Ist eine Aktivierung von Mikrogliazellen von pathophysiologischer Bedeutung?

Zusammenfassung

Störungen des Immunsystems wurden bei Patienten mit Schizophrenie und depressiven Störungen beschrieben. Dazu gehört eine gesteigerte numerische Dichte von Mikrogliazellen in bestimmten Hirnarealen – neben leichtgradig vermehrten Monozytenzahlen und einer erhöhten Konzentration proinflammatorischer Zytokine im peripheren Blut. Interessanterweise wurden ähnliche Veränderungen des Immunsystems bei Suizid-Patienten beobachtet – unabhängig von ihrer zugrunde liegenden psychiatrischen Diagnose. Diese Übersichtsarbeit fasst wichtige Daten aus Studien zusammen, die peripheres Blut, Liquor cerebrospinalis und humanes Hirngewebe (Post-mortem-Histologie und In-vivo-Positronenemissionstomografie) untersucht haben, um das mononukleäre Phagozytensystem (MPS) bei diesen psychisch kranken Patienten zu bewerten. Wir diskutieren, ob die Ergebnisse eher dafür sprechen, dass Mikrogliose und eine Aktivierung des MPS mit der Akuität bzw. einem besonderen Schweregrad der Erkrankung verknüpft sind, oder ob sie auf eine eigenständige Neurobiologie der Suizidalität hinweisen. Dabei ist zu bedenken, dass sich pathophysiologische Mechanismen im langfristigen Verlauf von psychiatrischen Erkrankungen ändern könnten. Möglicherweise spielen also bei neu erkrankten andere Immunmechanismen als bei chronisch kranken Patienten eine Rolle.

Summary

Immune alterations have been described in patients suffering from schizophrenia or affective disorders. These include an increased numerical density of microglial cells in certain brain areas, slightly elevated monocyte counts and increased levels of proinflammatory cytokines in the peripheral blood. Interestingly, similar immune alterations have been observed in suicide patients regardless of their underlying psychiatric diagnosis. This review summarizes relevant data from previous studies that have examined peripheral blood, cerebrospinal fluid and human brains (postmortem histology and in vivo positron emission tomography) to evaluate the mononuclear phagocyte system (MPS) in these psychiatrically ill patients. We discuss if the findings indicating MPS activation are rather associated with disease acuity/severity or with a distinct neurobiology of suicide. It is important to keep in mind that pathophysiological mechanisms could change during the long-term course of psychiatric diseases. Thus, different immune mechanisms may be involved in the pathophysiology of newly diseased patients compared to those with chronic disease stages.

Schlüsselwörter

Suizid - Suizidalität - Depression - Schizophrenie - Immunsystem - Mikrogliazellen - mononukleäres Phagozytensystem - Monozyten - Lymphozyten

Keywords

Suicide - suicidality - depression - schizophrenia - immune system - microglia - mononuclear phagocyte system - monocytes - lymphocytes

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