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Obsessive-Compulsive Disorder, PANDAS, and Tourette Syndrome: Immuno-inflammatory Disorders

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Neuroinflammation, Gut-Brain Axis and Immunity in Neuropsychiatric Disorders

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1411))

Abstract

In the last years, much focus has been given to the possible role of inflammatory and immunologic alterations in the pathophysiology of obsessive-compulsive disorder (OCD) and some related conditions, such as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) and Tourette syndrome (TS). Although the matter is intriguing, the available data are still controversial and/or limited. Therefore, the aim of this chapter was at reviewing and commenting on the literature on possible dysfunctions of inflammatory and immune system processes in OCD, PANDAS, and TS.

This narrative review was carried out through searching PubMed and Google Scholar for English language papers from January 1985 to December 31, 2021.

The data gathered up to now would suggest that the mechanisms involved might be heterogeneous according to the age of the patients and the disorder examined. Indeed, PANDAS seem more related to infections triggering autoimmunity not necessarily following group A beta-hemolytic streptococcal (GABHS) infection, as supposed in the past. Autoimmunity seems also important in TS, if coupled with an individual vulnerability that can be genetic and/or environmental. The data in adult OCD, albeit scattered and sometimes obtained in small samples of patients, would indicate that immune system and inflammatory processes are involved in the pathophysiology of the disorder. However, it is still unclear to conclude whether they are primary or secondary phenomena.

In conclusion, taken together, the current findings pave that way towards novel and promising domains to explore the pathophysiology of OCD and related disorders, as well towards the development of innovative therapeutic strategy beyond current pharmacological paradigms.

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Abbreviations

5-HT:

5-Hydroxytryptamine

ABGA:

Anti-basal ganglia antibodies

BBB:

Blood-brain barrier

BDNF:

Brain-derived neurotrophic factor

CASPR2:

Contactin-associated protein-like 2

CNS:

Central nervous system

COX-2:

Ciclooxigenase-2

CSF:

Cerebrospinal fluid

CSTC:

Cortico-striatal-thalamo-cortical

DSM-5:

Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

GABA:

Gamma-aminobutyric acid

GABARAP:

GABA receptor-associated protein

GABHS:

Group A beta-hemolytic streptococcus

HCs:

Healthy controls

HPA:

Hypothalamic-pituitary axis

IDO:

Indoleamine-2,3-dehydrogenase

IFN:

Interferon

IL:

Interleukin

LPS:

Lipopolysaccharide

MS:

Multiple sclerosis

NK:

Natural killer

NSAIDs:

Nonsteroidal anti-inflammatory drugs

OCD:

Obsessive-compulsive disorder

OCRDs:

Obsessive-compulsive and related disorders

OCS:

Obsessive-compulsive symptoms

PANDAS:

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

PANS:

Pediatric acute-onset neuropsychiatric syndrome

PD:

Parkinson’s disease

PET:

Positron emission tomography

ROS:

Reactive oxygen species

SLE:

Systemic lupus erythematosus

sTNFR1:

Soluble TNF receptor-1

sTNFR2:

Soluble TNF receptor-2

Th:

T helper

TM:

Transverse myelitis

TNF:

Tumor necrosis factor

Treg:

T regulatory

TS:

Tourette syndrome

VT:

Distribution volume

Y-BOCS:

Yale-Brown obsessive-compulsive scale

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Authors and Affiliations

  1. Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy

    Donatella Marazziti, Stefania Palermo, Alessandro Arone, Lucia Massa, Elisabetta Parra, Marly Simoncini, Lucia Martucci & Maria Francesca Beatino

  2. Saint Camillus International University of Health and Medical Sciences – UniCamillus, Rome, Italy

    Donatella Marazziti

  3. Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, University of Siena, Siena, Italy

    Andrea Pozza

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  1. Donatella Marazziti
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  2. Stefania Palermo
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Correspondence to Donatella Marazziti .

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  1. Department of Psychiatry, Korea University Ansan Hospital, Ansan, Korea (Republic of)

    Yong-Ku Kim

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Marazziti, D. et al. (2023). Obsessive-Compulsive Disorder, PANDAS, and Tourette Syndrome: Immuno-inflammatory Disorders. In: Kim, YK. (eds) Neuroinflammation, Gut-Brain Axis and Immunity in Neuropsychiatric Disorders. Advances in Experimental Medicine and Biology, vol 1411. Springer, Singapore. https://doi.org/10.1007/978-981-19-7376-5_13

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