Bipolar disorder and antibodies against the N-methyl-d-aspartate receptor: A gate to the involvement of autoimmunity in the pathophysiology of bipolar illness
Bipolar disorder and antibodies against the N-methyl-d-aspartate receptor: A gate to the involvement of autoimmunity in the pathophysiology of bipolar illness
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DOI：
10.1016/j.neubiorev.2015.05.012
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发表时间：
2015-08
影响因子：
8.2
通讯作者：
Jordi León-Caballero;Isabella Pacchiarotti;A. Murru;M. Valentí;F. Colom;B. Benach;Víctor Pérez;Josep Dalmau;E. Vieta
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文献类型：
--
作者：
Jordi León-Caballero;Isabella Pacchiarotti;A. Murru;M. Valentí;F. Colom;B. Benach;Víctor Pérez;Josep Dalmau;E. Vieta
双相情感障碍(BD)与包括自身免疫性疾病在内的其他疾病共病的高患病率支持了BD本质是一种生物疾病类别的假设。因此，免疫失调过程可能在至少某些亚型BD的发生发展中发挥重要作用。越来越多的证据表明，N-甲基-d-天冬氨酸受体(NMDAR)可能与BD的病理生理有关。某些可能出现情感性症状的自身免疫性疾病的生理病理基础可能的一个关键机制是产生抗NMDAR自身抗体(自动抗体)。最具特征的自身免疫性抗NMDAR疾病是抗NMDAR脑炎。研究发现，这些患者中有4%在患病期间出现孤立的、主要是情绪性的精神症状。从这一综述中出现的一个有趣的建议是，在抗NMDAR自身抗体水平升高的患者中触发情感症状的相同机制可能涉及至少一个BD亚组的生理病理。抗NMDAR自身抗体与BD的关系尚需进一步研究。
The high prevalence of comorbidity between bipolar disorder (BD) and other medical conditions, including autoimmune diseases, supports the hypothesis of the nature of BD as a biological illness category. Hence, an immune dysregulation process may play an important role in the development of at least certain subtypes of BD. Increasing evidence also suggests that the N-methyl-d-aspartate receptor (NMDAR) may be relevant in the pathophysiology of BD. A possible key mechanism underlying the physiopathology of certain autoimmune diseases that may present with affective symptoms might be the production of anti-NMDAR auto-antibodies (auto-Abs). The best characterized autoimmune anti-NMDAR disease is the anti-NMDAR encephalitis. It has been found that 4% of these patients present isolated, mostly affective, psychiatric manifestations during their illness. An interesting suggestion emerged from this overview is that the same mechanisms that trigger affective symptoms in patients with increased anti-NMDAR auto-Abs levels could be involved in the physiopathology of at least a subgroup of BD. Future studies are needed to characterize the relationship between anti-NMDAR auto-Abs and BD.