mammalian cells, as well as in different pathogenic conditions. This review highlights recent data published by researchers, including our own team, on roles of Galectin-3 in the nervous system. Here, we discuss the roles of Galectin-3 in brain development, its roles in glial cells, as well as the interactions of glial cells with other neural and invading cells in pathological conditions. Galectin-3 plays an important role in the pathogenesis of neuroinflammatory and neurodegenerative disorders, such as multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. On the other hand, there is also evidence of the protective role of Galectin-3 due to its anti-apoptotic effect in target cells. Interestingly, genetic deletion of Galectin-3 affects behavioral patterns in maturing and adult mice. The results reviewed in this paper and recent development of highly specific inhibitors suggests that Galectin-3 may be an important therapeutic target in pathological conditions including the disorders of the central nervous system.

Serum galectin-3 levels are decreased in schizophrenia

Objective:

To determine whether changes in serum galectin-3 (gal-3) concentrations in schizophrenia patients have etiopathogenetic importance. Since very little research has assessed the connection between galectins and schizophrenia, we wanted to examine alterations in the inflammatory marker gal-3 in schizophrenia and investigate possible correlations between clinical symptomatology and serum concentrations.

Methods:

Forty-eight schizophrenia patients and 44 healthy controls were included in this study. The Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS) were administered to determine symptom severity. Venous blood samples were collected, and serum gal-3 levels were measured.

Results:

Mean serum gal-3 levels were significantly lower in schizophrenia patients, and there were no significant differences in age or sex with the control group. There was also a significant positive correlation between serum gal-3 concentrations and negative schizophrenia symptoms according to the SANS.

Conclusion:

The results indicate that gal-3 is decreased in schizophrenia patients, which could contribute to inflammation in the pathogenesis of schizophrenia.

Serum Galectin-3 Levels in Children with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with underlying pathogenesis and etiological factors not fully understood. We assumed that galectin-3, which is also linked with inflammatory responses, may play an important role in the ethiopathogenesis of ADHD. In this study, we aimed to investigate whether serum galectin-3 levels are related to ADHD in childhood.

METHODS

The current study consisted of 35 treatment-naive children with ADHD and 35 control subjects. The severities of ADHD and conduct disorder symptoms were assessed via parent- and teacher-rated questionnaires. The severity of anxiety and depression symptoms of the children were determined by the self-report scale. Venous blood samples were collected and serum galectin-3 levels were measured.

RESULTS

The ADHD group had significantly higher serum Galectin-3 levels than the control group. To control confounding factors, including age, sex, and BMI percentile, one-way analysis of covariance (ANCOVA) test was also performed. Analyses revealed a significantly higher serum log- Galectin-3 levels in children with ADHD compared to controls. No association was found between the mean serum galectin-3 levels and sociodemographic characteristics and clinical test scores, except the oppositional defiant behavior scores.

CONCLUSION

Our research supports the hypothesis that serum levels of galectin-3 might be related to ADHD.

Mortality risk following acute coronary syndrome among patients with schizophrenia: A meta-analysis

Patients with schizophrenia have a higher incidence of coronary artery disease. This meta-analysis was performed to evaluate the influence of a prior diagnosis of schizophrenia on mortality following acute coronary syndrome (ACS). Relevant longitudinal follow-up studies were obtained via systematic search of PubMed and Embase databases. A random effect model was used to perform the meta-analysis. This meta-analysis included 3,611,343 hospitalized patients with ACS from nine follow-up studies. The results show that, in patients with schizophrenia, ACS was associated with a significantly higher risk of mortality (multivariate adjusted risk ratio [RR]: 1.66, p < .001) with significant heterogeneity (I2 = 93%) compared to the results of mentally healthy patients. Subgroup analyses demonstrated that patients with schizophrenia were associated with higher ACS mortality within one month (RR: 1.68, p < .001) and during a follow-up period of ≥one year (RR: 1.71, p = .01), in studies with (RR: 1.65, p = .06) and without the adjustment of revascularization treatments (RR: 1.68, p = .004), as compared with the results of mentally healthy patients. These results indicate that patients with schizophrenia have a higher than expected mortality risk in the case of acute coronary events.

Cytokine Alterations in Schizophrenia: An Updated Review

Schizophrenia, a multisystem disorder with an unknown etiology, is associated with several immune dysfunctions, including abnormal levels of circulating cytokines. In this review, we investigated the changes of cytokines in schizophrenic patients, their connection with behavioral symptoms severity and their potential clinical implications. We also assessed the possible causative role of abnormal cytokine levels in schizophrenia pathogenesis. Based on meta-analyses, we categorized cytokines according to their changes in schizophrenic patients into four groups: (1) increased cytokines, including interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-1β, IL-12, and transforming growth factor (TGF)-β, (2) non-altered cytokines, including IL-2, IL-4, and IL-17, (3) increased or non-altered cytokines, including IL-8 and interferon (IFN)-γ, and (4) IL-10 with increased, decreased, and non-altered levels. Notably, alterations in cytokines may be variable in four different categories of SP, including first-episode and drug-naïve, first-episode and non-drug-naïve, stable chronic, and chronic in acute relapse. Furthermore, disease duration, symptoms severity, incidence of aggression, and cognitive abilities are correlated with levels of certain cytokines. Clinical implications of investigating the levels of cytokine in schizophrenic patients include early diagnosis, novel therapeutic targets development, patient stratification for choosing the best therapeutic protocol, and predicting the prognosis and treatment response. The levels of IL-6, IL-8, IFN-γ, IL-2 are related to the treatment response. The available evidence shows a potential causative role for cytokines in schizophrenia development. There is a substantial need for studies investigating the levels of cytokines before disease development and delineating the therapeutic implications of the disrupted cytokine levels in schizophrenia.