The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression.
The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression.
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发表时间：
2008-02
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通讯作者：
M. Maes;M. Kubera;J. Leunis
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作者：
M. Maes;M. Kubera;J. Leunis
现在有证据表明，抑郁症（MDD）伴随着炎症反应系统（IRS）的激活，促炎细胞因子和脂多糖（LPS）可能会诱导抑郁症状。本研究的目的是检查是否增加胃肠道通透性与增加易位的LPS从革兰氏阴性菌可能在MDD的病理生理学中发挥作用。为此，本研究探讨了血清中的IgM和伊加浓度对革兰氏阴性肠杆菌，哈夫尼氏菌，铜绿假单胞菌，摩根氏菌，恶臭假单胞菌，克氏柠檬酸杆菌和克雷伯氏菌的LPS在MDD患者和正常对照组。发现MDD患者血清中抗肠杆菌LPS的IgM和伊加的阳性率和中位数均显著高于正常人。这些差异在获得显著诊断性能的程度上是显著的，即ROC曲线下面积为90.1%。IgM和伊加水平升高的症状表现为疲劳、自主神经和胃肠道症状以及感染的主观感觉。结果表明，肠粘膜功能障碍的特点是增加易位的革兰氏阴性细菌（漏肠）发挥了作用，在炎症病理生理的抑郁症。这表明，增加的LPS易位可能会引起免疫反应，从而激活IRS在一些MDD患者，并可能诱导特定的“疾病行为”的症状。提示MDD患者应通过本研究中使用的IgM和伊加检测来检查漏肠，并相应地进行漏肠治疗。
There is now evidence that major depression (MDD) is accompanied by an activation of the inflammatory response system (IRS) and that pro-inflammatory cytokines and lipopolysacharide (LPS) may induce depressive symptoms. The aim of the present study was to examine whether an increased gastrointestinal permeability with an increased translocation of LPS from gram negative bacteria may play a role in the pathophysiology of MDD. Toward this end, the present study examines the serum concentrations of IgM and IgA against LPS of the gram-negative enterobacteria, Hafnia Alvei, Pseudomonas Aeruginosa, Morganella Morganii, Pseudomonas Putida, Citrobacter Koseri, and Klebsielle Pneumoniae in MDD patients and normal controls. We found that the prevalences and median values for serum IgM and IgA against LPS of enterobacteria are significantly greater in patients with MDD than in normal volunteers. These differences are significant to the extent that a significant diagnostic performance is obtained, i.e. the area under the ROC curve is 90.1%. The symptom profiles of increased IgM and IgA levels are fatigue, autonomic and gastro-intestinal symptoms and a subjective feeling of infection. The results show that intestinal mucosal dysfunction characterized by an increased translocation of gram-negative bacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. It is suggested that the increased LPS translocation may mount an immune response and thus IRS activation in some patients with MDD and may induce specific "sickness behaviour" symptoms. It is suggested that patients with MDD should be checked for leaky gut by means of the IgM and IgA panel used in the present study and accordingly should be treated for leaky gut.